Exploring the Personal Recovery Construct in Bipolar Disorders: Definition, Usage and Measurement. A Systematic Review

Abstract

Personal recovery from psychiatric disorders is a journey toward a satisfying and hopeful life despite the possible persistence of symptoms. This concept has gained interest and become an increasingly important goal in mental health care programmes. Personal Recovery is well described in the context of severe mental illnesses in general, but little is known about this journey in bipolar disorders and the factors underlying it. A systematic review was conducted according to the PRISMA recommendations, focusing on studies exploring personal recovery in bipolar disorder specifically. The latter have integrated a comprehensive approach to the concept, the existing means of measurement or have explored the levers of recovery in care. Twenty-four articles were selected, including seven qualitative, 12 observational, and five interventional studies. The Bipolar Recovery Questionnaire was the only scale developed de novo from qualitative work with bipolar people. Personal recovery did not correlate very closely with symptomatology. Some elements of personal recovery in bipolar disorder were similar to those in other severe mental illnesses: meaning in life, self-determination, hope, and low self-stigma. Specific levers differed: mental relationships with mood swings, including acceptance and decrease in hypervigilance, and openness to others, including trust and closeness. The studies highlighted the role of caregiver posture and the quality of communication within care, as well as the knowledge gained from peers. The choice to exclude articles not focused on bipolar disorder resulted in the provision of very specific information, and the small number of articles to date may limit the scope of the evidence. New components of personal recovery in bipolar disorder emerged from this review; these components could be taken into account in the construction of care tools, as well as in the caregiving posture. Strengthening skills of openness to others could also be a central target of recovery-focused care.

Recovery after a suicidal episode: Developing and validating the Recovery Evaluation and Suicide Support Tool (RESST).

“…Our findings support a theory of personal recovery as a global construct. This is a significant finding because personal recovery, although viewed as a broad concept, is often assessed as multiple interrelated factors without recognizing a higher order nature (e.g., Chirio-Espitalier et al, 2022). Our findings indicate that suicide personal recovery is a unified construct, consisting of Self-Worth, Life Worth, Social Worth, and Self-Understanding as lower order correlated factors (Sokol et al, 2022).…”

“What makes you well?” Supports of well-being in bipolar disorder. A qualitative study

“…Two recent systematic reviews have helped to specify the characteristics of personal recovery (PR) in BD (Chirio-Espitalier et al, 2022 , Jagfeld et al, 2021 ). The review of Chirio-Espitalier and colleagues showed that PR is intimately linked with metacognitive relationships maintained with mood fluctuations including resilience and decreasing of hypervigilance.…”

Validation of the Bipolar Recovery Questionnaire for the Portuguese Population: Recovery and Predictors in People with Bipolar Disorder

“…5,6 However, a growing body of evidence suggests that this symptom-centered approach may not fully address the complexities and holistic needs of individuals living with BD 7 and people with BD have shown their dissatisfaction with this model, exhibiting interest in taking control of their lives rather than returning to the elusive state of the premorbid level of functioning. 8 According to Merikangas et al, 1 BD is responsible for the loss of more disability-adjusted life-years than all forms of cancer or major neurologic conditions, which has a marked effect on the overall quality of life (QoL) of both patients and their families. 9 Consequently, mental health is witnessing a paradigm shift towards embracing a personal recovery-focused model, which encompasses pursuing a satisfying and meaningful life, even when clinical symptomatology is present.…”

“…10,11 This concept has become increasingly important and is seen as a desired outcome for mental health care programs in severe mental disorders, specifically for BD. 8 Recovery is described as a personal journey of coping with mental illness, which involves a series of subjective experiences and, therefore, is based on the person's empowerment, self-directedness and perception of competence to deal with their difficulties. 12 Hence, considering the significant impact that BD has on various aspects of daily life (i.e., work productivity, interpersonal relationships, etc.…”

“…According to a recent systematic review of personal recovery instruments in BD, 8 there are only two recoveryfocused scales specifically validated for BD: the Questionnaire of Personal Recovery (QPR) and the Bipolar Recovery Questionnaire (BRQ). The QPR was initially a 22-item questionnaire with two subscales (intrapersonal and interpersonal recovery) developed from service users' accounts of recovery from psychosis, recruited in the National Health Service (United Kingdom).…”