title: Effective self-management strategies for bipolar disorder: A community-engaged Delphi Consensus Consultation study.
abstract: Self-management represents an important complement to psychosocial treatments for bipolar disorder (BD), but research is limited. Specifically, little is known about self-management approaches for elevated mood states; this study investigated self-management strategies for: (1) maintaining balance in mood, and (2) stopping progression into hypomania/mania.
  
  
  
  To identify the common components of BD self-management, Delphi Consensus Consultation methods were combined with a Community-Based Participatory Research (CBPR) approach across five study phases: (1) Qualitative dataset content analysis; (2) Academic/grey literature reviews; (3) Content analysis; (4) Two Delphi rounds (rating strategies on a 5-point Likert scale, Very Unhelpful-Very Helpful), and; (5) Quantitative analysis and interpretation. Participants were people with BD and healthcare providers.
  
  
  
  Phases 1 and 2 identified 262 and 3940 candidate strategies, respectively; 3709 were discarded as duplicates/unintelligible. The remaining 493 were assessed via Delphi methods in Phase 4: 101 people with BD and 52 healthcare providers participated in Round 1; 83 of the BD panel (82%) and 43 of the healthcare provider panel (83%) participated in Round 2-exploratory factor analysis (EFA) was conducted on Round 2 results.
  
  
  
  EFA was underpowered and sample was not ethnically diverse, limiting generalizability.
  
  
  
  High concordance was observed in ratings of strategy effectiveness between the two panels. Future research could usefully investigate the provisional discovery here of underlying factors which link individual strategies. For example, 'maintaining hope' underpinned strategies for maintaining balance, and 'decreasing use of stimulants' underpinned strategies to interrupt hypo/manic ascent. There is merit in combining CBPR and Delphi methods.
authors.affiliation: Department of Psychiatry, University of British Columbia, Canada. Electronic address: erin.michalak@ubc.ca.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Michalak
authors.affiliation: Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Suto
authors.affiliation: Department of Psychology, University of British Columbia, Canada.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Barnes
authors.affiliation: Department of Psychology, University of Guelph, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hou
authors.affiliation: CREST.BD, Department of Psychiatry, University of British Columbia, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Lapsley
authors.affiliation: CREST.BD, Department of Psychiatry, University of British Columbia, Canada.
authors.forename: Mike W
authors.initials: MW
authors.lastname: Scott
authors.affiliation: Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Murray
authors.affiliation: Department of Psychiatry, University of British Columbia, Canada.
authors.forename: Jehannine
authors.initials: J
authors.lastname: Austin
authors.affiliation: Department of Psychiatry, University of British Columbia, Canada.
authors.forename: Nusha Balram
authors.initials: NB
authors.lastname: Elliott
authors.affiliation: School of Psychology, Faculty of Health, Deakin University, Geelong, Australia; Department of Psychiatry, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: Berk
authors.affiliation: CREST.BD, Department of Psychiatry, University of British Columbia, Canada.
authors.lastname: Crest Bd
mesh_terms: D001714:Bipolar Disorder / Q000628:therapy*; D055812:Community-Based Participatory Research; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D012648:Self Care / Q000379:methods*
keywords: Bipolar disorder; Community-Based Participatory Research; Delphi Consensus Consultation; Self-management