Search

Introduction Peer online mental health forums are commonly used and offer accessible support. Positive and negative impacts have been reported by forum members and moderators, but it is unclear why these impacts occur, for whom and in which forums. This multiple method realist study explores underlying mechanisms to understand how forums work for different people. The findings will inform codesign of best practice guidance and policy tools to enhance the uptake and effectiveness of peer online mental health forums. Methods and analysis In workstream 1, we will conduct a realist synthesis, based on existing literature and interviews with approximately 20 stakeholders, to generate initial programme theories about the impacts of forums on members and moderators and mechanisms driving these. Initial theories that are relevant for forum design and implementation will be prioritised for testing in workstream 2. Workstream 2 is a multiple case study design with mixed methods with several online mental health forums differing in contextual features. Quantitative surveys of forum members, qualitative interviews and Corpus-based Discourse Analysis and Natural Language Processing of forum posts will be used to test and refine programme theories. Final programme theories will be developed through novel triangulation of the data. Workstream 3 will run alongside workstreams 1 and 2. Key stakeholders from participating forums, including members and moderators, will be recruited to a Codesign group. They will inform the study design and materials, refine and prioritise theories, and codesign best policy and practice guidance. Ethics and dissemination Ethical approval was granted by Solihull Research Ethics Committee (IRAS 314029). Findings will be reported in accordance with RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) guidelines, published as open access and shared widely, along with codesigned tools. Trial registration number ISRCTN 62469166; the pr

With the increasing trend of digitalisation in the health sector, eHealth is being deployed to facilitate interaction between health professionals and service users without physical contact or close proximity. It became prominent during the COVID-19 era when mobility for physical meetings was restricted. Focusing on a video-supported digital toolkit, REACT-NOR, this study explored the experiences of caregivers and supporters in relation to the notion of boundary object. In-depth semi-structured interviews were conducted with 10 supporters and 11 caregivers to gather first-hand experience on the use of the digital tool. It emerged from the study that the use of REACT-NOR made a huge difference for the involved parties by bridging the knowledge gap between supporters and caregivers. The use of the video in particular was useful in engaging and emotionally connecting the supporters and caregivers, resulting in an exciting digital experience. The effectiveness of the digital tool can be explained in the context of a boundary object in that it facilitated the processes of transferring, translating and transforming knowledge. The tool exhibited the attributes of dynamism, flexibility, standardisation and shared structure, which resonates with the notion of a boundary object. An understanding of how boundary objects work is crucial especially with remote care, as depicted in this study, due to the fact that the transfer of knowledge involves multiple processes such as sharing of new and existing knowledge, translation to make it accessible to others and transformation to render it usable across different boundaries.

Introduction: Suicide is a leading cause of death globally. People with psychosis are at increased risk of suicide death and up to half experience suicidal thoughts and/or engage in suicidal behaviors in their lifetime. Talking therapies can be effective in alleviating suicidal experiences. However, research is yet to be translated into practice, demonstrating a gap in service provision. The barriers and facilitators in therapy implementation require a thorough investigation including the perspectives of different stakeholders such as service users and mental health professionals. This study aimed to investigate stakeholders’ (health professionals and service users) perspectives of implementing a suicide-focused psychological therapy for people experiencing psychosis in mental health services. Methods: Face-to-face, semi-structured interviews with 20 healthcare professionals and 18 service users were conducted. Interviews were audio recorded and transcribed verbatim. Data were analyzed and managed using reflexive thematic analysis and NVivo software. Results: For suicide-focused therapy to be successfully implemented in services for people with psychosis, there are four key aspects that need to be considered: (i) Creating safe spaces to be understood; (ii) Gaining a voice; (iii) Accessing therapy at the right time; and (iv) Ensuring a straightforward pathway to accessing therapy. Discussion: Whilst all stakeholders viewed a suicide-focused therapy as valuable for people experiencing psychosis, they also recognize that enabling successful implementation of such interventions will require additional training, flexibility, and resources to existing services.

