SOCIODEMOGRAPHIC VARIABLES AS A PREDICTIVE FACTORS IN

DEVELOPMENT OF BIPOLAR DEPRESSION AMONG PATIENTS IN FMC OWO,

ONDO STATE

BY

BAMIDELE OREOLUWA OLUWATOMIWA

MATRIC NUMBER: AUO19AN2259

BEING A PROJECT SUBMITTED TO

DEPARTMENT OF NURSING SCIENCES, COLLEGE OF BASIC HEALTH

SCIENCES

ACHIEVERS UNIVERSITY, OWO, ONDO STATE

IN PARTIAL FULFILLMENT FOR THE REQUIREMENTS OF THE AWARD OF

“BACHELOR OF NURSING CERTIFICATE”

JUNE 2024

i
 DECLARATION

This is to declare that this research project titled “SOCIODEMOGRAPHIC VARIABLES AS A

PREDICTIVE FACTORS IN DEVELOPMENT OF BIPOLAR DEPRESSION AMONG

PATIENTS IN FMC OWO, ONDO STATE” carried out by BAMIDELE OREOLUWA

OLUWATOMIWA is solely the result of my work except where acknowledged as being derived

from other person (s) or resources.

Matric number: AUO19AN2259

Signature: ……………….……

Date: ………………………….

CERTIFICATION
ii
This is to certify that this project carried out by BAMIDELE OREOLUWA OLUWATOMIWA

with matric number AUO19AN2259 has been examined, certified, and approved for the award

of Bachelor of Nursing Science.

…………………. ………………..
DR. B.A AYENI DATE
RN, RPNON, BSc, BNSc, MSc, PhD
(Project Supervisor)

…………………. ……………….
DR O.O ABIODUN DATE
RN, RM, RPHN, BNSc, MSc, PhD
(Head of Department)

Signature …………….
Name: ………………... DATE …………….
(Chief Examiner)

ABSTRACT
iii
Bipolar disorder, a chronic and often debilitating mental health condition, is characterized by

significant mood swings, including manic and depressive episodes. Understanding the socio-

demographic factors influencing bipolar disorder is crucial for effective management and

treatment. This study investigated sociodemographic variables as a predictive factor in

development of bipolar depression among patients in FMC Owo, Ondo state. This study

involved a descriptive cross-sectional study which was carried out among 384 members in

Federal Medical Centre, Owo, Ondo state. A self-structured questionnaire was employed for this

study and data were gathered from consented respondents. The data collected were analyzed

statistically. The research questions were answered using descriptive statistics of frequency and

percentage. Findings from the study revealed significant proportion of respondents (46.9%) had

been diagnosed with bipolar disorder within the past five years. The prevalence of depressive

episodes was high, reported by 84.4% of respondents. Furthermore, 46.9% of respondents had a

family history of bipolar disorder, highlighting the genetic and environmental factors influencing

the disorder's manifestation. Approximately 46.9% of respondents acknowledged that socio-

demographic variables like age, gender, socioeconomic status, and cultural background could

influence the development of bipolar disorder. By examining these socio-demographic aspects,

we can better address the holistic needs of individuals with bipolar disorder and improve their

overall quality of life.

Wordcount: 211

Keywords: bipolar disorder, socio-demographic factors, predictive factors, depressive episodes,

family history

DEDICATION

iv
This research is dedicated to God Almighty and my parents.

ACKNOWLEDGEMENT

v
I gratefully acknowledge the contributions of all participants who generously shared their

experiences and insights for this study on bipolar disorder. Their cooperation and willingness to

participate were essential in advancing our understanding of the socio-demographic factors

influencing the development and management of this complex mental health condition. Also

extend our appreciation to the staff and administration of Federal Medical Centre, Owo, Ondo

State, for their support and facilitation throughout the research process. Their dedication to

patient care and research made this study possible and impactful. Additionally, I thank my

parents for the finance, my supervisor Dr B.A Ayeni and head of department, Dr. O.O Abiodun

for their valuable guidance and feedback. This research would not have been achievable without

the collective efforts of all involved.

