Quality of Life Associated With Internalized Stigma and Resilience in Bipolar Disorder

black and white, bipolar
black and white, bipolar
Psychotherapeutic approaches may strengthen resilience, reduce internalized stigma, and improve quality of life.

Individuals with bipolar I disorder report a significantly lower quality of life than healthy individuals, according to a study published in the Journal of Affective Disorders. This association persists regardless of the severity of bipolar symptoms and is correlated with resilience and internalized stigma.

This study included 60 individuals with a bipolar I disorder, as well as 77 healthy controls recruited from the community. Participants diagnosed with bipolar I disorder, even those presenting with low levels of symptoms and internalized stigma, reported resilience and quality of life that was significantly beneath that of healthy controls.

Quality of life showed significant associations with internalized stigma, residual depressive symptoms, and resilience, though residual symptoms of mania showed no significant associations.

The Young Mania Rating Scale and the Montgomery-Åsberg Depression Rating Scale were used to measure symptoms of bipolar I disorder, and patients’ levels of internalized stigma were measured by the Internalized Stigma of Mental Illness scale. The Resilience Scale and the Berliner Lebensqualitätsprofil were utilized to assess resilience and quality of life. Limitations include a small sample size as well as a lack of reporting on side effects, which affect quality of life and therefore may have affected the results.

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The study researchers conclude that “[quality of life] of patients suffering from bipolar I disorder, even when only mildly ill, is strongly associated with the degree of resilience and internalized stigma, and that particularly residual depressive symptoms have a negative impact on [quality of life]. In addition to drug treatment, psychotherapeutic approaches should be applied to strengthen resilience, to reduce internalized stigma, and, ultimately, to improve quality of life.”


Post F, Pardeller S, Frajo-Apor B, et al. Quality of life in stabilized outpatients with bipolar I disorder: Associations with resilience, internalized stigma, and residual symptomsJ Affect Disord. 2018; 238:399-404.