title: Coping strategies used by poorly adherent patients for self-managing bipolar disorder.
abstract: BACKGROUND
  Bipolar disorder (BD) is a chronic mental illness associated with reduced quality of life, high rates of suicide, and high financial costs. Evidence indicates that psychosocial stress might play an important role in the onset and course of BD.
  
  
  OBJECTIVE
  The objective of this study was to address the gap between coping theory and the clinical use of coping strategies used to self-manage BD.
  
  
  METHODS
  In-depth interviews were conducted with a sample of 21 poorly adherent patients with BD. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes.
  
  
  RESULTS
  Transcript-based analysis generated two major domains of coping strategies used to self-manage BD: 1) problem focused (altering eating habits, managing mood-stabilizing medications, keeping psychiatric appointments, seeking knowledge, self-monitoring, and socializing) and 2) emotion focused (distracting activities, denial, isolation, modifying/avoiding, helping others, and seeking social support). Participants used both types of coping strategies to deal with stressful situations brought about by the internal and external demands associated with self-management of BD.
  
  
  CONCLUSIONS
  This qualitative study provided a first step in evaluating coping strategies as a possible mediator in the self-management of BD and has implications for health care providers. Being able to characterize an individual's coping behaviors can help patients modify or replace more maladaptive coping with better coping strategies in the self-management of this chronic mental illness.
authors.affiliation: Center for Health Care Research and Policy, MetroHealth Medical Center; Department of Psychiatry.
authors.forename: Carol
authors.initials: C
authors.lastname: Blixen
authors.affiliation: Department of Psychiatry.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Levin
authors.affiliation: Department of Psychiatry.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Cassidy
authors.affiliation: Center for Health Care Research and Policy, MetroHealth Medical Center.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Perzynski
authors.affiliation: Department of Psychiatry; Department of Neurology, Neurological Institute; Department of Biostatistics & Epidemiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
keywords: bipolar disorder; coping strategies; self-management