TABLE OF CONTENTS

vi
Content Page

Title Page i

Declaration ii

Certification iii

Abstract iv

Dedication v

Acknowledgement vi

Table of Contents vii

List of Tables x

List of Figures xi

CHAPTER ONE

INTRODUCTION

Background to the Study 1

Statement of the Problem 4

Objectives of the Study 5

Research Questions 5

Research Hypothesis 6

Significance 6

vii
Scope of the Study 7

Operational Definition of Terms 7

CHAPTER TWO

LITERATURE REVIEW

Conceptual Review 9

Theoretical Review 16

Empirical Review 18

CHAPTER THREE

METHODOLOGY

Research Design 20

Research Settings 20

Target Population 21

Sample Size Determination 21

Sampling Technique 21

Instruments for Data Collection 22

Validity of the Research Instrument 22

Reliability of the Research Instrument 22

Method of Data Collection 23

viii
Method of Data Analysis 23

Ethical Consideration 23

CHAPTER FOUR

RESULTS

Presentation of Results 24

Answering Research Questions 34

CHAPTER FIVE

DISCUSSION OF FINDINGS

Discussion 36

Implications to Nursing 38

Limitations of Study 40

Summary 41

Conclusion 42

Recommendations 42

Suggestions for Further Studies 45

REFERENCES

QUESTIONNAIRE

ix
 LIST OF TABLES

4.1 Sociodemographic Characteristics of the Respondents 24

4.2 Respondents Level of Knowledge 26

4.3 Specific Socio-Demographic Factors as Predictive Indicators

for Bipolar Disorder 28

4.4 Impact of Socio-Demographic Variables on Bipolar Disorder 30

4.5 Implications of Socio-Demographic Factors on Treatment Outcomes 35

4.6 Socioeconomic status and the development of bipolar disorder among patients

in FMC, Owo, Ondo State

36

x
 LIST OF FIGURES

4.1 Summary of Respondents Knowledge 47

xi
xii
 CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Depressive disorder stands as a widespread and substantial cause of disability globally (WHO,

2020). Manifesting through persistent sadness, loss of interest or pleasure, feelings of guilt or

worthlessness, disturbed sleep or appetite, fatigue, and impaired concentration persisting for at

least two weeks), this condition poses significant challenges to individuals' well-being. If not

addressed promptly, depressive disorders have the potential to escalate to severe levels,

potentially culminating in suicidal ideation or attempts (World Health Organization, 2020). On

the contrary, bipolar disorder (BPD) is characterized by mood fluctuations, encompassing

depressive episodes alongside periods of abnormally elevated or irritable mood termed manic or

hypomanic episodes. Manic symptoms entail heightened energy, reduced need for sleep, racing

thoughts, distractibility, and participation in risky behaviors (National Institute of Mental Health,

2021).

The global prevalence of depressive disorders is alarming, affecting over 350 million individuals,

according to estimates from the World Health Organization (World Health Organization, 2020).

Depressive disorders, along with substance abuse and other mental illnesses, contribute to a

substantial burden of disease, accounting for more than 183.9 million disability-adjusted life

years (DALYs) worldwide (Vigo et al., 2020). In fact, depressive disorders alone are responsible

for more than 40.5% of this burden. Furthermore, depressive disorders are associated with

numerous adverse outcomes, including lower quality of life, increased comorbidity with other

medical conditions such as diabetes and arthritis, cognitive and emotional impairment, and

heightened mortality rates, primarily due to suicide (Friedrich, 2021). Similarly, bipolar disorder

1
imposes a considerable economic and social burden. It affects over 7% of individuals with

DALYs, contributing to unemployment, decreased productivity, and elevated mortality rates

(Vigo et al., 2020). The economic costs associated with the treatment and management of bipolar

disorder are substantial, exacerbating the burden on healthcare systems and society as a whole.

According to worldwide disease burden estimates, substance abuse and mental illness cause

more than 183.9 million disability-adjusted life years (DALY), with depressive disorders

accounting for more than 40.5%. It is one of the most important public health issues, associated

with a significantly lower quality of life and interaction with others, comorbidity with other

illnesses, cognitive and emotional impairment, and a high mortality (Fiedler, 2020). It's the

leading cause of suicide. Depressive disorders cause health problems such as suicide, diabetes,

arthritis, and substance abuse, as well as a fourfold increase in mortality rates when compared to

healthy people (Fiedler, 2020). The report on the global burden of disease connected to substance

addiction and mental disorders costs more than $ 183.9 million. More than 7% of DALY

sufferers have bipolar illness. In addition to the high cost of therapy, bipolar disorder increases

the risk of unemployment, decreased productivity, and mortality. Furthermore, bipolar disorder

has a considerable impact on risky sexual behavior, low quality of life, functional disability,

suicide, and interpersonal relationships (Obo et al. 2019). According to the social causation of

mental illness being poor in the economy or decline in daily income, and struggling to secure

food, household, and shelter will lead to depressive disorder (Smith and Mazure, 2021).

Bipolar disorder is a severe mental illness characterized by recurrent episodes of mania and

depression, affecting approximately 2.4% of the global population (Vos et al., 2020). It is

characterized by alternating periods of mania or hypomania and depression. It affects individuals

worldwide, with significant variations in prevalence and presentation across different socio-

2
demographic groups (Calkin et al., 2020). The prevalence and impact of bipolar disorder vary

across different socio-demographic groups. The age of onset of bipolar disorder is another

important consideration, with research indicating variability across age groups. While symptoms

often emerge in late adolescence or early adulthood, late-onset bipolar disorder has been

recognized as a distinct clinical entity, associated with unique socio-demographic characteristics

(Bourne et al., 2023). Additionally, socioeconomic status continues to be a significant predictor

of illness severity and treatment outcomes, with individuals from lower socioeconomic

backgrounds facing greater barriers to accessing mental health care services (Mwangi et al.,

2020). Socioeconomic status also plays a significant role in the manifestation and course of

bipolar disorder. Individuals from lower socioeconomic backgrounds may face barriers to

accessing mental health care, leading to delayed diagnosis and inadequate treatment (Bhugra et

al., 2020). Additionally, socioeconomic disparities can contribute to increased stress and reduced

social support, exacerbating the severity of bipolar disorder symptoms. Recent findings indicate

potential gender differences in the manifestation and course of the illness (Marengo et al., 2022).

