Occupational participation challenges in adults with mood disorders: A Kawa (River) Model-guided qualitative study

Mood disorders disrupt occupational participation by interfering with routines, roles, and social connectedness. The Kawa (River) model offers a culturally sensitive, metaphor-based framework to explore how individuals perceive and navigate barriers, supports, and opportunities in daily life.

Thirteen adults with mood disorders were recruited from a university psychiatry clinic. Participants completed semi-structured interviews guided by the Kawa model, including river drawings and reflective questions. Interviews were transcribed and analyzed using Colaizzi's phenomenological method. Rigor was supported through reflexive memos, consensus coding, audit trails, peer debriefing, and integration of field notes.

Participants described life flow as turbulent, stagnant, or clear, reflecting disrupted routines, fluctuating motivation, and occasional stability. Occupational participation was limited by psychological symptoms, strained relationships, stigma, and rigid environments, yet supported by driftwood resources such as strengths, hobbies, spirituality, social support. Spaces reflected aspirations for independence, growth, stability.

The Kawa model provided participants with a supportive framework to share experiences of occupational participation and challenges. Its metaphorical and visual structure encouraged reflection, made complex experiences more accessible, and highlighted barriers and resources. Findings suggest the model can help occupational therapists understand how mood disorders shape daily life and support collaborative goal-setting within culturally responsive practice.