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

患有双相情感障碍的人可能会从事对自己或他人有风险的行为[1，2]。这包括自杀和自残、过度吸毒、酗酒或吸毒以及危险性行为的增加[3-8]。更多地了解这种行为是至关重要的，因为正确的治疗方法有助于患有双相情感的人“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学模型将危险行为解释为试图避免情绪低落、情绪高涨的反应或对冲动/奖励敏感的行为[1，10，11]。这些方法为心理干预的发展提供了信息，以改善情绪变化的应对策略。然而，这些方法的有效性好坏参半，缺乏定性研究表明有价值的功能和恢复结果改善的证据[12，13]。目前的研究依赖于对假设过程的问卷调查，这限制了人们对双相情感障碍患者主观体验的了解。例如，他们很少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，以及这样的行为可能具有多大的社会规范性。因此，很明显，需要一种混合方法来理解支撑双相情感障碍风险的过程。这应该将深入的定性方法与探索人们如何用自然语言描述他们的经历的方法结合起来，而不是受到典型研究或临床环境的限制。对于可能被污名化的危险行为，这一点尤其重要。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