title: An ISBD perspective on the sociocultural challenges of managing bipolar disorder: A content analysis.
abstract: OBJECTIVE
  Clinical management of bipolar disorder patients might be affected by culture and is further dependent on the context of healthcare delivery. There is a need to understand how healthcare best can be delivered in various systems and cultures. The objective of this qualitative study was to gain knowledge about culture-specific values, beliefs and practices in the medical care provided to patients with bipolar disorders from a provider perspective in various areas of the world.
  
  
  METHODS
  The International Society for Bipolar Disorders (ISBD) network provided the framework for this qualitative study. An electronic interview with open-ended questions was administered to 19 international experts on bipolar spectrum disorder representing the International Society for Bipolar Disorders chapter network in 16 countries and six continents. In addition, there were two in-depth interviews with bipolar spectrum disorder experts done prior to the survey. The data were analysed using content analysis, and the information was structured using the software NVivo by QSR International Pty Ltd.
  
  
  RESULTS
  All participants described sociocultural factors as important in healthcare delivery to bipolar patients in their part of the world, both in accessing healthcare and in providing culturally appropriate care. Factors that affected the provider's ability to supply good clinical management of patients were access to treatment options and long-term follow-up, as well as general strategies to combat stigma. In some societies, the patients' use of alternative treatments, gender issues and religion were also important factors. Understanding the impact of such culturally specific factors was overall regarded as essential for proper treatment interventions.
  
  
  CONCLUSIONS
  Sociocultural factors clearly affect the nature and quality of medical services delivered to bipolar patients. Financial, social and cultural factors affect patients' health-seeking behaviour, and this highlights the need for knowledge about such factors in order to adequately identify and treat bipolar patients globally. Culturally adapted training and psychoeducation programmes are particularly warranted.
authors.affiliation: Global Mental Health Research Group (GMHRG), Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Norway.
authors.forename: Christine H
authors.initials: CH
authors.lastname: Oedegaard
authors.affiliation: IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.|Melbourne School of Population and Global Health and Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: Berk
authors.affiliation: IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.|Department of Psychiatry, The University of Melbourne, Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Parkville, VIC, Australia.|The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.affiliation: Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.affiliation: Comprehensive Doctors Medical Group, Arcadia, CA, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Dilsaver
authors.affiliation: Beersheva Mental Health Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Belmaker
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway keti@haukeland.no.|Division of Psychiatry, Haukeland University hospital, Bergen, Norway.
authors.forename: Ketil J
authors.initials: KJ
authors.lastname: Oedegaard
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway.|Division of Psychiatry, Haukeland University hospital, Bergen, Norway.
authors.forename: Ole B
authors.initials: OB
authors.lastname: Fasmer
authors.affiliation: Global Mental Health Research Group (GMHRG), Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Norway.
authors.forename: Ingunn M
authors.initials: IM
authors.lastname: Engebretsen
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000208:ethnology* / Q000628:therapy*; D003431:Cross-Cultural Comparison; D065246:Culturally Competent Care / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D011570:Psychiatry / Q000706:statistics & numerical data*; D036301:Qualitative Research; D011787:Quality of Health Care / Q000706:statistics & numerical data*
keywords: Bipolar disorder; International Society for Bipolar Disorders; NVivo; health service delivery; qualitative research; transcultural; treatment