1. Bipolar Disorder and Financial Difficulties: A Preliminary Study and Psychological Model.
Dr. Thomas Richardson
Principal Clinical Psychologist, Solent NHS Trust

2. Acknowledgements Co-Authors: Megan Jansen Chris Fitch
Dr. Lorraine Bell
Wendy Turton
Funded:
Research Capability Funding NIHR
Thanks to participants and all those who referred.
Solent Research department esp. Dr. Sarah Williams

3. ICD-10: Diagnostic Criteria
Mania:
“The individual may embark on extravagant and impractical schemes, spend money recklessly…”
Hypomania:
Possible: “appearance of interests in quite new ventures and activities, or mild over-spending.” 

4. Debt and Mental Health Richardson et al. (2013) meta-analysis:
Those with depression more than twice as likely to be in debt.
Richardson et al. (2015, 2016):
Vicious cycle between financial difficulties and eating disorder risk, alcohol problems and anxiety in students.

5. Previous Research: Bipolar
High risk for gambling (Jones et al., 2015).
Fletcher et al. (2013) Impulse spending when hypomanic in 70%
Poor financial management associated with impulsivity Cheema et al. (2015)
Caregivers report financial difficulties and impulsive spending a source of stress (Beentjes, et al. 2012)
Nothing on debt or impact on mental health

6. Qualitative Analysis
44 with Bipolar Disorder answered written questions
Six took part in focus group
Thematic analysis
Richardson, T., Jansen, M., Turton, W. & Bell, L. The Relationship Between Bipolar Disorder and Financial Difficulties: A Qualitative Examination of Patient’s Views. Clinical Psychology Forum, 295, 2-6.

7. Themes Themes Quotes 1. Overspending a. Impulse Shopping
b. Excessive Generosity
· “Impulsive purchases… will spend all that I have when I am manic or hypo-manic.”
· “I became high and gave away all my
savings to charity 4 years ago.”
2. Anxiety/Depression
a. Suicidality
· “The realisation of debt can trigger a
depressive bout.”
· “The very reason I tried to commit suicide 3 years ago.”
3. Regret/Guilt
· “Regret about overspending – “What made me buy these things!?”

8. Themes Themes Quotes 4. Poor Planning/Avoidant Coping
· “Prone to burying head in the sand,
ignoring demands for payments.”
5. Vicious Cycle
· “It’s a vicious cycle. I realise I’m spending and putting my family in financial stress and leads to larger depression. This is then leads to comfort spending again.”
6. Poor Employment
· “Affected work and the amount I earn. Had to take an £8000 pay cut to support positive mental health.”
7. Comfort Spending
· “During down periods, I essentially comfort spend.”

9. Themes: Timeline with Mood Changes
Diagram illustrate how these themes might map on to mood episodes of time.

10. Method: Participants
54 patients with Bipolar Disorder recruited from Community Mental Health Teams in Portsmouth
40 took part at a second time point 4 months later
One paper submitted and under review, one in preperation.

11. Method: Measures Finances:
Finances: debt, problems paying bills, perceived financial wellbeing
Compulsive shopping scale “There are times when I have a strong urge to buy.”
Mental Health:
Centre Epidemiological Studies Depression Scale
Altman Self-Rating Mania Scale
Perceived Stress Scale
GAD-7

12. Method: Measures Psychological Variables
Rosenberg Self-Esteem Scale: “I certainly feel useless at times”.”
Mindful Attention Awareness Scale: “It seems I am “running on automatic” without much awareness of what I’m doing”
Dysfunctional Attitude Scale 24 item: “If I try hard enough, I should be able to excel at anything I attempt”
Barratt Impulsivity Scale 15 item: “I act on the spur of the moment”

13. Method: Measures Psychological Variables
Brief Hypomanic Attitudes and Positive Predictions Inventory: “When I feel good, I know that whatever I do, I could do no wrong”
9 item subjective thought over activation questionnaire: “My thoughts never stop’”

14. Results Over Time
Poorer perceived financial wellness increased anxiety and stress over time (after controlling baseline symptoms).
How clients saw there finances more important than objective measures such as number loans

15. Results Over Time
Greater financial difficulties increased later thoughts around achievement, goal focus and hypomanic cognitions.
Greater impulsivity- greater later financial difficulties
Note in above baseline scores not controlled for.
Poorer perceived financial wellness lowered self-esteem over time

16. Compulsive Spending: Partial correlations over time
Higher Dependency on Others
Lower Mindfulness
r=-.46, p<.01
r=.28, p<.05
r=.42, p<.01
Depression
Greater
Compulsive Spending
r=.28, p<.01
Stress
r=.41, p<.01
r=.48, p<.01
r=.34, p<.05
r=-.45 p<.01.
Greater Achievement Focus
Anxiety

17. Poor perceived financial wellness
Hypomanic cognitions
Increased desire to achieve
Goal focus: solve financial problems
Financial
difficulties
Plan to make money
Compulsive spending
Avoid finances
Poor financial planning
Unstable employment, benefits
Hypomanic
symptoms
Impulsive
Desire for
comfort
Poor perceived financial wellness
Excessive generosity
Less mindful/
aware
Anxiety
Regret/guilt
Depression
Suicidality
Have to go without items e.g. clothes
Depend on others more: need approval
Low self-esteem

19. Conclusions
Finances affect mental health and vice versa in Bipolar: Vicious cycle.
Compulsive spending is key: might not be random: goal-focused possibly to try and make money.
Many psychological mechanisms.
Role for psychological therapies: CBT, Mindfulness.
Future research needed: Test model and develop interventions.

20. Questions to consider
Does this fit what you have seen with Bipolar clients?
Is there anything missing?
What does this mean in terms of intervention and prevention?