For instance, women may experience more frequent depressive episodes, whereas men may

exhibit more severe manic symptoms (Smith et al., 2021). Ethnicity and cultural factors

influence the expression and management of bipolar disorder. Studies have shown variations in

symptom presentation, help-seeking behaviors, and treatment preferences among different ethnic

and cultural groups. Cultural beliefs and practices regarding mental illness may impact the

stigma associated with bipolar disorder and affect treatment adherence and outcomes (Adeponle

et al., 2019), Research has highlighted the need of cultural sensitivity in diagnosis and therapy,

since cultural beliefs and practices might influence help-seeking behaviors and treatment

adherence. (Talbott et al., 2023). Moreover, ethnic minority groups may experience disparities in

3
access to quality mental health care, contributing to poorer clinical outcomes (Johnson et al.,

2022). Despite progress in understanding the socio-demographic correlates of bipolar disease,

there is still a need for context-specific research, especially in disadvantaged areas like Ondo

State, Nigeria. Investigating the involvement of socio-demographic characteristics in the

development of bipolar disorder among patients at the Federal Medical Centre (FMC) in Owo is

critical for adapting therapies to this population's specific needs. Identifying predictive

characteristics related with bipolar disorder can help doctors improve early detection,

intervention, and treatment results in Ondo State.

1.2 Statement of Problem

Despite advancements in understanding bipolar disorder, there is a critical gap in research

regarding the influence of socio-demographic variables on the development of bipolar disorder

among patients in FMC, Owo, Ondo State, Nigeria. While studies worldwide have identified

socio-demographic factors as significant predictors of bipolar disorder (Smith et al., 2021;

Johnson et al., 2022), there is a scarcity of research specifically examining this relationship

within the local context of Ondo State. Furthermore, existing literature often lacks representation

from underserved regions, such as Owo, limiting the generalizability of findings to the local

population.

Understanding how socio-demographic variables such as age, gender, socioeconomic status, and

cultural background intersect with the development of bipolar disorder is crucial for tailoring

interventions to meet the unique needs of patients in FMC, Owo, Ondo State. Without this

understanding, healthcare providers may struggle to identify at-risk individuals, leading to delays

in diagnosis and suboptimal treatment outcomes. Additionally, the lack of localized research on

4
this topic hampers efforts to implement targeted public health initiatives aimed at reducing the

burden of bipolar disorder within the community.

Therefore, there is an urgent need for research focused on exploring the role of socio-

demographic variables as predictive factors in the development of bipolar disorder among

patients in FMC, Owo, Ondo State. By elucidating these relationships, this study aims to

contribute to the advancement of knowledge in the field of bipolar disorder and inform evidence-

based strategies for early detection, intervention, and support for affected individuals in the local

community.

1.3 Objectives of the Study

The main objective of the study is to identify socio demographic variables as predictive factors

in development of bipolar disorder among affected patients in FMC, Owo, Ondo State.

The specific objectives of the study are to:

1. To examine the level of knowledge on socio demographic variables as predictive factors

in development of bipolar disorder among affected patients in FMC, Owo, Ondo State.

2. To identify the specific socio-demographic factors that may serve as predictive indicators

for the onset and severity of bipolar disorder among affected patients in FMC, Owo,

Ondo State.

3. To explore the impact of socio-demographic variables on the clinical presentation and

course of bipolar disorder among affected patients in FMC, Owo, Ondo State.

4. To assess the implications of socio-demographic factors on treatment outcomes and

healthcare utilization patterns among affected patients in FMC, Owo, Ondo State.

1.4 Research Questions

5
 1. What is the level of knowledge on socio demographic variables as predictive factors in

development of bipolar disorder among affected patients in FMC, Owo, Ondo State?

2. Which specific socio-demographic factors are most strongly associated with the onset

and severity of bipolar disorder in affected patients in FMC, Owo, Ondo State?

3. In what ways do socio-demographic variables impact the clinical presentation and

trajectory of bipolar disorder among affected patients in FMC, Owo, Ondo State?

4. What are the implications of socio-demographic factors on treatment adherence,

healthcare utilization patterns, and outcomes for affected individuals diagnosed with

bipolar disorder in FMC, Owo, Ondo State?

1.5 Research Hypothesis

(H0): There is no significant relationship between socioeconomic status and the development of

bipolar disorder among patients in FMC, Owo, Ondo State.

1.6 Significance of the Study

To Patients:

Patients diagnosed with bipolar disorder may benefit from personalized treatment approaches

that consider their socio-demographic characteristics. The study findings can empower patients

by highlighting the relevance of addressing socio-demographic factors in optimizing treatment

outcomes and promoting recovery. The study may encourage the development of targeted

support services and resources tailored to the needs of patients in the local community.

Understanding the role of socio-demographic factors in mental health can empower patients to

advocate for their needs and rights.

To Nurses:

6
The study will provide nurses with valuable insights into the socio-demographic factors that

influence the development of bipolar disorder among patients. This knowledge can aid nurses in

recognizing at-risk individuals, facilitating early detection, and providing appropriate

interventions.

