Understanding how people living with bipolar disorder talk about risk on social media

双相情感障碍患者可能会做出对自己或他人都有风险的行为[1,2]。这包括自杀和自残、过度消费、酗酒或吸毒以及危险的性行为日益普遍[3-8]。更多地了解这种行为是至关重要的，因为在正确的帮助下，双相情感障碍患者“有可能通过最佳治疗恢复正常功能”p 45（[9]）。目前双相情感障碍的心理模型将冒险行为解释为试图避免情绪低落，对情绪提升或冲动/奖励敏感的反应[1,10,11]。这些方法为心理干预的发展提供了信息，以改善应对情绪变化的策略。然而，这些方法的有效性参差不齐，在功能和恢复结果的改善方面缺乏证据，而定性研究表明这些改善是有价值的[12,13]。目前的研究依赖于对假设过程的问卷测量，这限制了对双相情感障碍患者主观体验的了解。例如，他们几乎没有告诉我们这些人是如何定义风险的，为什么他们选择从事一些这样的行为，以及这些行为在多大程度上是社会规范的。因此，很明显，需要一种混合方法来了解双相情感障碍风险的基础过程。这应该结合深入的定性方法和探索人们如何用自然语言描述他们的经历的方法，而不受典型研究或临床环境的限制。这对于那些可能被污名化的冒险行为尤其重要。服务用户越来越多

Individuals living with bipolar disorder are likely to engage in behaviours which can be risky forthemselves or others [1, 2]. This includes increased prevalence of suicide and self-harm, excessivespending, alcohol or drug use and risky sexual behaviour [3-8]. Understanding more about thisbehaviour is crucial as with the right help people living with bipolar "have the potential to returnto normal function with optimal treatment"p 45 ([9]).Current psychological models of bipolar explain risky behaviour as an attempt to avoid low mood,a response to mood elevation or to impulsivity/sensitivity to reward [1, 10, 11]. These approacheshave informed the development of psychological interventions to improve coping strategies formood change. However, the effectiveness of such approaches is mixed and evidence is lacking for improvements in the functional and recovery outcomes which qualitative research has shown arevalued [12, 13]. Current research has relied on questionnaire measures of hypothesisedprocesses, which limits what can be learnt about the subjective experiences of people living withbipolar. For instance, they tell us little about how such individuals define risk, why they chose toengage in some such behaviours and how socially normative such behaviour might be. It is cleartherefore, that a mixed method approach is needed to understand the processes which underpinrisk in bipolar. This should combine in-depth qualitative approaches with methods that explorehow people describe their experiences in natural language, not constrained by typical research orclinical settings. This is particularly important for risky behaviour that is likely to have beenstigmatised.Services users increasingly