Introduction: People with lived expertise in managing mental health challenges can be an important source of knowledge and support for other people facing similar challenges, and for carers to learn how best to help. However, opportunities for sharing lived expertise are limited. Living libraries support people with lived expertise to be ‘living books’, sharing their experiences in dialogue with ‘readers’ who can ask questions. Living libraries have been piloted worldwide in health-related contexts but without a clear model of how they work or rigorous evaluation of their impacts. We aim to develop a programme theory about how a living library could be used to improve mental health outcomes, using this theory to codesign an implementation guide that can be evaluated across different contexts. Methods and analysis: We will use a novel integration of realist synthesis and experience-based codesign (EBCD) to produce a programme theory about how living libraries work and a theory and experience informed guide to establishing a library of lived experience for mental health (LoLEM). Two workstreams will run concurrently: (1) a realist synthesis of literature on living libraries, combined with stakeholder interviews, will produce several programme theories; theories will be developed collaboratively with an expert advisory group of stakeholders who have hosted or taken part in a living library and will form our initial analysis framework; a systematic search will identify literature about living libraries; data will be coded into our analysis framework, and we will use retroductive reasoning to explain living libraries’ impacts across multiple contexts. Individual stakeholder interviews will help refine and test theories; (2) data from workstream 1 will inform 10 EBCD workshops with people with experience of managing mental health difficulties and health professionals to produce a LoLEM implementation guide; data from this process will also inform the theory in workstream

Background: Going to university is an important milestone in many people’s lives. It can also be a time of significant challenge and stress. There are growing concerns about mental health amongst student populations including suicide risk. Student mental health and counselling services have the potential to prevent suicide, but evidence-based therapies are required that fit these service contexts. The Broad-Minded Affective Coping intervention (BMAC) is a brief (6 sessions), positive imagery-based intervention that aims to enhance students access to past positive experiences and associated emotions and cognitions. Pilot data provides preliminary support for the BMAC for students struggling with suicidal thoughts and behaviours, but this intervention has not yet been evaluated in the context of a randomised controlled trial (RCT). The Mental Imagery for Suicidality in Students Trial (MISST) is a feasibility RCT that aims to determine the acceptability and feasibility of evaluating the BMAC as an intervention for university students at risk of suicide within a larger efficacy trial. Key feasibility uncertainties have been identified relating to recruitment, retention, and missing data. Intervention acceptability and safety will also be evaluated. Method: MISST is a feasibility randomised controlled trial design, with 1:1 allocation to risk assessment and signposting plus BMAC or risk assessment and signposting alone. Participants will be university students who self-report experiences of suicidal ideation or behaviour in the past 3 months. Assessments take place at baseline, 8, 16, and 24 weeks. The target sample size is 66 participants. A subset of up to 20 participants will be invited to take part in semi-structured qualitative interviews to obtain further data concerning the acceptability of the intervention. Discussion: The BMAC intervention may provide an effective, brief talking therapy to help university students struggling with suicidal thoughts that could be

Background: Bipolar disorder is characterised by episodes of mania and depression that cause significant impairment and disruptions to people’s lives. This diagnosis has been linked to increased rates of suicide, reduced lifespan, and increased mortality, although there is limited research exploring the challenges faced by people with bipolar disorder as they age. It is possible that there is an important interaction effect between ageing and bipolar disorder that exacerbates the difficulties faced by this group, meaning further attention and support is required. This thesis investigated the challenges faced by older adults with bipolar disorder and explored their preferences, priorities, and needs in later life. Knowledge gathered from four studies helped to identify potential adaptations to care that can be used to improve quality of life in this population and enable them to age well with bipolar disorder. Methods: A range of methods were used to complete this thesis. First, a systematic review and narrative synthesis of 23 papers reporting on 19 studies was completed to investigate the prevalence and predictors of physical health comorbidities in older adults with bipolar disorder. Second, a qualitative study consisting of photo elicitation interviews with 17 participants used reflexive thematic analysis to analyse data and explore what it means to age well for older adults with bipolar disorder. Third, 16 biographical narrative interviews were analysed using narrative analysis to understand the changing care and care needs of older adults with bipolar disorder. Finally, a multilevel analysis of seven waves from The English Longitudinal Study of Ageing data was completed to examine quality of life in older adults with bipolar mood states and assess the predictors of quality of life in this group. Results: Ageing with bipolar disorder was associated with an increased prevalence of certain physical health comorbidities such as cardiovascular disease and some forms

Background Personal recovery is of particular value in bipolar disorder, where symptoms often persist despite treatment. We previously defined the POETIC (Purpose and Meaning, Optimism and Hope, Empowerment, Tensions, Identity, Connectedness) framework for personal recovery in bipolar disorder. So far, personal recovery has only been studied in researcher-constructed environments (eg, interviews and focus groups). Support forum posts can serve as a complementary naturalistic data resource to understand the lived experience of personal recovery. Objective This study aimed to answer the question “What can online support forum posts reveal about the experience of personal recovery in bipolar disorder in relation to the POETIC framework?” Methods By integrating natural language processing, corpus linguistics, and health research methods, this study analyzed public, bipolar disorder support forum posts relevant to the lived experience of personal recovery. By comparing 4462 personal recovery–relevant posts by 1982 users to 25,197 posts not relevant to personal recovery, we identified 130 significantly overused key lemmas. Key lemmas were coded according to the POETIC framework. Results Personal recovery–related discussions primarily focused on 3 domains: “Purpose and meaning” (particularly reproductive decisions and work), “Connectedness” (romantic relationships and social support), and “Empowerment” (self-management and personal responsibility). This study confirmed the validity of the POETIC framework to capture personal recovery experiences shared on the web and highlighted new aspects beyond previous studies using interviews and focus groups. Conclusions This study is the first to analyze naturalistic data on personal recovery in bipolar disorder. By indicating the key areas that people focus on in personal recovery when posting freely and the language they use, this study provides helpful starting points for formal and informal carers to understand the concerns of p