By understanding how socio-demographic variables impact the clinical presentation and course

of bipolar disorder, nurses can tailor care plans to meet the specific needs of patients from

diverse backgrounds. This approach promotes patient-centered care and improves treatment

outcomes. The findings of this study can inform nurses about the importance of addressing

socio-demographic factors in providing holistic care and promoting mental health literacy within

the community.

To Community:

By shedding light on the socio-demographic factors associated with bipolar disorder, the study

can challenge stereotypes and reduce stigma surrounding mental illness within the community.

This can promote a more supportive and inclusive environment for individuals living with

bipolar disorder and their families. Engaging with the local community through research

initiatives fosters collaboration between healthcare providers, policymakers, and community

stakeholders. The study can raise awareness about the importance of addressing socio-

demographic factors in mental health promotion and encourage community-based interventions.

To Policy Makers:

The study findings can inform the development of evidence-based policies and guidelines aimed

at addressing socio-demographic disparities in mental health care delivery. This includes

strategies to improve access to services, reduce inequalities, and promote mental health literacy.

7
Policy makers can use the study results to prioritize resource allocation for mental health services

and support programs targeted at vulnerable populations. This ensures that resources are directed

towards areas with the greatest need, maximizing the impact of interventions.

1.7 Scope of the Study

The study is delimited to patients suffering from bipolar disorder in Federal Medical Centre in

the locality of Owo in Ondo State.

1.8 Operational Definition of Terms

Bipolar: "Bipolar" refers to a mood disorder characterized by alternating periods of depression

and mania or hypomania.

Bipolar Disorder: Bipolar disorder is a mental health condition characterized by episodes of

depression and mania or hypomania.

Depression: Depression refers to a mood disorder characterized by persistent feelings of

sadness, hopelessness, and loss of interest or pleasure in activities.

Nurses: Nurses are healthcare professionals employed at the Federal Medical Centre (FMC) in

Owo, Ondo State, who are responsible for providing care and support to patients diagnosed with

bipolar disorder.

Patients: Patients in this study are individuals diagnosed with bipolar disorder who are receiving

medical care and treatment specifically for bipolar disorder at the Federal Medical Centre (FMC)

in Owo, Ondo State.

Socio-demographic Variables: Socio-demographic variables refer to specific characteristics of

individuals or populations, including age, gender, socioeconomic status (income, education,

occupation), and cultural background (ethnicity, religion, language spoken), which are

8
hypothesized to influence the development and course of bipolar disorder among patients in

FMC, Owo, Ondo State.

CHAPTER TWO

LITERATURE REVIEW

2.1 Conceptual Review

Depression

Depression, also known as major depressive disorder, is a common and serious mental health

condition characterized by persistent feelings of sadness, hopelessness, and loss of interest or

pleasure in activities that were once enjoyed. It affects how a person thinks, feels, and handles

daily activities, and it can significantly impair their ability to function in various aspects of life.

Symptoms of depression can vary widely among individuals but often include:

1. Persistent Sadness: Feeling sad, empty, or hopeless most of the time.

2. Loss of Interest or Pleasure: Losing interest in activities or hobbies that were once

enjoyable.

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 3. Changes in Appetite or Weight: Significant changes in appetite, leading to weight loss or

gain.

4. Sleep Disturbances: Insomnia (difficulty falling asleep or staying asleep) or hypersomnia

(excessive sleepiness).

5. Fatigue or Loss of Energy: Feeling tired or having little energy, even after restful sleep.

6. Feelings of Worthlessness or Guilt: Persistent feelings of worthlessness, guilt, or self-

blame.

7. Difficulty Concentrating or Making Decisions: Trouble focusing, remembering details, or

making decisions.

8. Physical Symptoms: Unexplained physical ailments such as headaches, digestive issues,

or chronic pain.

9. Psychomotor Agitation or Retardation: Restlessness or slowed movement and speech.

10. Suicidal Thoughts or Behavior: Thoughts of death or suicide, suicide attempts, or self-

harming behaviors.

Depression can be caused by a combination of genetic, biological, environmental, and

psychological factors. Trauma, stress, abuse, major life changes, chronic illness, and certain

medications can also contribute to the development of depression. Additionally, individuals with

a family history of depression or other mental health disorders may be at a higher risk.

Treatment for depression often involves a combination of psychotherapy, medication, and

lifestyle changes. Psychotherapy, such as cognitive-behavioral therapy (CBT) or interpersonal

therapy (IPT), can help individuals explore their thoughts and emotions, develop coping

strategies, and improve interpersonal relationships. Antidepressant medications, such as selective

serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs),

10
may be prescribed to help regulate mood and alleviate symptoms. Lifestyle changes such as

regular exercise, healthy eating habits, stress management techniques, and social support are also

important components of depression treatment.

It's essential for individuals experiencing symptoms of depression to seek help from a mental

health professional. Depression is a treatable condition, and with the right support and treatment,

many people can recover and experience improved quality of life. Early intervention is key to

managing symptoms and preventing the onset of more severe complications.

