Validation of the Bipolar Recovery Questionnaire for the Portuguese Population: Recovery and Predictors in People with Bipolar Disorder
DOI:
https://doi.org/10.20344/amp.20790Keywords:
Bipolar Disorder, Psychometrics, Recovery of Function, Reproducibility of Results, Surveys and Questionnaires, TranslationsAbstract
Introduction: The paradigm in mental health care is progressively moving towards a recovery-focused perspective. Thus, there is a need for validated instruments to measure recovery in bipolar disorder (BD). The Bipolar Recovery Questionnaire (BRQ) is the most used instrument to assess it. The aim of this study was to translate and perform a cross-cultural adaptation of the BRQ to European Portuguese (PT-PT) and to explore further associations of recovery with sociodemographic and emotional regulation, as well as recovery predictors to inform future research and clinical practice.
Methods: The BRQ was forward-translated and back-translated until a consensus version was found, and a test-retest design was used to assess temporal stability. Participants were recruited in public hospitals and organizations supporting people with BD, either referred by their psychiatrists or psychologists or through self-referral. Eighty-eight individuals diagnosed with BD were recruited to complete a battery of Portuguese-validated self-report questionnaires to assess recovery (BRQ), clinical mood symptoms (Hospital Anxiety and Depression Scale), affect (Positive and Negative Affect Scale), well-being (brief Quality of Life for Bipolar Disorder; Satisfaction with Life Scale) and emotion regulation (Difficulties in Emotion Regulation Scale).
Results: The BRQ showed excellent internal consistency with a Cronbach alpha of 0.92, and test-retest exhibited good reliability (r = 0.88). Construct validity was confirmed through/by positive and moderate correlations with quality of life (QoL; r = 0.58) and positive affect (r = 0.52), and negative moderate correlations with depression (r = -0.64), and negative affect (r = -0.55). Both satisfaction with life (β = 0.38, p = 0.010) and recovery (β = 0.34, p = 0.022) impacted quality of life, supporting the BRQ’s incremental validity. Depressive symptoms and emotion dysregulation accounted for 51% of its variance.
Conclusion: The BRQ is a valid and reliable instrument to measure recovery in people with BD in the Portuguese population and is suitable for both clinical and research contexts.
Downloads
References
Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011;68:241-51. DOI: https://doi.org/10.1001/archgenpsychiatry.2011.12
Treuer T, Tohen M. Predicting the course and outcome of bipolar disorder: a review. Eur Psychiatry. 2010;25:328-33. DOI: https://doi.org/10.1016/j.eurpsy.2009.11.012
Echezarraga A, Calvete E, González-Pinto AM, Las Hayas C. Resilience dimensions and mental health outcomes in bipolar disorder in a follow-up study. Stress Heal. 2018;34:115-26. DOI: https://doi.org/10.1002/smi.2767
Bonnin CD, Reinares M, Martinez-Aran A, Jimenez E, Sanchez-Moreno J, Sole B, et al. Improving functioning, quality of life, and well-being in patients with bipolar disorder. Int J Neuropsychopharmacol. 2019;22:467-77. DOI: https://doi.org/10.1093/ijnp/pyz018
Andersson P, Tistad M, Eriksson Å, Enebrink P, Sturidsson K. Implementation and evaluation of illness management and recovery (IMR) in mandated forensic psychiatric care – study protocol for a multicenter cluster randomized trial. Contemp Clin Trials Commun. 2022;27:100907. DOI: https://doi.org/10.1016/j.conctc.2022.100907
Nestsiarovich A, Hurwitz NG, Nelson SJ, Crisanti AS, Kerner B, Kuntz MJ, et al. Systemic challenges in bipolar disorder management: a patient-centered approach. Bipolar Disord. 2017;19:676-88. DOI: https://doi.org/10.1111/bdi.12547
Yildiz A, Ruiz P, Nemeroff CB, editors. The bipolar book: history, neurobiology, and treatment. New York: Oxford University Press; 2015. DOI: https://doi.org/10.1093/med/9780199300532.001.0001
Chirio-Espitalier M, Schreck B, Duval M, Hardouin JB, Moret L, Bronnec MG. Exploring the personal recovery construct in bipolar disorders: definition, usage and measurement. a systematic review. Front Psychiatry . 2022;13:876761. DOI: https://doi.org/10.3389/fpsyt.2022.876761
Ogilvie AD, Morant N, Goodwin GM. The burden on informal caregivers of people with bipolar disorder. Bipolar Disord. 2005;7:25-32. DOI: https://doi.org/10.1111/j.1399-5618.2005.00191.x
Frost BG, Tirupati S, Johnston S, Turrell M, Lewin TJ, Sly KA, et al. An integrated recovery-oriented model (IRM) for mental health services: evolution and challenges. BMC Psychiatry. 2017;17:1-17. DOI: https://doi.org/10.1186/s12888-016-1164-3
Jacob K. Recovery model of mental illness: a complementary approach to psychiatric care. Indian J Psychol Med. 2015;37:117-9. DOI: https://doi.org/10.4103/0253-7176.155605
Carpiniello B, Vita A, Mencacci C, editors. Recovery and major mental disorders. Cham: Springer International Publishing; 2022. DOI: https://doi.org/10.1007/978-3-030-98301-7
Fico G, Anmella G, Murru A, Vieta E. Predictors of clinical recovery in bipolar disorders. In: Carpiniello B, Vita A, Mencacci C, editors. Recovery and major mental disorders . Cham: Springer International Publishing; 2022. p. 155-72. DOI: https://doi.org/10.1007/978-3-030-98301-7_10
Thornton T, Lucas P. On the very idea of a recovery model for mental health. J Med Ethics. 2011;37:24-8. DOI: https://doi.org/10.1136/jme.2010.037234
Neil ST, Killbride M, Pitt L, Nothard S, Welford M, Sellwood W, et al. The questionnaire about the process of recovery (QPR): a measurement tool developed in collaboration with service users. Psychosis. 2009;1:145-55. DOI: https://doi.org/10.1080/17522430902913450
Law H, Neil ST, Dunn G, Morrison AP. Psychometric properties of the questionnaire about the process of recovery (QPR). Schizophr Res. 2014;156:184-9. DOI: https://doi.org/10.1016/j.schres.2014.04.011
Williams J, Leamy M, Pesola F, Bird V, Le Boutillier C, Slade M. Psychometric evaluation of the questionnaire about the process of recovery (QPR). Br J Psychiatry. 2015;207:551-5. DOI: https://doi.org/10.1192/bjp.bp.114.161695
Kraiss JT, Ten Klooster PM, Chrispijn M, Stevens AW, Kupka RW, Bohlmeijer ET. Measuring personal recovery in people with bipolar disorder and exploring its relationship with well-being and social role participation. Clin Psychol Psychother. 2019;26:540-9. DOI: https://doi.org/10.1002/cpp.2371
Jones S, Mulligan LD, Higginson S, Dunn G, Morrison AP. The bipolar recovery questionnaire: psychometric properties of a quantitative measure of recovery experiences in bipolar disorder. J Affect Disord. 2013;147:34-43. DOI: https://doi.org/10.1016/j.jad.2012.10.003
Fenn J, Tan CS, George S. Development, validation and translation of psychological tests. B J Psych Adv. 2020;26:306-15. DOI: https://doi.org/10.1192/bja.2020.33
Hirschfeld RM. The mood disorder questionnaire: a simple, patient-rated screening instrument for bipolar disorder. Prim Care Companion J Clin Psychiatry. 2002;4:9-11. DOI: https://doi.org/10.4088/PCC.v04n0104
Azevedo J, Castilho P, Carreiras D, Martins MJ, Carvalho CB, Cherpe S, et al. Development of the clinical interview for bipolar disorder (CIBD) – rational and experts’ panel evaluation. J Neurol Neurol Sci Disord. 2023;9:45-54. DOI: https://doi.org/10.17352/jnnsd.000056
Castelo MS, Carvalho ER, Gerhard ES, Costa CM, Ferreira ED, Carvalho AF. Validação da versão em português do questionário de transtornos do humor em uma população de pacientes psiquiátricos. Braz J Psychiatry. 2010;32:424-8. DOI: https://doi.org/10.1590/S1516-44462010005000024
Michalak EE, Murray G, Collaborative RESearch Team to Study Psychosocial Issues in Bipolar Disorder (CREST.BD). Development of the QoL.BD: a disorder-specific scale to assess quality of life in bipolar disorder. Bipolar Disord. 2010;12:727-40. DOI: https://doi.org/10.1111/j.1399-5618.2010.00865.x
Azevedo J, Roque M, Carreiras D, Castilho P, Macedo A. Quality of life in bipolar disorder: portuguese validation of the brief QoL.BD questionnaire. J Psychiatry Ment Disord. 2023;8:1-7. DOI: https://doi.org/10.26420/JPsychiatryMentalDisord.2023.1064
Galinha IC, Pais-Ribeiro J. Contribuição para o estudo da versão portuguesa da positive and negative affect schedule (PANAS): II – estudo psicométrico. Análise Psiclógica. 2005;2:219-27. DOI: https://doi.org/10.14417/ap.84
Watson D, Clark L, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54:1063-70. DOI: https://doi.org/10.1037//0022-3514.54.6.1063
Zigmond AS, Snaith RP, Snaith PR. The hospital anxiety and depression scale. Acta Psychiatr Scand.1983;67:361-70. DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a portuguese version of the hospital anxiety and depression scale. Psychol Health Med. 2007;12:225-37. DOI: https://doi.org/10.1080/13548500500524088
Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess. 1985;49:71-5. DOI: https://doi.org/10.1207/s15327752jpa4901_13
Laranjeira CA. Preliminary validation study of the portuguese version of the satisfaction with life scale. Psychol Heal Med. 2009;14:220-6. DOI: https://doi.org/10.1080/13548500802459900
Coutinho J, Ribeiro E, Ferreirinha R, Dias P. Versão portuguesa da escala de dificuldades de regulação emocional e sua relação com sintomas psicopatológicos. Rev Psiquiatr Clin. 2010;37:145-51. DOI: https://doi.org/10.1590/S0101-60832010000400001
Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41-54. DOI: https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Kline RB. Principles and practice of structural equation modeling. New York: Guilford Press; 2005.
Peterson RA. A meta-analysis of cronbach’s coefficient alpha. J Consum Res. 1994;21:381-91. DOI: https://doi.org/10.1086/209405
Dancey C, Reidy J. Statistics without maths for psychology. 7th ed. London: Pearson Education; 2017.
Field A, Miles J, Field Z. Discovering statistics using SPSS. Sage. 2013;81:169-70. DOI: https://doi.org/10.1111/insr.12011_21
Todd NJ, Jones SH, Lobban FA. “Recovery” in bipolar disorder: how can service users be supported through a self-management intervention? A qualitative focus group study. J Ment Heal. 2012;21:114-26. DOI: https://doi.org/10.3109/09638237.2011.621471
Kraiss JT, ten Klooster PM, Frye E, Kupka RW, Bohlmeijer ET. Exploring factors associated with personal recovery in bipolar disorder. Psychol Psychother. 2021;94:667-85. DOI: https://doi.org/10.1111/papt.12339
Weintraub MJ, Schneck CD, Walshaw PD, Chang KD, Sullivan AE, Singh MK, et al. Longitudinal trajectories of mood symptoms and global functioning in youth at high risk for bipolar disorder. J Affect Disord. 2020;277:394-401. DOI: https://doi.org/10.1016/j.jad.2020.08.018
Hancock J, Perich T. Personal recovery in psychological interventions for bipolar disorder: a systematic review. Aust Psychol. 2022;57:215-25. DOI: https://doi.org/10.1080/00050067.2022.2083484
Michalak EE, Yatham LN, Lam RW. Quality of life in bipolar disorder: a review of the literature. Health Qual Life Outcomes. 2005;3:72. DOI: https://doi.org/10.1186/1477-7525-3-72
Becerra R, Cruise K, Murray G, Bassett D, Harms C, Allan A, et al. Emotion regulation in bipolar disorder: are emotion regulation abilities less compromised in euthymic bipolar disorder than unipolar depressive or anxiety disorders? Open J Psychiatry. 2013;3:1-7. DOI: https://doi.org/10.4236/ojpsych.2013.34A001
Wingo AP, Baldessarini RJ, Holtzheimer PE, Harvey PD. Factors associated with functional recovery in bipolar disorder patients. Bipolar Disord. 2010;12:319-26.x DOI: https://doi.org/10.1111/j.1399-5618.2010.00808.x
Peters A, Sylvia LG, da Silva Magalhães PV, Miklowitz DJ, Frank E, Otto MW, et al. Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the systematic treatment enhancement program for bipolar disorder (STEP-BD). Psychol Med. 2014;44:3455-67. DOI: https://doi.org/10.1017/S0033291714000804
Hendrick V, Altshuler LL, Gitlin MJ, Hammen C. Gender and bipolar illness. J Clin Psychiatry. 2000;61:7623. DOI: https://doi.org/10.4088/JCP.v61n0514
Arnold LM. Gender differences in bipolar disorder. Psychiatr Clin North Am. 2003;26:595-620. DOI: https://doi.org/10.1016/S0193-953X(03)00036-4
Wright K, Dodd AL, Warren FC, Medina-Lara A, Dunn B, Harvey J, et al. Psychological therapy for mood instability within bipolar spectrum disorder: a randomised, controlled feasibility trial of a dialectical behaviour therapy-informed approach (the ThrIVe-B programme). Int J Bipolar Disord. 2021;9:20. DOI: https://doi.org/10.1186/s40345-021-00226-4
Bojic S, Becerra R. Mindfulness-based treatment for bipolar disorder: a systematic review of the literature. Eur J Psychol. 2017;13:573-98. DOI: https://doi.org/10.5964/ejop.v13i3.1138
Lovas DA, Schuman-Olivier Z. Mindfulness-based cognitive therapy for bipolar disorder: a systematic review. J Affect Disord. 2018;240:247-61. DOI: https://doi.org/10.1016/j.jad.2018.06.017
Eisner L, Eddie D, Harley R, Jacobo M, Nierenberg AA, Deckersbach T. Dialectical behavior therapy group skills training for bipolar disorder. Behav Ther. 2017;48:557-66. DOI: https://doi.org/10.1016/j.beth.2016.12.006
Salvatore P, Tohen M, Khalsa HM, Baethge C, Tondo L, Baldessarini RJ. Longitudinal research on bipolar disorders. Epidemiol Psychiatr Sci. 2007;16:109-17. DOI: https://doi.org/10.1017/S1121189X00004711
Miola A, Cattarinussi G, Antiga G, Caiolo S, Solmi M, Sambataro F. Difficulties in emotion regulation in bipolar disorder: a systematic review and metaanalysis. J Affect Disord. 2022;302:352-60. DOI: https://doi.org/10.1016/j.jad.2022.01.102
van Rheenen TE, Murray G, Rossell SL. Emotion regulation in bipolar disorder: profile and utility in predicting trait mania and depression propensity. Psychiatry Res. 2015;225:425-32. DOI: https://doi.org/10.1016/j.psychres.2014.12.001
Kurtz M, Mohring P, Förster K, Bauer M, Kanske P. Deficits in explicit emotion regulation in bipolar disorder: a systematic review. Int J bipolar Disord. 2021;9:15. DOI: https://doi.org/10.1186/s40345-021-00221-9
Hatcher L. A step-by-step approach to using the SAS system for factor analysis and structural equation modeling. North Carolina: SAS Institute, Inc.; 1994.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.