BACKGROUND: People with severe mental illness (e.g. psychosis, bipolar disorder) experience poor oral health compared to the general population as shown by more decayed, missing and filled teeth and a higher prevalence of periodontal disease. Attending dental services allows treatment of oral health problems and support for prevention. However, people with severe mental illness face multiple barriers to attending routine dental appointments and often struggle to access care. Link work interventions use non-clinical support staff to afford vulnerable populations the capacity, opportunity, and motivation to navigate use of services. The authors have co-developed with service users a link work intervention for supporting people with severe mental illness to access routine dental appointments. The Mouth Matters in Mental Health Study aims to explore the feasibility and acceptability of this intervention within the context of a feasibility randomised controlled trial (RCT) measuring outcomes related to the recruitment of participants, completion of assessments, and adherence to the intervention. The trial will closely monitor the safety of the intervention and trial procedures. METHODS: A feasibility RCT with 1:1 allocation to two arms: treatment as usual (control) or treatment as usual plus a link work intervention (treatment). The intervention consists of six sessions with a link worker over 9 months. Participants will be adults with severe mental illness receiving clinical input from secondary care mental health service and who have not attended a planned dental appointment in the past 3 years. Assessments will take place at baseline and after 9 months. The target recruitment total is 84 participants from across three NHS Trusts. A subset of participants and key stakeholders will complete qualitative interviews to explore the acceptability of the intervention and trial procedures. DISCUSSION: The link work intervention aims to improve dental access and reduce oral hea

Background: Mental health (MH) peer online forums offer robust support where internet access is common, but healthcare is not, e.g., in countries with under-resourced MH support, rural areas, and during pandemics. Despite their widespread use, little is known about who posts in such forums, and in what mood states. The discussion platform Reddit is ideally suited to study this as it hosts forums (subreddits) for MH and non-MH topics. In bipolar disorder (BD), where extreme mood states are core defining features, mood influences are particularly relevant. Objectives: This exploratory study investigated posting patterns of Reddit users with a self-reported BD diagnosis and the associations between posting and emotions, specifically: 1) What proportion of the identified users posts in MH versus non-MH subreddits? 2) What differences exist in the emotions that they express in MH or non-MH subreddit posts? 3) How does mood differ between those users who post in MH subreddits compared to those who only post in non-MH subreddits? Methods: Reddit users were automatically identified via self-reported BD diagnosis statements and all their 2005–2019 posts were downloaded. First, the percentages of users who posted only in MH (non-MH) subreddits were calculated. Second, affective vocabulary use was compared in MH versus non-MH subreddits by measuring the frequency of words associated with positive emotions, anxiety, sadness, anger, and first-person singular pronouns via the LIWC text analysis tool. Third, a logistic regression distinguished users who did versus did not post in MH subreddits, using the same LIWC variables (measured from users’ non-MH subreddit posts) as predictors, controlling for age, gender, active days, and mean posts/day. Results: 1) Two thirds of the identified 19,685 users with a self-reported BD diagnosis posted in both MH and non-MH subreddits. 2) Users who posted in both MH and non-MH subreddits exhibited less positive emotion but more anxiety and sadne