Depression stands as a pervasive mental health disorder affecting individuals across diverse

socio-demographic backgrounds. It encompasses a range of symptoms, including persistent

sadness, loss of interest or pleasure, fatigue, and impaired concentration. Age plays a significant

role in the experience of depression. Research suggests that depression prevalence varies across

different age groups, with adolescents and young adults facing elevated rates of depressive

symptoms (Liang et al., 2022). Factors such as hormonal changes, academic stressors, and social

pressures contribute to the vulnerability of younger individuals to depression. Conversely, older

adults may contend with age-related stressors such as chronic illness, loss of loved ones, and

social isolation, which can also precipitate depressive episodes (Wang et al., 2020).

Gender differences in depression prevalence and symptomatology are well-documented. Women

tend to experience depression at higher rates compared to men, possibly due to biological,

psychological, and socio-cultural factors (Johnson et al., 2022). Societal expectations, gender

roles, and hormonal fluctuations may contribute to the increased vulnerability of women to

depression. Conversely, men may be less likely to seek help for depressive symptoms due to

societal norms emphasizing emotional stoicism and self-reliance (Smith et al., 2021).

11
Socioeconomic status significantly influences the risk of depression. Individuals from lower

socioeconomic backgrounds are more likely to experience financial strain, unemployment, and

limited access to healthcare, all of which contribute to the development and exacerbation of

depressive symptoms (Wang et al., 2020). Conversely, higher SES individuals may have greater

access to resources, social support networks, and coping mechanisms, reducing their risk of

depression (Liang et al., 2022).

Cultural background shapes individuals' understanding and expression of depressive symptoms.

Cultural beliefs, stigma surrounding mental illness, and cultural norms related to emotional

expression influence help-seeking behaviors and treatment preferences (Johnson et al., 2022).

Cultural factors also impact the manifestation of depressive symptoms, with some cultures

emphasizing somatic complaints or physical symptoms over psychological distress (Smith et al.,

2021).

Bipolar Disorder

Bipolar disorder is a complex and chronic mental health condition characterized by extreme

shifts in mood, energy, and activity levels. It affects approximately 2.8% of adults globally and is

associated with significant impairment in functioning and quality of life (Fraguas et al., 2020).

The exact cause of bipolar disorder remains elusive, but it is widely believed to result from a

combination of genetic, environmental, and neurobiological factors. Family studies have shown a

strong genetic predisposition, with certain genes implicated in the disorder's development.

Environmental triggers such as stressful life events, substance abuse, and disruptions in circadian

rhythms can also contribute to its onset or exacerbation. Neurobiological research suggests

abnormalities in neurotransmitter systems, particularly dopamine, serotonin, and norepinephrine,

as well as alterations in brain structure and function, particularly in regions involved in mood

12
regulation. Advances in neuroimaging techniques have provided insights into the neurobiology

of bipolar disorder. For example, functional magnetic resonance imaging (fMRI) studies have

revealed aberrant patterns of activity in brain regions implicated in emotion regulation, such as

the prefrontal cortex and amygdala (Benedetti et al., 2022). Additionally, research using positron

emission tomography (PET) has identified alterations in neurotransmitter systems, including

dopamine and serotonin, which may contribute to mood dysregulation in bipolar disorder (Hassel

et al., 2021).

Genome-wide association studies (GWAS) have identified numerous genetic variants associated

with bipolar disorder, highlighting its polygenic nature. Recent studies have also explored the

role of epigenetic mechanisms, such as DNA methylation and histone modification, in the

development and course of the disorder (Schulze et al., 2023). Furthermore, advances in genetic

sequencing technologies have enabled researchers to investigate rare genetic mutations that

confer susceptibility to bipolar disorder, offering new insights into its etiology (Saito et al.,

2024).

Bipolar disorder is characterized by two main mood episodes: manic and depressive. Manic

episodes are marked by elevated or irritable mood, increased energy, racing thoughts, decreased

need for sleep, impulsivity, and grandiosity. Depressive episodes involve persistent feelings of

sadness, hopelessness, fatigue, changes in appetite or sleep patterns, and thoughts of death or

suicide. Some individuals may also experience mixed episodes, which combine symptoms of

both mania and depression, presenting a unique challenge in diagnosis and treatment.

Diagnosing bipolar disorder can be challenging due to its varied presentation and overlap with

other psychiatric conditions. Clinicians rely on a comprehensive assessment, including a

thorough medical history, physical examination, and psychiatric evaluation. Standardized

13
diagnostic criteria, such as those outlined in the Diagnostic and Statistical Manual of Mental

Disorders (DSM-5), help guide the diagnostic process. Additionally, tools like mood charts and

rating scales can aid in tracking mood symptoms over time, facilitating accurate diagnosis and

monitoring of treatment response.

The management of bipolar disorder typically involves a combination of pharmacotherapy,

psychotherapy, and psychosocial interventions. Recent developments in pharmacological

treatments include the exploration of novel targets, such as glutamatergic and inflammatory

pathways, for the development of more effective medications with fewer side effects (Vieta et

al., 2020). Additionally, digital therapeutics, such as smartphone applications and web-based

programs, are being increasingly utilized to deliver evidence-based interventions for mood

stabilization and symptom management (Faurholt-Jepsen et al., 2023). Mood stabilizers, such as

lithium, anticonvulsants, and atypical antipsychotics, are commonly used to manage mood

episodes and prevent recurrence. Psychosocial interventions play a crucial role in the long-term

management of bipolar disorder, addressing factors such as medication adherence, stress

management, and lifestyle modification. Recent research has highlighted the efficacy of

interventions such as cognitive-behavioral therapy (CBT), interpersonal and social rhythm

therapy (IPSRT), and family-focused therapy (FFT) in reducing relapse rates and improving

psychosocial functioning (Miklowitz et al., 2022). Moreover, peer support programs and online

communities offer valuable sources of social support and encouragement for individuals living

with bipolar disorder (Barnes et al., 2021). Lifestyle modifications, such as maintaining a regular

sleep schedule, avoiding substance abuse, and engaging in regular exercise, can also support

mood stability and overall well-being.

