The bidirectional impact of perceived and enacted support on mood in bipolar outpatients: A two-year prospective study

Bipolar disorder (BD) is a chronic illness, and a great need has been expressed to elucidate factors affecting the course of the disease. Social support is one of the psychosocial factors that is assumed to play an important role in the course of BD, but it is largely unknown whether the depressive and/or manic symptoms also affect the patients' support system. Further, the perception of one's social support appears to have stronger effects on disease outcomes than one's enacted or received support, but whether this also applies to BD has not been investigated. The objective of this study is to examine temporal, bidirectional associations between mood states (depression and mania) and both enacted and perceived support in BD patients.The current study was conducted among 173 BD I and II outpatients, with overall light to mild mood symptoms. Severity of mood symptoms and social support (enacted as well as perceived) were assessed every 3 months, for 2 years (1146 data points). Multilevel regression analyses (linear mixed-models) showed that lower perceived support during 3 months was associated with subsequent higher levels of depressive, but not of manic symptoms in the following 3 months. Vice versa, depressive symptoms during 3 months were associated with less perceived support in the following 3 months. Further, manic symptoms during 3 months were associated with less enacted support in the subsequent 3 months.The current study suggests that perceived, but not enacted, support is consistently related to depressive symptoms in a bidirectional way, while mania is specifically associated with a subsequent loss of enacted support. Clinical implications of the current findings are discussed.