The associations between illness perceptions and social rhythm stability on mood symptoms among patients with bipolar disorder

Esther Ching Lan Lin, Marc Weintraub, David J. Miklowitz, Po See Chen, Shih Kai Lee, Hsin Chi Chen, Ru Band Lu

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: The association between illness perceptions and the effectiveness of patients’ illness-management strategies has been supported across a range of medical and psychiatric disorders. Few studies have examined these variables or their association in bipolar disorder (BD). This study examined the main and interactive associations between illness perceptions and one important illness management strategy - social rhythms stability on mood symptom severity in adults with BD. Methods: A cross-sectional study with 131 patients with BD in Taiwan was conducted using clinician- and patient-rated mood symptoms, self-reported illness perceptions, and a measure of daily and nightly social rhythms. Results: Illness perceptions were associated with mood symptom severity, but social rhythms were not. Unfavorable illness perceptions (e.g., beliefs of experiencing more BD symptoms, having stronger emotional responses to the illness) were associated with more severe mood symptoms. Favorable illness perceptions (e.g., beliefs of being able to understand and control the illness) were associated with less severe mood symptoms, with personal control as the strongest correlate of mood symptom severity. Finally, social rhythm stability moderated the relationship between unfavorable illness perceptions and clinician-rated manic symptoms. Limitations: The cross-sectional design limits our ability to make causal conclusions. Also, the effects pertain to patients in remission and may not generalize to more severely ill or hospitalized bipolar patients. Conclusions: This study indicates that in patients with BD, illness perceptions are associated with symptom severity. Interventions to enhance favorable IPs and reduce unfavorable IPs may improve mood outcomes, particularly when patients have adopted regular social rhythms.

Original languageEnglish
Pages (from-to)517-523
Number of pages7
JournalJournal of Affective Disorders
Publication statusPublished - 2020 Aug 1

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Psychiatry and Mental health


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