Age as a Predictor of Bipolar Disorder:

14
Research indicates that age plays a significant role in the onset and progression of bipolar

disorder. Adolescents and young adults may experience the initial onset of bipolar disorder, with

symptoms often manifesting during late adolescence or early adulthood (Meyer et al., 2021).

Younger age at onset has been associated with more severe symptoms, increased risk of

comorbidities, and poorer treatment outcomes (Latalova et al., 2020). Conversely, older adults

may present with different clinical characteristics, such as more frequent depressive episodes and

greater medical comorbidities, highlighting the importance of age-specific interventions in

managing bipolar disorder (Sajatovic et al., 2023).

Gender Disparities in Bipolar Disorder:

Gender differences in the presentation and course of bipolar disorder are well-documented, with

women often experiencing more frequent and severe depressive episodes compared to men

(Khalifa et al., 2022). Hormonal fluctuations, psychosocial stressors, and gender-specific

treatment-seeking behaviors contribute to these disparities (Adeoye et al., 2020). Women may

also face additional challenges related to pregnancy, postpartum period, and hormonal

contraceptive use, which can exacerbate bipolar disorder symptoms (Khalifa et al., 2022).

Understanding gender-specific risk factors and treatment responses is essential for providing

targeted and effective care to individuals with bipolar disorder.

Socioeconomic Status and Bipolar Disorder Outcomes:

Socioeconomic status (SES) influences access to resources, healthcare services, and social

support networks, thereby shaping the course and outcomes of bipolar disorder. Individuals from

lower SES backgrounds may face barriers to accessing mental health treatment, leading to delays

in diagnosis, inadequate treatment adherence, and poorer clinical outcomes (Ogundipe et al.,

2023). Economic stressors, unemployment, and housing instability further exacerbate the burden

15
of bipolar disorder among marginalized populations (Ogundipe et al., 2023). Conversely, higher

SES individuals may have greater access to specialized care, psychotherapy, and supportive

services, facilitating improved symptom management and recovery (Adeoye et al., 2020).

Cultural Influences on Bipolar Disorder:

Cultural beliefs, values, and practices influence individuals' experiences of bipolar disorder and

shape help-seeking behaviors within the community. Cultural stigma surrounding mental illness,

spiritual beliefs about causation, and traditional healing practices impact treatment engagement

and adherence among patients in Owo, Ondo State (Meyer et al., 2021). Culturally sensitive

approaches that integrate traditional healing modalities, family involvement, and community

support networks are essential for enhancing treatment acceptability and efficacy in diverse

cultural contexts (Ogundipe et al., 2023).

2.2 Theoretical Review

The Roy Adaptation Model (RAM), developed by Sister Callista Roy, is a widely recognized

nursing theory that provides a framework for understanding individuals' adaptation to health and

illness challenges (Roy & Andrews, 1999). The model emphasizes the importance of assessing

individuals' adaptive responses and the factors influencing these responses, including the person,

environment, health, and nursing. Applying the RAM to the study on socio-demographic

variables as predictive factors in the development of bipolar disorder among patients in FMC,

Owo, Ondo State, offers valuable insights into how patients adapt to the challenges posed by

bipolar disorder within their socio-cultural context.

Application to the Study

Person Component:

16
In the Roy Adaptation Model, the person is the focal point of nursing care, and their adaptive

responses to health challenges are of primary interest. In the context of bipolar disorder, patients'

socio-demographic characteristics, such as age, gender, socioeconomic status, and cultural

background, influence their adaptation to the illness. For example, younger patients may face

unique challenges in coping with the stigma associated with mental illness, while individuals

from lower socioeconomic backgrounds may experience barriers to accessing healthcare

services. By examining how these socio-demographic variables impact patients' adaptive

responses to bipolar disorder, nurses can tailor interventions to address individual needs

effectively.

Environment Component:

The environment encompasses internal and external factors that influence individuals' adaptation

processes. Within the context of the study, the environment includes both the physical setting of

the Federal Medical Centre in Owo and the broader socio-cultural context of Ondo State,

Nigeria. Socio-demographic variables such as cultural beliefs, social support networks, and

access to healthcare resources shape patients' experiences of bipolar disorder and their ability to

adapt to the illness. Nurses play a crucial role in creating a supportive environment that

facilitates patients' adaptation by promoting culturally sensitive care, providing education and

resources, and advocating for patients' needs within the healthcare system.

