Qualitative investigation of relatives’ and service users’ experience of mental healthcare for suicidal behaviour in bipolar disorder

Abstract

ObjectivePeople with bipolar disorder are known to be at high risk of engaging in suicidal behaviours, and those who die by suicide have often been in recent contact with mental health services. The objective of this study was to explore suicidal behaviour in bipolar disorder and how this is monitored and managed by mental health services.AimsTo identify themes within relatives’ and service users’ accounts of mental healthcare, related to management and prevention of suicidal behaviour in bipolar disorder.DesignThematic analysis of 22 semistructured interviews.ParticipantsParticipants were aged 18 years or over, fluent in written and spoken English, and either had bipolar disorder with a history of suicidal behaviour, or were relatives of people with bipolar disorder who had died by suicide.SettingEngland, UK.Primary outcomeThemes identified from participants’ accounts of mental healthcare for suicidal behaviours in bipolar disorder.ResultsTwo main themes were identified. ‘Access to care’ was characterised by a series or cycle of potential barriers to care (eg, gate-keepers, lack of an accurate diagnosis) which had the potential to increase risk of suicidal behaviour if failure to access care continued over time. ‘Problems with communication’ captured the importance of maintaining open routes of communication between all parties involved in care to ensure successful monitoring and management of suicidal behaviours in bipolar disorder.ConclusionsMental health services need to be accessible and respond rapidly to people with suicidal behaviour in bipolar disorder. Open communication and inclusion of relatives in care, where appropriate, could help closer monitoring of changes in symptoms that indicate increased risk.

Caring for a Family Member with Psychosis or Bipolar Disorder Who Has Experienced Suicidal Behaviour: An Exploratory Qualitative Study of an Online Peer-Support Forum

“…As in a prior study with families of people with bipolar disorder receiving healthcare support following suicidal behaviour [ 17 ], health services were described as unable or unwilling to include carers in key decisions regarding their family member’s care or provide information regarding how carers could effectively support their family members. Findings of the current study also indicate that feeling unsupported by health services when caring for someone experiencing suicidal behaviour exacerbates carer distress, especially in circumstances where carers feel that their potential involvement in care is overlooked.…”

“…This suggests that psychosis may present carers with additional barriers to recognising and responding to suicidal behaviour. Furthermore, interviews with service users and family members of people experiencing bipolar disorder investigating perceptions of healthcare support [ 17 ] highlight how carers’ desires to be actively involved in care offered to service users are not always met. Challenges included difficulties accessing professional healthcare support in suicidal crises, conflict with staff, and confidentiality, which restricted carer access to information that may have assisted with understanding suicidal behaviour [ 17 ].…”

“…Furthermore, interviews with service users and family members of people experiencing bipolar disorder investigating perceptions of healthcare support [ 17 ] highlight how carers’ desires to be actively involved in care offered to service users are not always met. Challenges included difficulties accessing professional healthcare support in suicidal crises, conflict with staff, and confidentiality, which restricted carer access to information that may have assisted with understanding suicidal behaviour [ 17 ]. This emerging evidence base provides some indication of the challenges faced by carers when supporting someone with psychosis or bipolar disorder and co-occurring suicidal behaviour.…”

Evolución en el diagnóstico del trastorno afectivo bipolar entre 2010 y 2015. Caldas, Colombia

“…Según Bauer et al (11) , sin discriminación del origen étnico, la nacionalidad o el estatus socio-económico, el TAB afecta alrededor del 1% de la población, siendo una de las mayores causas de discapacidad entre la gente joven. La incidencia del suicidio entre pacientes con TAB es alta, siendo 20 veces mayor que en la población general (12)(13)(14) .…”