Bipolar disorder is a chronic disease that can present lifelong challenges. However, remission rates and even complete recovery can and have been seen. Finding the factors associated with recovery from bipolar disorder can give us all hope, and also provide health care workers with specific strategies to enhance the possibilities of recovery.
A recent Canadian study using data from the 2012 Canadian Community Health Survey-Mental Health looked at three levels of recovery from bipolar disorder:
- Remission of symptoms for the past year. Individuals who have had no symptoms of bipolar disorder for a year are considered to be recovered. However, other disorders/problems may be present.
- Absence of psychiatric disorders. Based on no suicidal ideation in the past year, nor bipolar disorder, depressive episode, anxiety disorders, nor alcohol or drug dependence including cannabis and other drugs.
- Complete mental health. This incorporates measures such as happiness, life satisfaction, psychological flourishing and absence of mental illness.
In the survey, 21,085 respondents’ data was analyzed, of whom 555 reported having had a diagnosis of bipolar disorder. Of these, 44% reported being free from bipolar disorder in the preceding year, and 34% were free of both bipolar disorder and any other mental illness. 23% of those with a lifetime diagnosis of bipolar disorder reported experiencing complete mental health (CMH) in the preceding month.
Factors associated with the achievement of remission and CMH included an absence of chronic pain, higher household income, religious or spiritual practice, older age, and lifetime absence of drug and/or alcohol use disorders. People who were not experiencing chronic pain had a 50% higher chance of achieving remission of symptoms and complete mental health. This suggests that more attention needs to be paid to chronic pain during treatment for bipolar disorder.
Higher household income was associated with recovery from bipolar disorder, even in Canada, where universal health care is the norm. Poverty creates higher stress and anxiety, even in the absence of mental illness, and so it is not surprising that patients at lower income levels will struggle more.
Individuals who participated in religious or spiritual activities, or utilized prayer and/or meditation as a coping strategy also had higher odds of experiencing symptom-free lives or complete mental health. This finding is in harmony with a number of recent studies showing the importance of religion in improved social support and quality of life, as well as stress management and general wellness.
Another factor importantly associated with recovery was older age. Younger patients are frequently found to have higher levels of treatment non-adherence, with substance use disorders, and general anxiety disorder. Growing older seems to make it easier to cope, and move on.
The study found that those who reported no drug or alcohol use disorders at any time in their lives had higher chances of achieving remission of symptoms or complete mental health. Thus, the presence of substance use disorders, present or past needs to be considered in treatment and recovery from bipolar disorder.
Respondents who reported having a close personal friend or family member in whom they can confide and talk with about important decisions were nearly 18 times more likely to achieve CMH than those who did not have social support. Health care providers need to consider ways that they can encourage and increase access to social support of this nature.
Overall, the study found that only 23% of bipolar patients achieved complete mental health, but the study also found several significant factors, some of which can be worked on and enhanced in the treatment of mental illness, especially when complete recovery is the goal. If more attention is given to these factors, both by patients and by their carers, perhaps greater levels of recovery and complete mental health will be seen.
Limitations of the study
It should be noted that this study used self-reported survey materials for analysis. There could be some bias toward positivity due to stigma in reporting symptoms, and some respondents may have been unavailable for follow-up due to illness or hospitalization. Also, some information was not included in the original survey, such as severe mental illnesses like schizophrenia, and treatment history, use of medications, and other possible confounding factors.
Reference:
Melanie J. Katz et al., Journal of Affective Disorders Reports, https://doi.org/10.1016/j.jadr.2024.100808. In Press. Accessed July 29, 2024.