Living the life that you want following a diagnosis of Bipolar Disorder A thesis submitted to The University of Manchester for the degree of Doctor of Clinical Psychology in the Faculty of Biology, Medicine and Health 2018 Helen R Warwick School of Health Sciences Division of Psychology and Mental Health Contents List of Tables ..................................................................................................................... 5 List of Figures .................................................................................................................... 5 Word Count ........................................................................................................................ 4 Abstract ............................................................................................................................. 6 Declaration ......................................................................................................................... 7 Copyright Statement ........................................................................................................... 8 Acknowledgements ............................................................................................................. 9 Paper 1: ‘What People Diagnosed with Bipolar Disorder Experience as Distressing’: A Meta- Synthesis of Qualitative Research ........................................................................................ 11 Abstract ........................................................................................................................ 12 1. Introduction ............................................................................................................... 13 2. Method ...................................................................................................................... 15 2.1 Searches and screening ......................................................................................... 16 2.1.1 Search strategy .................................................................................................. 16 2.1.2 Inclusion and exclusion criteria ............................................................................ 17 2.1.3 Screening ........................................................................................................... 18 2.2 Data synthesis ....................................................................................................... 19 2.3 Appraisal of study quality ....................................................................................... 21 3. Results ...................................................................................................................... 21 3.1 Study and participant characteristics ....................................................................... 22 3.2 Study quality ......................................................................................................... 49 3.3 Qualitative evidence synthesis ................................................................................ 52 4. Discussion ................................................................................................................. 59 4.1 Strengths and limitations ........................................................................................ 61 4.2 Conclusions ........................................................................................................... 62 References .................................................................................................................... 63 Paper 2: Living the Life You Want Following a Diagnosis of Bipolar Disorder: A Grounded Theory Approach .......................................................................................................................... 70 Abstract ........................................................................................................................ 71 1. Introduction ............................................................................................................... 72 1.1 Study aims ............................................................................................................ 76 2. Method ...................................................................................................................... 76 2.1 Design .................................................................................................................. 76 2.2 Participants ........................................................................................................... 77 2.3 Procedure ............................................................................................................. 81 2.3.1 Diagnostic interview ............................................................................................ 81 2.3.2 Sampling ............................................................................................................ 82 2.3.3 Qualitative interviews .......................................................................................... 82 2 2.4 Analysis ................................................................................................................ 83 2.4.1 Model development and quality checks ................................................................. 84 3. Results ...................................................................................................................... 84 4. Discussion ............................................................................................................... 106 4.1 Findings in the context of current literature ........................................................... 106 4.2 Further clinical implications .................................................................................. 109 4.3 Limitations and suggestions for future research ..................................................... 110 4.4 Conclusions ......................................................................................................... 111 References .................................................................................................................. 112 Paper 3: A Critical and Reflective Review of Papers 1 and 2: A Systematic Review of Distress and an Empirical Study on Facilitating ‘Living the Life You Want’ Following a Diagnosis of Bipolar Disorder .......................................................................................................................... 116 1. Introduction ............................................................................................................. 117 2. Paper 1: Systematic review ....................................................................................... 117 2.1 Rationale ............................................................................................................ 117 2.2 Searching ............................................................................................................ 118 2.3 Screening ............................................................................................................ 120 2.4 Analysis .............................................................................................................. 120 2.5 Quality appraisals ................................................................................................ 121 3. Paper 2: Empirical paper ........................................................................................... 122 3.1 Rationale ............................................................................................................ 122 3.2 Developing the research ...................................................................................... 123 3.3 Recruitment phase .............................................................................................. 124 3.4 Conducting interviews .......................................................................................... 126 3.5 Transcribing ........................................................................................................ 128 3.6 Coding ................................................................................................................ 129 4. Overall reflections, clinical implications and conclusions ............................................... 130 References .................................................................................................................. 133 Appendices .................................................................................................................. 136 Appendix 1: Author guidelines for the Journal of Affective disorders ............................. 137 Appendix 2: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines .................................................................................. 153 Appendix 3: The review protocol registered with PROSPERO International prospective register of systematic reviews .................................................................................... 155 Appendix 4: The CASP Qualitative Research Checklist for qualitative literature ............... 165 Appendix 5: A table summarising which included papers contained codes within each developed theme ...................................................................................................... 170 Appendix 6: A table with further examples of quotations for each theme and subtheme for the systematic review ...............................................................................................