Research paper Effective self-management strategies for bipolar disorder: A community-engaged Delphi Consensus Consultation study Erin E. Michalak a,n , Melinda J. Suto b , Steven J. Barnes c , Sharon Hou d , Sara Lapsley e , Mike W. Scott e , Greg Murray f , Jehannine Austin a , Nusha Balram Elliott a , Lesley Berk g,h , CREST.BD e,1 a Department of Psychiatry, University of British Columbia, Canada b Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada c Department of Psychology, University of British Columbia, Canada d Department of Psychology, University of Guelph, Canada e CREST.BD, Department of Psychiatry, University of British Columbia, Canada f Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia g School of Psychology, Faculty of Health, Deakin University, Geelong, Australia h Department of Psychiatry, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia article info Article history: Received 16 December 2015 Received in revised form 23 June 2016 Accepted 26 June 2016 Available online 11 July 2016 Keywords: Bipolar disorder Self-management Delphi Consensus Consultation Community-Based Participatory Research abstract Background: Self-management represents an important complement to psychosocial treatments for bipolar disorder (BD), but research is limited. Specifically, little is known about self-management approaches for elevated mood states; this study investigated self-management strategies for: (1) maintaining balance in mood, and (2) stopping progression into hypomania/mania. Methods: To identify the common components of BD self-management, Delphi Consensus Consultation methods were combined with a Community-Based Participatory Research (CBPR) approach across five study phases: (1) Qualitative dataset content analysis; (2) Academic/grey literature reviews; (3) Content analysis; (4) Two Delphi rounds (rating strategies on a 5-point Likert scale, Very Unhelpful-Very Helpful), and; (5) Quantitative analysis and interpretation. Participants were people with BD and healthcare providers. Results: Phases 1 and 2 identified 262 and 3940 candidate strategies, respectively; 3709 were discarded as duplicates/unintelligible. The remaining 493 were assessed via Delphi methods in Phase 4: 101 people with BD and 52 healthcare providers participated in Round 1; 83 of the BD panel (82%) and 43 of the healthcare provider panel (83%) participated in Round 2—exploratory factor analysis (EFA) was con- ducted on Round 2 results. Limitations: EFA was underpowered and sample was not ethnically diverse, limiting generalizability. Discussion: High concordance was observed in ratings of strategy effectiveness between the two panels. Future research could usefully investigate the provisional discovery here of underlying factors which link individual strategies. For example, ‘maintaining hope’ underpinned strategies for maintaining balance, and ‘decreasing use of stimulants’ underpinned strategies to interrupt hypo/manic ascent. There is merit in combining CBPR and Delphi methods. & 2016 Elsevier B.V. All rights reserved. 1. Introduction Many bipolar disorder (BD) publications begin with so-called ‘bipolar misery statistics’ (Lobban et al., 2012), speaking to the considerable disability and dysfunction associated with the con- dition. Indeed, most data in the field paint a bleak picture. Even optimal medication management fails to ward off mood episodes in many living with BD (Gitlin et al., 1995), a mood disorder fre- quently characterized by high rates of relapse and hospitalization Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders http://dx.doi.org/10.1016/j.jad.2016.06.057 0165-0327/& 2016 Elsevier B.V. All rights reserved. n Correspondence to: Division of Mood Disorders, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1. E-mail address: erin.michalak@ubc.ca (E.E. Michalak). 1 CREST.BD is a Canadian government (Canadian Institutes of Health Research) funded multidisciplinary network dedicated to advancing bipolar disorders research and knowledge exchange, particularly embracing Community-Based Par- ticipatory Research. Journal of Affective Disorders 206 (2016) 77–86