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PhD Studentship: Illness and Treatment Perceptions in Bipolar Disorder

Applications are invited for a fully-funded full-time PhD studentship exploring illness and treatment perceptions in bipolar disorder.

For further details and to download the relevant application form, please visit: http://www.worcester.ac.uk/researchstudentships

Bipolar disorder (BD) is a long-term, serious condition. To promote recovery, individuals diagnosed with BD benefit from different methods of self-management. There are particular advantages derived from individuals being able to spot early warning signs of recurrence and fully engaging with treatment recommendations. Self-management is a challenge across all long-term conditions, but there are particular challenges in the presence of mood instability. Health psychology theory provides some explanation of the link between perceptions and behaviour, particularly when mediated by coping response. This applied PhD study will explore in detail the development, content and impact of illness and treatment perceptions amongst people diagnosed with bipolar disorder, considering implications for theory and practice.

Closing date: Monday 05 Jun 2017

Reference number: N/A

Job details

Job details

Salary
£13,863
Hours
37 hours per week
Start
2nd October 2017
Duration
3 years
Responsible to
Professor Eleanor Bradley
Responsible for
N/A
Interview date
28th/29th June 2017

Background

Background

Bipolar disorder (BD) is characterised by periods of extreme mood, including depression, mania and hypomania and has been highlighted by the World Health Organisation as being one of the sixth most debilitating conditions (Murray and Lopez, 1997 cited in Todd et al, 2012). BD is a long-term condition with no ‘typical’ illness course and highly variable outcomes; whereas some people may experience long periods of mood stability, others may experience frequent mood changes. There are two main subtypes of BD: bipolar I disorder (BPI) which includes episodes of mania (approx 1% lifetime prevalence); and bipolar II disorder (BPII) which includes episodes of hypomania but not mania in addition to episodes of depression (approx 4% lifetime prevalence). A diagnosis of schizoaffective disorder – bipolar type is made in the presence of bipolar disorder where there are also schizophrenia-like psychotic symptoms that are present in the absence of a major mood episode (DSM-5, American Psychiatric Association, 2013).

Early identification and treatment of BD leads to an enhanced prognosis. However, many people experience diagnostic delay, with one study suggesting a delay of 6 years between first experiencing symptoms of depression or mood swings and requesting a medical appointment, with an additional 6 years to a diagnosis of either BD or schizoaffective disorder (Berk et al, 2007). Diagnostic classification is also a challenge; those with BPI and BPII are likely to present differently (Borda, 2016) and Berk et al (2007) found that 26.6% of those eventually diagnosed with either BD or schizoaffective disorder had a previous diagnosis. Someone living with a diagnosis of BD ideally needs to be able to learn to identify early warning signs of mood swings and how to manage these for their rest of their lives, so acceptance of the diagnosis may be difficult and take time (Owen and Saunders, 2013).

Medication is the usual treatment for those diagnosed with BD – albeit in combination with other non-pharmacological options, including psychological approaches (e.g CBT), psycho-education (e.g self-management) and complementary therapies (e.g yoga and meditation). People living with BD utilise a wide variety of approaches to support their self-management and combine these in multiple ways (Vargas-Huicochea et al, 2014). Self-management; taking ownership over treatment and increasing control over the impact of the condition (Salyers et al, 2007); is a vital part of the recovery journey (Todd et al, 2012). Self-management is challenging for many people diagnosed with long-term conditions, but is particularly difficult for those diagnosed with BD due to mood instability (Blixen et al, 2016). Recovery is not only about the absence of symptoms, but requires individuals to take responsibility for their own wellness (Tse et al, 2014). Indeed, self-management and building on existing techniques is an important recovery theme for those diagnosed with BD (Todd et al, 2012).

Discontinuation of treatment (partial or total) occurs in approximately 20 – 70% of individuals (Vargas-Huicochea et al, 2014) and on average, 40% of people diagnosed with BD do not adhere to their medicines (Clatworthy et al, 2007). Vargas-Huicochea et al (2014) suggest that the use of medicines over the long-term is one of the most troubling aspects for those diagnosed with BD. Intentional non-adherence is a complex phenomenon which is best understood in terms of the beliefs and expectations influencing patient motivation to begin and persist with treatment (Clatworthy et al, 2007). The high rates of non-adherence amongst those diagnosed with BD and association with poorer clinical outcomes (Sajatovic et al, 2008) suggest this is an important area for further study. Health psychology theories can help us to understand the links between perceptions and behaviours. The self-regulatory model explains the cognitive processes underpinning peoples’ perceptions of health threats – which may be either internally derived (experiences, symptoms) or externally attributed (diagnostic label). People respond to these threats by building a cognitive representation (mental map) which helps them to make sense of the threat then guide their behaviour. These cognitive representations are shaped by 5 attributes: illness identity, timeline, consequences, cause and control which often remain implicit and identified by inference e.g non-adherence (Leventhal et al, 1997).

Research across chronic conditions, including BD, has shown that illness-related behaviours are related to illness representations (Clatworthy et al, 2007). Being interested and informed about the way each individual experiences and interprets their symptoms is central to patient / professional relationships and may be a key factor in relation to clinical outcomes (Vargas- Huicochea et al, 2014). Indeed, Lobban et al (2013) found that beliefs about mood swings played an important role in clinical outcome (time to relapse and severity of depression over time). Important constituents of these beliefs included perceptions about severity of consequence, illness identity and locus of control.

The relationship between beliefs and outcome can be mediated by coping response – with further research recommended to look at perceptions of personal control in addition to the content and complexity of illness beliefs (Lobban et al, 2013). Personal control may be of particular interest as research conducted with participants diagnosed with schizophrenia-spectrum disorders and BD found they were more likely to appraise greater external locus of control in relation to their physical health than those diagnosed with other mental health difficulties (Buhagiar et al, 2011).

This PhD will provide an opportunity for further investigation into the development, content and impact of illness and treatment perceptions amongst people diagnosed with bipolar disorder.

Objectives for the study will include:-

• Development of a detailed outline of the common-sense models employed by people diagnosed with bipolar disorder to understand their illness and treatment experiences. The framework of self-regulatory theory (SRT) will be utilised to interpret how different stages of the care across the care pathway, including diagnostic experiences / delay, have informed both illness and treatment perceptions.

• To highlight then interpret any variation between the perceptions of illness and treatment amongst those diagnosed with different subtypes of BD (BPI, BPII, schizoaffective disorder) or those with a specific clinical course (such as rapid cycling or postpartum only episodes) to highlight key barriers to treatment adherence and guide the development of person-centred approaches.

• To explore how illness perceptions shape decisions about help-seeking and treatment, including relationships with behaviours (including adherence to medication) and the role of personal control (external or internal).

Main duties

Main duties

Person specification

Person specification

Essential:

Applicants should have or be able to evidence:

• A First or Upper Second (2.1) Honours Degree, or expect to receive one by October 2017;

• A sound understanding of, and interest in health psychology;

• A clear interest in mental health research;

• Experience of relevant research methods and skills;

• Ability to contribute to research study design;

• Means of travelling independently to conduct research interviews with research participants in their own homes. Research participants live throughout the UK;

• Computer literacy;

• Proficiency in oral and written English;

• Ability to organise and meet deadlines;

• Good interpersonal skills;

• Ability to work independently and contribute to a team;

• Commitment and an enthusiastic approach to completing a higher research degree;

Desirable:

• Education to Masters Degree level in a relevant area. As part of its mission statement the University is committed to widening participation for its higher degrees. Although most candidates will have an undergraduate and/or a Masters degree, the University is happy to accept applications from candidates with relevant professional qualifications and work related experience

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