Health Component:

The health component of the Roy Adaptation Model focuses on individuals' health status and

their adaptive responses to health challenges. Bipolar disorder significantly impacts patients'

physical, emotional, and social well-being, requiring ongoing adaptation to manage symptoms

and maintain overall health. By considering socio-demographic variables as predictive factors in

17
the development of bipolar disorder, nurses can assess patients' unique health needs and tailor

interventions to promote effective coping strategies and symptom management. Additionally,

understanding how socio-demographic factors influence the course of bipolar disorder can

inform preventive measures and early intervention strategies to mitigate adverse outcomes.

Nursing Component:

The nursing component of the Roy Adaptation Model emphasizes the role of nurses in

facilitating individuals' adaptation to health challenges. Nurses at FMC, Owo, Ondo State, are

integral to the care of patients with bipolar disorder, providing assessment, education, support,

and treatment interventions. By applying the principles of the Roy Adaptation Model, nurses can

assess patients' adaptive responses within the context of their socio-demographic characteristics,

identify factors contributing to maladaptation, and implement targeted interventions to promote

patients' well-being and enhance their adaptation to bipolar disorder.

2.3 Empirical Review

In a study conducted by Bete et al. (2024) on Depressive disorder, bipolar disorder, and

associated factors among adults, in the Eastern part of Ethiopia, the study aimed to assess the

prevalence of depressive and bipolar disorders among adults in Kersa, Haramaya, and Harar

Health and Demographic Surveillance Sites in Eastern Ethiopia. However, there was a paucity of

data on the prevalence of depressive disorder, and bipolar disorder in the study area. A

community-based cross-sectional study was conducted among 1,416 participants. A multi-stage

sampling was employed to select the participants. DSM-5 diagnostic criteria was used to assess

depressive disorder and bipolar disorder. Data was collected using a standard questionnaire. Data

were entered into Epi-Data 3.1 and analyzed using SPSS version 26. Both binary and

18
multivariate logistic regression analyses were done. Those with a p-value < 0.05 in the final

model were considered statistically significant. The results showed that the overall prevalence of

depressive and bipolar disorders among study participants was 6.7% (95% CI: 5.40, 8.20) and

2.1% (95% CI: (1.40, 3.00), respectively. The independent predictors of depressive disorder

included a family history of mental illness, chronic medical illnesses, unemployment, low

educational status, divorced or widowed, poor social support, and current alcohol use or khat

chewing. Single, males, divorced or widowed, and current consumers of alcohol were

independent predictors for bipolar disorder. The results of the investigation showed that bipolar

illness and depression were significant public health issues. It was shown that although bipolar

disorder is highly prevalent in the society, depression is a widespread concern. As a result, it is

imperative that the relevant body grow and enhance the provision of mental health services.

Furthermore, research on the effects and burdens of bipolar disorder in the community is

required.

In a study conducted by Jidong, et al. (2023) on bipolar disorders in Nigeria: a mixed-methods

study of patients, family caregivers, clinicians, and the community members’ perspectives. BDs

are historically under-researched compared to other mental health disorders, especially in Sub-

Saharan Africa and Nigeria. A mixed-methods design was adopted. Study 1 examined

the public knowledge of BDs in relation to sociodemographic outcomes using quantitative

data whilst Study 2 qualitatively assessed the lived experiences of patients with BDs, clinicians,

and family caregivers. In Study 1, a non-clinical sample of n = 575 participants responded to a

compact questionnaire that examined their knowledge of BDs and how they relate to certain

sociodemographic variables. One-way ANOVA was used to analyse quantitative data. Study 2

interviewed N = 15 participants (n = 5 patients with BDs; n = 7 clinicians; n = 3 family

19
caregivers). These semi-structured interviews were audio-recorded, transcribed, and thematically

analysed.

In Study 1, findings showed no statistically significant differences, suggesting low awareness of

BDs, especially among vulnerable populations such as young people and older adults. However,

there was a trajectory in increased knowledge of BDs among participants between the ages of

25–44 years and part-time workers compared to other ages and employment statuses. In Study 2,

qualitative findings showed that BDs are perceived to be genetically and psycho-socially induced

by specific lived experiences of patients and their family caregivers. Although psychotropic

medications and psychotherapy are available treatment options in Nigeria, cultural and religious

beliefs were significant barriers to treatment uptake. This study provides insight into knowledge

and beliefs about BDs, including the lived experiences of patients with BDs, their caregivers and

clinicians in Nigeria. It highlights the need for further studies assessing Nigeria's feasibility and

acceptability of culturally adapted psychosocial interventions for patients with BDs.

20
 CHAPTER THREE

METHODOLOGY

This chapter presents the methodology to be employed by the researcher during the course of the

study. Discussed in this chapter include: research design, research settings, target population,

sample size and sampling technique, instrument of data collection, validity and reliability of

research instrument, method of data collection, method of data analysis and ethical

considerations.

3.1 Research Design

This study adopted a descriptive cross-sectional study to be conducted in Federal Medical

Centre, Owo, Ondo state.

3.2 Research Settings

The study was carried out among patients suffering from bipolar disorder in Federal Medical

Centre Owo, Ondo state.

