Introduction
Personal recovery (PR) is of particular value in bipolar disorder (BD) where symptoms often persist despite treatment, but so far has only been studied in researcher-constructed environments (interviews, focus groups). Support forum posts can serve as a complementary naturalistic data resource to understand the lived experience of PR.
Method
A systematic review synthesised qualitative evidence on PR in BD from interviews and focus groups. Natural language processing methods automatically identified users of the online discussion forum Reddit with a self-reported BD diagnosis and analysed their characteristics and posting behaviour. Corpus linguistics determined significantly overused words in PR-relevant vs. non-relevant posts, which were then coded via qualitative framework analysis.
Results
The review resulted in the first framework for PR in BD, POETIC (Purpose & meaning, Optimism & hope, Empowerment, Tensions, Identity, Connectedness). The Self-reported BD Diagnosis (S-BiDD) dataset comprises 21M posts by 20K users. They are mainly young or middle-aged US-based adults with an almost equal masculine-feminine gender distribution that often report additional MH comorbidities. Moreover, Reddit users with a self-reported BD diagnosis who exhibit more intense emotions in their posts, are more likely to post in MH support subreddits. Experiences in 4.5K PR-relevant online posts by 2K users mainly focussed on three POETIC domains: Purpose & meaning (particularly reproductive decisions, work), Connectedness (romantic relationships, social support), Empowerment (self-management, personal responsibility). The analysis confirmed the validity of the POETIC framework, but highlighted PR issues that only came up online.
Discussion
This project was the first to analyse naturalistic data on PR in BD. Indicating the key areas that people focus on in PR when posting freely and the language they use, provides helpful starting points for formal and informal carers to understand the concerns of people diagnosed with BD and to consider how best to offer support.