Qualitative Research proposal

Statement of the Problem
Approximately 80% of bipolar depression (BD) patients experience job loss, and 40% of BD
patients experience prolonged periods of unemployment in their adult working years
(Baldessarini et al., 2020). Much of the work disruptions are associated with the disability
associated with depression that affects bipolar patients. Timely diagnosis, adequate
understanding, and appropriate and effective treatment for use in the short term and the long term
are essential (Vieta et al., 2019). Bipolar depression patients deserve adequate care and
assistance to manage the adverse effects associated with suffering from a combination of the two
conditions. However, these issues are insufficiently resolved.
Bipolar depression patients rarely receive appropriate treatment to help them live normal
lives. For patients experiencing an adult-onset of bipolar depression, an accurate diagnosis and
an appropriate treatment are usually delayed for approximately eight years (Baldessarini et al.,
2020). The duration is even longer for juvenile patients, with depression being the most prevalent
presenting polarity among patients with bipolar depression. Further, in about 17% of the cases
where individuals have bipolar depression, a diagnosis is usually not made until the individual
experiences and switches to mania (Baldessarini et al., 2020). The switch may be attributed to
exposure to a substance that has the effect of elevating a patient’s mood. However, depression
among bipolar patients is often underscored, with most studies looking at it from the perspective
of overall morbidity and other occurring mental health conditions. Further, suicide among the
young and old patients, specifically those using intercurrent medical illness, tends to make
bipolar depression overlooked over other conditions (Osby et al. 2018).

Further, research shows that bipolar depression patients fear seeking help for depression
(Butryn et al., 2018). Other than the inherent fear evident in some of these patients, others may
not identify increases in energy, libido, activity, or mood. Some of the patients may not
recognize that these states show the clinical presentation of depression. In some cases, especially
during early diagnosis, a close friend or family member is necessary to confirm a diagnosis. The
healthcare landscape is changing, and many people find themselves not having access to a
psychiatrist in good time (Rolin et al., 2020). The problem to be addressed by this study is the
obstacles that bipolar depression patients face that impede their ability to receive an early
diagnosis. Existing studies explain that diagnosis of bipolar depression takes a long period of
time.
The purpose of this proposed study will be to explore some of the issues that hinder the early
diagnosis of bipolar depression. Bipolar patients face a higher risk of psychosis. Suicide rates
and attempts are also high. If one case takes an average of eight years to diagnose and treat, then
there is a problem. Many bipolar patients could be living with depression. Given the long
diagnosis period, they face a risk of committing suicide even before they get an accurate
diagnosis and embark on proper treatment (McIntyre & Calabrese, 2019). Depression accounts
for a significant amount of time spent feeling unwell. It, therefore, is a huge issue among bipolar
patients. With an early diagnosis, early treatment is possible, and the tragedy of suicide and
issues of high mortality rates can be avoided.
The proposed study will address the following research questions;

1. How would you describe the depressive state?
2. What exactly is it like living with bipolar and depression?
3. What was it like before you received treatment for bipolar depression?

4. Have you been suicidal? If yes, how can you describe being in such a state or
   experiencing suicidal ideations?
5. How would you describe life after commencing treatment for depression?
6. What do you think could have been done earlier to ensure that you receive an earlier
   diagnosis?
   Article Analysis
   The first article is titled Bipolar I Disorder: A Qualitative Study of The Viewpoints of The
   Family Members of Patients on The Nature of The Disorder and Pharmacological Treatment
   Non-Adherence. The research is qualitative ethnography research that concentrates on Iranian
   patients with bipolar depression. The study population was family members of individuals
   diagnosed with bipolar depression in Iran (Mousavi et al., 2021). Purposive sampling was
   employed in order to come up with a representative sample. Twelve individuals were selected,
   having been diagnosed using the DSM-V criteria. The family members of these twelve
   individuals were then recruited for the study. The data collection process began with obtaining
   informed consent (Mousavi et al., 2021). The next step was the carrying out of in-depth
   interviews with the family members of the patients that were identified. The interviews were
   conducted in a hospital hall. Each interview was conducted separately, with only the interviewer
   and the interviewee taking part in the interview process. In carrying out each interview
   separately, the researchers ensured the independence and accuracy of the data collected. The
   interviewees would not be swayed by the responses of other people. Each interviewee was
   expected to be independent.
   Every interview took approximately twenty minutes and was recorded using digital
   devices. The interviewers were conducted by experts. The interviewers did not have prior

knowledge of the interviewees. The interview questions were, however, provided by the authors
of the study (Mousavi et al., 2021). Data analysis involved a thematic analysis. Interviews were
first transcribed, and then analysis was done. Field notes that were also taken in the interview
process were also used in the interview process. The main issue of trustworthiness relates to the
subjectivity of the research process. Since the study is qualitative, there is a high level of
subjectivity in the interpretation of the study results (Mousavi et al., 2021). The strengths of the
research include the fact that it explored pertinent issues relating to bipolar depression and the
fact that it ensured that researchers get firsthand information given by family members of bipolar
patients.
The second article is titled Efficacy and Safety of Transcranial Direct Current
Stimulation as an Add-on Treatment for Bipolar Depression A Randomized Clinical Trial. The
study is a phenomenological study (Sampaio-Junior et al., 2018). It centers on the firsthand
experiences of patients receiving treatment for bipolar depression. The population was the
general population of patients with bipolar depression. Patients with low suicide risk were
selected for the study. The study also selected patients who did not exhibit any response after one
treatment. Patients with depressive episodes were excluded from the study. Patients were placed
in comfortable settings where they received the treatment (Sampaio-Junior et al., 2018). No
instructions were given to the patients as they received the treatment. Patients were allowed to
read and use digital devices such as smartphones during the process of receiving the treatment.
However, patients were not expected to fall asleep, and interaction with staff was reduced to a
minimum.
Cathodes were placed in the left legs of the patients. Twelve 2-ma sessions were
administered each day to the patients. Stimulation was delivered to the patients, and interviews

were conducted on the process of the administration of the rays. Patients were also assessed with
any adverse impact documented. Changes in depression were analyzed, and this was done using
the eMontgomery-Åsberg Depression Rating Scale and Clinical Global Impression (CGI).
Treatment of bipolar depression is one of the issues that has not been explored holistically
(Sampaio-Junior et al., 2018). As a result, one of the main strengths of the present study is the
fact that it analyzed the efficacy of one of the treatment modes. In addition, the current study was
also effective because it helped center on the experience of the patients with bipolar disorder
(Sampaio-Junior et al., 2018). One problem is the fact that it excluded patients with various
depressive symptoms, and thus it ignored a critical population of bipolar patients. Ensuring that
all patient’s experiences are well captured could have gone a long way in improving the study.

References

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved
challenge. International journal of bipolar disorders, 8(1), 1-13.
Butryn, T., Bryant, L., Marchionni, C., & Sholevar, F. (2018). The shortage of psychiatrists and
other mental health providers: causes, current state, and potential solutions. International
Journal of Academic Medicine, 3(1), 5.
McIntyre, R. S., & Calabrese, J. R. (2019). Bipolar depression: the clinical characteristics and
unmet needs of a complex disorder. Current medical research and opinion, 35(11), 1993-
2005.
Mousavi, N., Norozpour, M., Taherifar, Z., Naserbakht, M., & Shabani, A. (2021). Bipolar I
disorder: a qualitative study of the viewpoints of the family members of patients on the
nature of the disorder and pharmacological treatment non-adherence. BMC
psychiatry, 21(1), 1-11.
Ösby, U., Westman, J., Hällgren, J., & Gissler, M. (2018). Mortality trends in cardiovascular
causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987–2010. The
European Journal of Public Health, 26(5), 867-871.
Rolin, D., Whelan, J., & Montano, C. B. (2020). Is it depression or is it bipolar
depression?. Journal of the American Association of Nurse Practitioners, 32(10), 703-
713.
Sampaio-Junior, B., Tortella, G., Borrione, L., Moffa, A. H., Machado-Vieira, R., Cretaz, E., …
& Brunoni, A. R. (2018). Efficacy and safety of transcranial direct current stimulation as

an add-on treatment for bipolar depression: a randomized clinical trial. JAMA
psychiatry, 75(2), 158-166.
Vieta, E., Salagre, E., Grande, I., Carvalho, A. F., Fernandes, B. S., Berk, M., … & Suppes, T.
(2019). Early intervention in bipolar disorder. American Journal of Psychiatry, 175(5),
411-426.