Strategies for occupational recovery processes in individuals with bipolar disorder type I: a qualitative study

Employment is a challenging life domain for individuals with bipolar disorder (BD), illustrated by high unemployment numbers and various experienced problems within the workplace. While regaining a satisfactory level of occupational functioning is an important aspect of recovery, there is little qualitative research exploring occupational recovery in individuals with BD. The aim of this qualitative study was first to gain insight into the (self-regulation) strategies used by patients and peer support workers with BD type I (BD-I) regarding their occupational functioning. Our second aim was to construct a conceptual model based on these strategies used to better understand how individuals with BD-I might recover during their occupational functioning. In our study, inspired by Glaser and Strauss' constructivist Grounded Theory, we interviewed 21 patients and 15 peer support workers with BD-I about their experiences in occupational functioning and about the strategies they use for dealing with difficulties, as well as their occupational recovery processes. We analysed the data through open, axial, and selective coding.

The results showed one overarching theme and three subthemes of strategies used by individuals with BD-I: (1) organizing work, (2) self-regulatory actions in relation to employment, and (3) getting support. Based on the narratives of the participants, a conceptual model was found in which differing strategies are used based on the recovery process: acute mood episode or longer lasting recovery process.

The narratives of individuals with BD-I show that two types of recovery can be experienced in relation to work: recovery after an acute mood episode and a longer lasting recovery process that is intertwined with several aspects of daily working life. We identified three different types of strategies that participants with BD-I implement to create a fitting employment situation and that it might depend on the type of recovery process which strategies are most helpful.