Background: Personal recovery, ‘living a satisfying, hopeful and contributing lifeeven with the limitations caused by the illness’ (Anthony, 1993) is of particular value in bipolar disorder where symptoms often persist despite treatment. So far, personal recovery has only been studied in researcher-constructed environments (interviews, focus groups). Support forum posts can serve as a complementary naturalistic data source. Objective: The overarching aim of this thesis was to study personal recovery experiences that people living with bipolar disorder have shared in online support forums through integrating health research, NLP, and corpus linguistics in a mixed methods approach within a pragmatic research paradigm, while considering ethical issues and involving people with lived experience. Methods: This mixed-methods study analysed: 1) previous qualitative evidence on personal recovery in bipolar disorder from interviews and focus groups 2) who self-reports a bipolar disorder diagnosis on the online discussion platform Reddit 3) the relationship of mood and posting in mental health-specific Reddit forums (subreddits) 4) discussions of personal recovery in bipolar disorder subreddits. Results: A systematic review of qualitative evidence resulted in the first framework for personal recovery in bipolar disorder, POETIC (Purpose & meaning, Optimism & hope, Empowerment, Tensions, Identity, Connectedness). Mainly young or middle-aged US-based adults self-report a bipolar disorder diagnosis on Reddit. Of these, those experiencing more intense emotions appear to be more likely to post in mental health support subreddits. Their personal recovery-related discussions in bipolar disorder subreddits primarily focussed on three domains: Purpose & meaning (particularly reproductive decisions, work), Connectedness (romantic relationships, social support), Empowerment (self-management, personal responsibility). Support forum data highlighted personal recovery issues that exclusive

Introduction Peer online mental health forums are commonly used and offer accessible support. Positive and negative impacts have been reported by forum members and moderators, but it is unclear why these impacts occur, for whom and in which forums. This multiple method realist study explores underlying mechanisms to understand how forums work for different people. The findings will inform codesign of best practice guidance and policy tools to enhance the uptake and effectiveness of peer online mental health forums. Methods and analysis In workstream 1, we will conduct a realist synthesis, based on existing literature and interviews with approximately 20 stakeholders, to generate initial programme theories about the impacts of forums on members and moderators and mechanisms driving these. Initial theories that are relevant for forum design and implementation will be prioritised for testing in workstream 2. Workstream 2 is a multiple case study design with mixed methods with several online mental health forums differing in contextual features. Quantitative surveys of forum members, qualitative interviews and Corpus-based Discourse Analysis and Natural Language Processing of forum posts will be used to test and refine programme theories. Final programme theories will be developed through novel triangulation of the data. Workstream 3 will run alongside workstreams 1 and 2. Key stakeholders from participating forums, including members and moderators, will be recruited to a Codesign group. They will inform the study design and materials, refine and prioritise theories, and codesign best policy and practice guidance. Ethics and dissemination Ethical approval was granted by Solihull Research Ethics Committee (IRAS 314029). Findings will be reported in accordance with RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) guidelines, published as open access and shared widely, along with codesigned tools. Trial registration number ISRCTN 62469166; the pr

In the western world, it is well known that the unequal distribution of power and resources unjustly impacts on peoples’ opportunity to lead their best lives, and on their health and recovery. Health inequalities can be observed across the border and they have a significant role to play for the 1billion people currently suffering with mental health difficulties and suicidality. Despite wide acknowledgement of the relationship between socioeconomic determinants and mental health ranging from research to politics, current efforts have not been able to put a halt to these issues that are steadily increasing to affect larger percentage of the world population. Partly this could be attributed to a lack of understanding and knowledge about the mechanism underlying the relationship between the socioeconomic environment and mental health. The present thesis is framed within a critical realist research paradigm and consists of four studies (a systematic review, a secondary public health data analysis, and two cross-sectional analyses of primary data). It aims to explore the potential role of cognitive ruminative thinking as a mediator in the relationship between individual socioeconomic indicators (both absolute and relative) and a range of mental health outcomes (depressive, (hypo-)manic mood, hallucinations, suicidality). It examines this for different subtypes of rumination (negative, positive, transdiagnostic), which allows for a more comprehensive understanding. The systematic review finds mixed evidence about the relationship of positive rumination and mood, but in doing so indicates the need to include positive rumination in the mediational model built. The public health secondary data offer the opportunity to test the mediational in a large general population sample. The findings are supportive of the hypothesized mediational role and thus the next two studies use data from a built-for-purpose survey that leads to the examination of a series of iterations of the medi

Introduction: People with lived expertise in managing mental health challenges can be an important source of knowledge and support for other people facing similar challenges, and for carers to learn how best to help. However, opportunities for sharing lived expertise are limited. Living libraries support people with lived expertise to be ‘living books’, sharing their experiences in dialogue with ‘readers’ who can ask questions. Living libraries have been piloted worldwide in health-related contexts but without a clear model of how they work or rigorous evaluation of their impacts. We aim to develop a programme theory about how a living library could be used to improve mental health outcomes, using this theory to codesign an implementation guide that can be evaluated across different contexts. Methods and analysis: We will use a novel integration of realist synthesis and experience-based codesign (EBCD) to produce a programme theory about how living libraries work and a theory and experience informed guide to establishing a library of lived experience for mental health (LoLEM). Two workstreams will run concurrently: (1) a realist synthesis of literature on living libraries, combined with stakeholder interviews, will produce several programme theories; theories will be developed collaboratively with an expert advisory group of stakeholders who have hosted or taken part in a living library and will form our initial analysis framework; a systematic search will identify literature about living libraries; data will be coded into our analysis framework, and we will use retroductive reasoning to explain living libraries’ impacts across multiple contexts. Individual stakeholder interviews will help refine and test theories; (2) data from workstream 1 will inform 10 EBCD workshops with people with experience of managing mental health difficulties and health professionals to produce a LoLEM implementation guide; data from this process will also inform the theory in workstream

Background: Carers of people with psychosis often provide vital emotional and practical support to friends, family members and other social contacts. Yet while people with psychosis are at increased risk of experiencing suicidal behaviour, including thinking about and attempting suicide, little is known of carers’ perspectives of providing support when this happens. This thesis therefore aimed to address the question: ‘What are carers’ experiences of supporting friends or family members with psychosis and suicidal behaviour?’ Methods: Three research methods were used to produce four articles. First, qualitative thematic synthesis was used to synthesise nineteen articles investigating carers’ experiences of supporting a friend or family member with suicidal behaviour. Second, reflexive thematic analysis was used to analyse online peer-to-peer conversations related to caring for someone with psychosis or bipolar disorder and suicidal behaviour. Third, reflexive thematic analysis was used to analyse twenty in-depth semi-structured interviews with friends and family members of people with psychosis and suicidal behaviour. Two articles based on this interview data are reported, focusing on the personal psychosocial impact of caregiving in this context, and on carers’ understandings of the relationship between psychotic experiences and suicidal behaviour, respectively. Results: Across studies, carers’ experiences were characterised by profound and ongoing fear of suicide. This left many stuck in a vicious cycle of hypervigilance to suicide risk, exasperation, and fatigue. Feeling unable to understand why suicidal behaviour occurred left carers in a distressing state of uncertainty about how to respond, an experience that was particularly apparent in the early and more acute periods of psychosis. Developing an understanding of how psychotic experiences contributed to suicidal behaviour allowed some carers to identify strategies for mitigating or avoiding situations that co

Background: Relatives of people with psychosis or bipolar disorder experience high levels of distress but typically are not offered the support they need. Peer online forums may offer a solution, but knowledge about who uses them, how and why is limited. The current study reported on online forum usage during the REACT (Relatives’ Education And Coping Toolkit) trial. Objective: We aimed to report: (1) who used the forum and why; (2) how sociodemographic factors are associated with participation; (3) the relationships between frequency, type of use, and outcomes; and (4) how the forum was used. Methods: Relationships between key socio-demographic characteristics, levels of forum use, and distress were statistically analysed. We used thematic and semantic analysis to understand the reasons relatives joined the forum and the key topics initiated by them. We also used the UCREL Semantic Analysis System (USAS) to compare how relatives and REACT Supporters (moderators) used the forum. Results: 348 participants with full forum use data from REACT were included in this study. The forum was accessed by 59% (207/348) of relatives across the whole age range with no significant associations between sociodemographic factors and forum participation, or between level/type of use and relatives’ distress levels. Relatives joined the forum primarily to find people in similar circumstances, express concerns and talk about stressful events. Relatives were concerned most about recent events, negative emotions linked to caring, experiences of conflict/threat, and concerns about suicide. These posts underscored both the challenges relatives were facing and that they felt safe to share these in this context. Conclusion: Whilst only a proportion of REACT participants engaged actively with its forum they are widely distributed across age and other sociodemographic groupings. Relatives used the forum for information, support and guidance and to offer detailed information about their experienc

Background: Personal recovery (PR), ‘living a satisfying, hopeful life even with the limitations caused by the illness’ is of particular value in bipolar disorder (BD). We complement evidence from researcher-constructed environments (interviews, focus groups) on PR with non-reactive support forum data. Methods: This poster presents two studies of international BD support forums (80% US users). Study 1 analysed applied automatic content analysis to 270K random posts (20M words) of 10K users via automatic content analysis. Study 2 analysed 4.4K PR-relevant posts (1.3M words) by 2K users via corpus framework analysis using the POETIC framework for PR in BD. Results: The main topics in BD forums were: MH symptoms (421K mentions), Professional treatment (208K), Personal narratives (35K), Recovery & self-management (35K), Recurrences & routines (25K). These topics are consistentin line with prior research. Study 2 demonstrated the validity of POETIC and showed three main domains in PR-related discussions: Connectedness (particularly romantic relationships, social support), Purpose & meaning (parenting, work), and Empowerment (self-management). Conclusions: This is the largest-scale analysis of BD online support forums to dateyet and the first study of non-reactive data on PR. Indicating the key PR areas people focus on when posting freely and the language they use, provides helpful starting points for therapists to collaboratively consider these issues with clients.

BACKGROUND: Outcome measurement in bipolar disorder (BD) traditionally focused on clinical improvement without considering other domains. Improvement trajectories in clinical and social-functional domains are different and can simultaneously appear in one while not in other domains. Measuring personal recovery (PR) has become a priority internationally. This review explored the shift in research investigating operational recovery definitions and underpinning factors of recovery in BD over the past four decades. METHODS: Studies defining recovery domains (other than clinical recovery) in BD were systematically reviewed; operational recovery definitions and factors assessed in association with recovery were thematically categorised and integrated in a narrative synthesis. RESULTS: Thirty-three studies, comprising 3638 participants from 19 countries were included. Identified operational recovery definition themes included i) PR ii) social-functional (SFR), and iii) occupational-residential (ORR) recovery. Examined factors were grouped as demographic, clinical and psychosocial factors. Predominantly demographic factors were linked to ORR and clinical factors to SFR. Depressive symptomatology was the only clinical factor associated with PR. Research investigating psychosocial factors in PR is emerging and has showed that resilience and appraisals of mood seem to be associated with PR. LIMITATIONS: Studies not available in English or examining functioning without defining recovery were excluded. CONCLUSIONS: Earlier operational recovery definitions of ORR and SFR were often arbitrary and inconsistent, and predominantly focused on clinical and demographic underpinning factors. While research attempts to follow the significant policy shifts towards personalised care by measuring what matters to individuals and exploring broader underpinning psychosocial factors, it is still lagging behind.

Background There is evidence to suggest that older people with Bipolar Disorder (BD) are more likely to demonstrate poor levels of functioning and score lower on well-being scales compared to non-clinical controls, even when in remission (Depp et al., 2006). To our knowledge, this is the first review paper to identify how quality of life and functioning has been measured in an older adult BD population. Methods We conducted a systematic review of studies including a quantitative measure of psychosocial functioning or quality of life and older people over the age of 50 with a formal diagnosis of BD I or II. Results Eleven studies (N = 726, mean age range 59.8 to 71.1) were included in the review, demonstrating a significant lack of research in the area compered to younger people with BD. The most commonly used measure of functioning was the Global Assessment of Functioning Scale (GAF) and results indicated that older adults with BD demonstrate a wide range of functioning. Limitations The review used a comprehensive and systematic search strategy, however, very few eligible studies were available for review. The pooled analyses and reported means must be interpreted with caution due to the relatively small sample sizes. Conclusions Older people with BD present with a wide range of functioning, ranging ‘major impairment’ to ‘superior’ scores. No existing validated measure assessing the psychosocial functioning or quality of life of older people with BD could be identified. Such a tool should be developed for use in future research.

Health researchers are increasingly using natural language processing (NLP) to study various mental health conditions using both social media and electronic health records (EHRs). There is currently no published synthesis that relates specifically to the use of NLP methods for bipolar disorder, and this scoping review was conducted to synthesize valuable insights that have been presented in the literature. This scoping review explored how NLP methods have been used in research to better understand bipolar disorder and identify opportunities for further use of these methods. A systematic, computerized search of index and free-text terms related to bipolar disorder and NLP was conducted using 5 databases and 1 anthology: MEDLINE, PsycINFO, Academic Search Ultimate, Scopus, Web of Science Core Collection, and the ACL Anthology. Of 507 identified studies, a total of 35 (6.9%) studies met the inclusion criteria. A narrative synthesis was used to describe the data, and the studies were grouped into four objectives: prediction and classification (n=25), characterization of the language of bipolar disorder (n=13), use of EHRs to measure health outcomes (n=3), and use of EHRs for phenotyping (n=2). Ethical considerations were reported in 60% (21/35) of the studies. The current literature demonstrates how language analysis can be used to assist in and improve the provision of care for people living with bipolar disorder. Individuals with bipolar disorder and the medical community could benefit from research that uses NLP to investigate risk-taking, web-based services, social and occupational functioning, and the representation of gender in bipolar disorder populations on the web. Future research that implements NLP methods to study bipolar disorder should be governed by ethical principles, and any decisions regarding the collection and sharing of data sets should ultimately be made on a case-by-case basis, considering the risk to the data participants and whether their privac

