A Qualitative Study of Lived Experiences of Bipolar Disorder in the Malaysian Population : Understanding Resilience-Related Self-Regulation from the Perspective of Social Ecology in Malaysia

Leong, Foo Weng and Jones, Steven and Lobban, Fiona (2026) A Qualitative Study of Lived Experiences of Bipolar Disorder in the Malaysian Population : Understanding Resilience-Related Self-Regulation from the Perspective of Social Ecology in Malaysia. PhD thesis, Lancaster University.

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Abstract

Background Living with bipolar disorder or any severe mental illness can be challenging. Therefore, living well with bipolar disorder is essential to having a meaningful and purposeful life and, at the same time, better mental health. Living well with bipolar disorder requires an active involvement in the overall management of one's life. The person’s effort and ability to manage their life with bipolar disorder can be affected by many factors. This research aims to understand and explore the lived experiences of individuals with bipolar disorder in the context of their environment. Socio-ecological theory was used from a resilience perspective to understand how people’s lives and bipolar disorder were affected by and related to their environment. In other words, their involvement in and perceptions of their life and illness were explored from the ongoing interactions with their social environment. Aims This study aims to understand the lived experiences and to explore the causal explanations for the resilience-related self-regulation behaviour of individuals with bipolar disorder in the socioecological context in Malaysia. Methods This research was divided into two parts. The first part involved conducting a scoping review to determine the extent of the existing literature relevant to the self-regulation of bipolar disorder. The second part involved qualitative semi-structured interviews with individuals with bipolar disorder about their lived self-regulation experiences from the socio-ecology perspective. The interview data were analysed using a thematic approach congruent with the critical realist paradigm. Results The scoping review in this study showed that many factors from the socio-ecological layers were involved concerning self-regulation in bipolar disorder. Most factors came from the lower socio-ecological layers, particularly the individual and microsystem aspects. As for the qualitative study, five themes were generated that supported the development of two causal explanations for the participants’ self-regulation behaviour. The themes were (I) Well-being as a multidimensional experience shaped differential engagement across culturally influenced biopsychosocial-spiritual life domains, (II) Physical strategies shaped by interpersonal relationships within the surrounding environment, (III) Cognitive and emotional strategies used in response to stress, (IV) Personal hopes, desires, and spiritual or religious influences on wellbeing, and (V) The mixed implications of social media for well-being. The causal explanations were (i) An individual’s perception and responses to illness and well-being experiences are shaped by the culturally influenced values placed on the biopsychosocial-spiritual life domains, (ii) Individuals are dynamic and resourceful agents actively approaching life circumstances in many ways that are beneficial to them. Conclusion The overall findings in this study revealed that individuals with bipolar disorder are dynamic and capable of identifying and utilising the relevant resources around them, which are connected to biological, psychological, social, and spiritual factors, for their well-being. This observation suggested that the biopsychosocial-spiritual domains influence their resiliencerelated self-regulation behaviour in the context of their social ecology. The knowledge developed in this study may benefit future mental health development programmes that focus on improving self-regulation among individuals with bipolar disorder.