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THE IMPACT OF SOCIAL SUPPORT ON THE WELL BEING OF BIPOLAR PATIENTS OF ARO NEURO PSYCHIATRIC HOSPITAL. OGUN STATE
CHAPTER ONE
INTRODUCTION
1.1 Background of the study
Bipolar Disorder (BD) is a severe, chronic, and impairing psychiatric illness. It has an estimated lifetime prevalence of 3.9% (Kessler et al., 2005) and is ranked in the top 10 leading causes of disability worldwide by the World Health Organization. The inter-episode period of BD is defined by the absence of a clinical mood episode (i.e., no depression, mania or hypomania is present), yet it is marked by depressive and/or manic symptoms more than 50% of the time (e.g., Judd et al., 2002, 2003). The inter-episode period is also characterized by instabilities in sleep (e.g., Harvey, 2008) and social rhythms (e.g., Grandin, Alloy, & Abramson, 2006), which likely increase the risk of relapse (e.g., Ehlers, Frank, & Kupfer, 1988) and contribute to persistent inter-episode symptoms and impairment (e.g., Fagiolini et al., 2005). A number of calls have been made for research that will improve inter-episode quality of life through the identification of clinically-relevant psychosocial factors (e.g., Miklowitz & Johnson, 2006). The present study aims to further elucidate the role of two such factors, social support and social strain, during the inter-episode period of BD with a focus on their cross-sectional association with instabilities in sleep and social rhythms.
Social Support
Social support encompasses psychological and material resources provided by one’s social network. Perceived social support (i.e., the subjective quality of social support) has been linked to well-being in healthy and medically ill individuals (e.g., Cohen & Wills, 1985; Uchino, Cacioppo, & Kiecolt-Glaser, 1996) and has been found to be a stronger correlate of well-being than objective measures of support (e.g., the number of support providers; Sarason, Sarason, & Pierce, 1990). Greater perceived social support has also been found to promote recovery and prevent relapse in unipolar depressed individuals (e.g., Moos, Cronkite, & Moos, 1998). Several lines of evidence suggest that social support may impact well-being and illness course in BD. For instance, lower levels of perceived social support have been found to predict depressive relapse (Cohen, Hammen, Henry, & Daley, 2004; Johnson, Winett, Meyer, Greenhouse, & Miller, 1999), while higher levels of social support have been theorized to reduce the risk of relapse, possibly
by improving medication adherence (e.g., Kleindienst, Engel, & Greil, 2005).
These findings suggest that social support is an important psychosocial factor in BD. However, to the best of the author’s knowledge, only two studies have assessed whether social support is deficient during the inter-episode period of BD, and these studies have yielded inconsistent findings. While one study found a group of inter-episode BD women to have deficient social support compared to control women (Romans & McPherson, 1992), another study found social support in inter-episode BD participants to be equivalent to that of controls (Staner et al., 1997). One possible explanation for this discrepancy is that while the former study used a measure of the perceived adequacy of social support, the latter used a measure that averages the amount of support (emotional, availability, and practical) received from the top five support providers. This second approach may decrease variability in scores. Additionally, by requiring individuals to identify five discrete support providers, this measure may serve more as a measure of objective support (e.g. number of adequate support providers) than perceived support. Given the small number of studies focused on social support in inter-episode BD and their mixed findings, additional research is needed to determine whether perceived social support is deficient during this phase of the illness and whether it is related to inter-episode instabilities in sleep and social rhythms.
Social Strain
Social strain encompasses adverse social experiences (e.g., being criticized, ignored, overburdened) that cause one to experience a negative reaction or concerns about one’s relationships (Rook, 1990). Social strain has been found to be associated with depressive symptoms (e.g., Franks et al., 1992) and has been identified as a separate construct from life stress (e.g., Lakey, Tardiff, & Drew, 1994) and social support (e.g., Rook, 1984).
1.2 Statement of the problem
social strain has not yet been investigated in BD. However, several studies have linked perceived criticism – one aspect of social strain – to symptoms in BD. For instance, greater distress generated by perceived criticism from friends/family is associated with an increased risk of depressive symptoms (e.g., Miklowitz et al., 2005). Furthermore, an extensive body of research indicates that expressed emotion (i.e., criticism, hostility, and over-involvement) in a bipolar individual’s family is associated with a higher level of manic symptoms (Simoneau, Miklowitz, & Saleem, 1998) and an increased risk of relapse (e.g., O’Connell, Mayo, Flatow, Cuthbertson, & O’Brien, 1991). Assessments of expressed emotion typically rely on observations of family members during the Camberwell Family Interview (Vaughn & Leff, 1976), while measures of perceived criticism assess only one
aspect of social strain. Thus, additional research is needed to determine whether social strain (i.e., perceptions of adverse experiences in naturally occurring social interactions) is elevated in inter- episode BD and whether it is related to inter-episode instabilities in sleep and social rhythms. Social Support, Social Strain, and Inter-episode Instabilities in Sleep and Social Rhythms
1.3 Objectives of the study
1. To understand the impact of social support on the well being of bi-polar patients
2. To understand the relationship between social support and well being of bi-polar patients
1.4 Research questions
1. What is the impact of social support on the well being of bi-polar patients?
2. What is the relationship between social support and well being of bi-polar patients?
1.5 Research hypothesis
H0: There is no relationship between social support and well being of bi-polar patients
H1: There is a relationship between social support and well being of bi-polar patients
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