Listening to Participant Voices: Defining and Measuring Resilience in Bipolar Disorder

Background: Bipolar disorder (BD) is a chronic mental health condition (1). Helping people live better with their mental illness is crucial to improving overall quality of life (2). Recently research has focused on the concept of resilience to achieve this goal (3). Nevertheless, the definition, and measurement of resilience in BD is poorly understood, with research focusing on general populations, failing to consider people with lived experience.

 

Approach: The present study is a qualitative, exploratory study aimed at understanding resilience in BD. Specifically, a thematic analysis approach was implemented. Four focus groups were conducted with 44 people with BD. Focus groups were recorded and transcribed in verbatim, offering insights into their lived experiences. Thus, focus groups ensured that people with BD were actively involved in the understanding of resilience among the population, which will be used for later projects focusing on the measurement in the context of BD.

 

Results: The focus groups were conducted in 2024 and 2025. The main objective was to explore resilience in BD and understand current definitions and measurement approaches. As such, the focus groups helped to understand resilience from a specific perspective considering the lived experience of people with BD, highlighting a need to include patient voices as part of integrated care models.

 

The focus groups underlined two significant perspectives. First, they encouraged reflection around the definition of resilience. Patients shared their concerns about the idea of resilience as the absence of symptoms, of relevance in BD, characterised by ongoing episodic mood changes. This could inform policies regarding interventions by including more inclusive resilience definitions. Illness stage and chronicity, a central theme, should be considered, rather than adopting a binary approach (resilient vs. non-resilient).

 

Second, the emerging themes revealed that current measurement tools of resilience may not be adequate for use in psychiatric patients. Patients criticised the idea of resilience as “bouncing back” as they felt that it stigmatised the illness by focusing on greater resilience being quicker recovery. This encouraged an analysis of the existing measurement tools, leading to the discovery that many measurement tools have not been validated in psychiatric populations. Accordingly, these populations are underserved in the literature on resilience. In turn, these results are currently being used to guide the development of a clinical interview to measure resilience in BD, including the patient experience.

 

Implications: Overall this research highlights a significant clinical need to include patients’ experience, as well as important limitations with definition and measurement. In doing so, this will contribute to an integrated approach between patients and healthcare providers, which can promote patient autonomy, vital for their ongoing recovery. These insights may also have broader clinical implications, illustrating the importance of addressing limitations, and including patient voices in the field of mental health as part of an inclusive, integrated care approach.