Background. The likelihood of suicidal behaviour is elevated amongst people with psychosis or bipolar disorder. This study aimed to understand how carers experience supporting family members with psychosis or bipolar disorder who have also experienced suicidal behaviour. Methods. A qualitative thematic analysis of online peer forum posts was carried out on the Relatives Education and Coping Toolkit (REACT) website, an online intervention for carers of people with psychosis and bipolar disorder. Analysis was based on 178 posts by 29 forum users. Posts were selected based on their relevance to suicidal behaviour. Results. Three themes were generated. “Suicide as the ultimate threat” highlights fears emerging from carers’ difficulties with understanding and managing suicidal behaviour. “Bouncing from one crisis to another” reflects carers’ experiences of recurring crises and the challenges of relying on emergency healthcare support. “It definitely needs to be easier to get help” emphasises carers’ desires to be acknowledged by healthcare professionals and included in support offered to service users. Conclusions. Digital platforms, including online forums, brief interventions such as safety planning, and interagency crisis models, hold the potential to meet carers’ needs in this context. However, further research is required to investigate the effectiveness and implementation of these approaches.

BACKGROUND: Relatives of people with psychosis or bipolar disorder experience high levels of distress but are typically not offered the support they need. Online peer forums may offer a solution, but knowledge about who uses them, how, and why is limited. This study reported on online forum use during the Relatives Education and Coping Toolkit (REACT) trial. OBJECTIVE: We aimed to report who used the forum and why; how sociodemographic factors are associated with participation; the relationship among frequency, type of use, and outcomes; and how the forum was used. METHODS: The relationships between key sociodemographic characteristics, levels of forum use, and distress were statistically analyzed. We used thematic and semantic analyses to understand the reasons for relatives joining the forum and the key topics initiated by them. We also used the University Centre for Computer Corpus Research on Language Semantic Analysis System to compare how relatives and REACT supporters (moderators) used the forum. RESULTS: A total of 348 participants with full forum use data from REACT were included in this study. The forum was accessed by 59.4% (207/348) of the relatives across the entire age range, with no significant associations between sociodemographic factors and forum participation, or between level or type of use and relatives' distress levels. Relatives joined the forum primarily to find people in similar circumstances, express concerns, and talk about stressful events. Relatives were most concerned about recent events, negative emotions linked to caring, experiences of conflict or threat, and concerns about suicide. These posts underscored both the challenges the relatives were facing and the fact that they felt safe sharing them in this context. CONCLUSIONS: Although only a proportion of REACT participants engaged actively with its forum, they were widely distributed across age and other sociodemographic groupings. Relatives used the forum for information, support

Background There has been little research into the psychosocial needs of older people living with bipolar disorder (BD). There is evidence to suggest that psychological treatments developed for working aged adults are effective. These treatments may not be acceptable or effective for an older population due to differences in presentation in later life. Aims The overarching aim of the thesis was to develop a recovery focused therapy (RfT) for older people with BD. The main aims were to: improve our understanding of how BD presents in older adults, identify whether any potential adaptations were needed to an existing therapy (RfT) to meet the needs of an older adult population and to evaluate the feasibility and acceptability of RfT for older adults (RfT-OA) with BD. Methods Study one was a systematic review of psychosocial functioning and quality of life in older people with BD. Study two was a qualitative study, using focus group methodology, to increase our understanding of BD in later life and inform the development of RfT-OA. Study three was a mixed methods study to evaluate the feasibility and acceptability of RfT-OA. Results The results from study one indicate that older adults demonstrate a wide range of functioning. Study two found that older adults with BD reported changes in their symptomatology, physical health and cognition. They proposed a number of specific adaptions for delivering RfT-OA including techniques to enhance memory and learning and recommendations for the therapist including: nurturing pre-existing strengths and work focused on building assertiveness and confidence. The findings from study three largely support the feasibility and acceptability of RfT-OA. Clinical assessment measures provided evidence of a signal for effectiveness on a range of outcomes including: mood symptoms, time-to-relapse and functioning. Conclusions The findings suggest that RfT-OA is feasible, acceptable and has the potential to improve a range of outcomes for older

Background. The likelihood of suicidal behaviour is elevated amongst people with psychosis or bipolar disorder. This study aimed to understand how carers experience supporting family members with psychosis or bipolar disorder who have also experienced suicidal behaviour. Methods. A qualitative thematic analysis of online peer forum posts was carried out on the Relatives Education and Coping Toolkit (REACT) website, an online intervention for carers of people with psychosis and bipolar disorder. Analysis was based on 178 posts by 29 forum users. Posts were selected based on their relevance to suicidal behaviour. Results. Three themes were generated. “Suicide as the ultimate threat” highlights fears emerging from carers’ difficulties with understanding and managing suicidal behaviour. “Bouncing from one crisis to another” reflects carers’ experiences of recurring crises and the challenges of relying on emergency healthcare support. “It definitely needs to be easier to get help” emphasises carers’ desires to be acknowledged by healthcare professionals and included in support offered to service users. Conclusions. Digital platforms, including online forums, brief interventions such as safety planning, and interagency crisis models, hold the potential to meet carers’ needs in this context. However, further research is required to investigate the effectiveness and implementation of these approaches.