21
The Federal Medical Centre established in 1989, was formerly called General hospital, Owo, and

it was taken over by Federal government from Ondo state government. The hospital is located

geographically on coordinates 7.21746oN and 5.597658oE” along Adekunle Ajasin road. It has

300 beds with eleven wards and nineteen clinical departments as follows: Out Patient, Internal

Medicine, Orthopedic and Trauma, Obstetrics/Gynecology, Radiology, Psychiatry,

Physiotherapy, Ophthalmology, Dental Services, Community Health, Emergency Services,

Surgery, Anesthesia, Dietetics, Medical Records, ENT, Histopathology, Intensive Care Unit,

Pathology and Pediatrics. It also has an HIV antiretroviral therapy (HART) Centre and an

outpatient diabetic clinic.

3.3 Target Population

The target population for this study comprised of all bipolar depressed patients in Federal

Medical Centre Owo, Ondo state. However, this population could not be fully determined due to

irregular/absence of follow up care of out-patients.

3.4 Sample Size Determination

The sample size for the study was determined using Cochran formula (Cochran, 1977)
2
z × p ( 1− p )
n=
E2

Where,

n = required sample size

Z = Z-score corresponding to the desired confidence level (e.g., 1.96 for a 95% confidence level)

p = estimated proportion of the population with the attribute of interest

E = desired margin of error (expressed as a proportion)

n=¿ ¿

22
The sample size for the study was 384.

3.5 Sampling Technique

Simple random sampling was used in selecting the participants for this study.

 Inclusion Criteria

Bipolar patients (male and female) suffering from depression in Federal Medical Centre

Owo, Ondo state willing to participate in the study.

 Exclusion Criteria

Bipolar patients (male and female) suffering from depression in Federal Medical Centre

Owo, Ondo state not willing to participate in the study.

3.6 Instruments for Data Collection

The instrument for data collection is a structured questionnaire. The questionnaire was divided

into five (5) sections.

Section A collected sociodemographic information from the respondents using 12 items.

Section B examined the level of knowledge using a five-point Likert scale, comprising 8 items.

Section C identified the specific socio-demographic factors that may serve as predictive

indicators for the onset and severity of bipolar disorder among affected patients using a five-

point Likert scale, comprising 8 items.

Section D determined the impact of socio-demographic variables on the clinical presentation and

course of bipolar disorder among affected patients in FMC, Owo, Ondo State, using a five-point

Likert scale, comprising 8 items.

Section E assessed the implications of socio-demographic factors on treatment outcomes and

healthcare utilization patterns among affected patients in FMC, Owo, Ondo State using a five-

point Likert scale, comprising 8 items.

23
3.7 Validity of the Research Instrument

To ensure validity, face and content validity was adopted. This was achieved through

consultation with the supervisor and other experts in the field of nursing research for necessary

corrections and insight of the alignment of the variables, objectives, and conceptual framework

on which the study was based.

3.8 Reliability of the Research Instrument

Reliability of the research instrument was ascertained using test-retest method. A pilot study was

conducted among 10 nurses and repeated after 2-week interval using the same study population.

The responses from the first and second pre-test administration was analyzed using Pearson

Product Moment Correlation formula and a computed correlational value of 0.81 was gotten and

the research was considered reliable.

3.9 Method of Data Collection

Prior to data collection, permission was obtained from the Head of Clinical Services, Federal

Medical Centre, Owo. The purpose of the research was explained to all patients and their consent

was obtained. Primary data was used for the study using questionnaires to collect information

from the respondents. The questionnaires were distributed and collected by the researcher and 2

trained assistants. The questionnaires administered to the subjects were retrieved immediately,

and properly checked and any resulting data errors were corrected before data analysis.

3.10 Method of Data Analysis

Descriptive statistics including frequencies and percentages were used for data analysis.

Measurement of central tendency was done using mean. Data was presented using simple

frequency tables. The data was analyzed using IBM SPSS 23.

3.11 Ethical Consideration

24
Ethical approval was obtained from the Research Ethics Committee of the Federal Medical

Centre Owo, Ondo State. Written consent was obtained from the respondents before

administering the questionnaire. The study’s objectives were explained to the patients and

emphasized that the information obtained from the study was treated with utmost confidentiality.

There were no potential risks that caused any harm to the study subjects. The records was coded

to eliminate names and other personal identification of respondents throughout the study process

to ensure anonymity. Findings from the study were used strictly for research purposes.

CHAPTER FOUR

RESULTS

This chapter discusses the analyses and presentation of data.

4.1 Presentation of Results

Table 4.1. Sociodemographic Characteristics of the Respondents

Variable Frequency Percentage (%)

Age
18-30 120 31.3
31-45 150 39.1
46-60 90 23.4
60+ 24 6.3
Gender
Male 150 39.1
Female 234 60.9
Marital Status
Single 90 23.4
Married 240 62.5
Divorced 36 9.4
Widowed 18 4.7
Ethnicity
Yoruba 300 78.1

25
 Igbo 40 10.4
Hausa 20 5.2
Others 24 6.3
Religion
Christianity 280 72.9
Islam 80 20.8
Traditional 24 6.3
Educational Level
No formal education 10 2.6
Primary education 30 7.8
Secondary education 150 39.1
Tertiary education 194 50.5
Employment Status
Employed (full-time) 180 46.9
Employed (part-time) 36 9.4
Unemployed 108 28.1
Student 40 10.4
Retired 20 5.2
Monthly Household Income
Less than ