Resilience in Bipolar Disorder and Interrelationships With Psychopathology, Clinical Features, Psychosocial Functioning, and Mediational Roles: A Systematic Review

A systematic review was conducted to examine resilience in bipolar disorder (BD) and its relationship to demographic, psychopathology, illness features, and psychosocial functioning.

A literature search was conducted from database inception to August 2022 using PubMed, Web of Science, EMBASE, and PsycINFO. Reference lists were also manually searched for relevant articles.

Studies were included if they involved patients with a primary diagnosis of BD, were published in English, and measured resilience using a clearly defined rating scale. Studies were excluded if they were case reports, systematic reviews, or conference articles. Of the initial 100 records screened after duplicates were removed, 29 articles were finally included in the systematic review.

Information extracted included the number and type of subjects, socio-demographic characteristics, resilience scale(s) used, and relevant clinical correlates.

Higher resilience in BD was associated with specific psychopathology (lower severity of depressive and psychotic symptoms; less rumination, hopelessness, impulsivity, and aggression; fewer depressive episodes and suicide attempts), clinical features (self-directed temperament, less childhood trauma, and positive attitudes toward pharmacologic treatment), social factors (better social support and family organization), and psychosocial functioning (better quality of life, social functioning, personal recovery, and spiritual well-being). Resilience also mediated pathways between childhood trauma, depression, and quality of life.

Based on resilience models, BD patients can be helped to better manage challenges and stressors and bolster internal compensatory factors and external protective factors during the course of their illness.