BACKGROUND: Relatives of people with psychosis or bipolar disorder experience high levels of distress but are typically not offered the support they need. Online peer forums may offer a solution, but knowledge about who uses them, how, and why is limited. This study reported on online forum use during the Relatives Education and Coping Toolkit (REACT) trial. OBJECTIVE: We aimed to report who used the forum and why; how sociodemographic factors are associated with participation; the relationship among frequency, type of use, and outcomes; and how the forum was used. METHODS: The relationships between key sociodemographic characteristics, levels of forum use, and distress were statistically analyzed. We used thematic and semantic analyses to understand the reasons for relatives joining the forum and the key topics initiated by them. We also used the University Centre for Computer Corpus Research on Language Semantic Analysis System to compare how relatives and REACT supporters (moderators) used the forum. RESULTS: A total of 348 participants with full forum use data from REACT were included in this study. The forum was accessed by 59.4% (207/348) of the relatives across the entire age range, with no significant associations between sociodemographic factors and forum participation, or between level or type of use and relatives' distress levels. Relatives joined the forum primarily to find people in similar circumstances, express concerns, and talk about stressful events. Relatives were most concerned about recent events, negative emotions linked to caring, experiences of conflict or threat, and concerns about suicide. These posts underscored both the challenges the relatives were facing and the fact that they felt safe sharing them in this context. CONCLUSIONS: Although only a proportion of REACT participants engaged actively with its forum, they were widely distributed across age and other sociodemographic groupings. Relatives used the forum for information, support

Background: Personal recovery (PR), ‘living a satisfying, hopeful life even with the limitations caused by the illness’ is of particular value in bipolar disorder (BD). We complement evidence from researcher-constructed environments (interviews, focus groups) on PR with non-reactive support forum data. Methods: This poster presents two studies of international BD support forums (80% US users). Study 1 analysed applied automatic content analysis to 270K random posts (20M words) of 10K users via automatic content analysis. Study 2 analysed 4.4K PR-relevant posts (1.3M words) by 2K users via corpus framework analysis using the POETIC framework for PR in BD. Results: The main topics in BD forums were: MH symptoms (421K mentions), Professional treatment (208K), Personal narratives (35K), Recovery & self-management (35K), Recurrences & routines (25K). These topics are consistentin line with prior research. Study 2 demonstrated the validity of POETIC and showed three main domains in PR-related discussions: Connectedness (particularly romantic relationships, social support), Purpose & meaning (parenting, work), and Empowerment (self-management). Conclusions: This is the largest-scale analysis of BD online support forums to dateyet and the first study of non-reactive data on PR. Indicating the key PR areas people focus on when posting freely and the language they use, provides helpful starting points for therapists to collaboratively consider these issues with clients.

Health researchers are increasingly using natural language processing (NLP) to study various mental health conditions using both social media and electronic health records (EHRs). There is currently no published synthesis that relates specifically to the use of NLP methods for bipolar disorder, and this scoping review was conducted to synthesize valuable insights that have been presented in the literature. This scoping review explored how NLP methods have been used in research to better understand bipolar disorder and identify opportunities for further use of these methods. A systematic, computerized search of index and free-text terms related to bipolar disorder and NLP was conducted using 5 databases and 1 anthology: MEDLINE, PsycINFO, Academic Search Ultimate, Scopus, Web of Science Core Collection, and the ACL Anthology. Of 507 identified studies, a total of 35 (6.9%) studies met the inclusion criteria. A narrative synthesis was used to describe the data, and the studies were grouped into four objectives: prediction and classification (n=25), characterization of the language of bipolar disorder (n=13), use of EHRs to measure health outcomes (n=3), and use of EHRs for phenotyping (n=2). Ethical considerations were reported in 60% (21/35) of the studies. The current literature demonstrates how language analysis can be used to assist in and improve the provision of care for people living with bipolar disorder. Individuals with bipolar disorder and the medical community could benefit from research that uses NLP to investigate risk-taking, web-based services, social and occupational functioning, and the representation of gender in bipolar disorder populations on the web. Future research that implements NLP methods to study bipolar disorder should be governed by ethical principles, and any decisions regarding the collection and sharing of data sets should ultimately be made on a case-by-case basis, considering the risk to the data participants and whether their privac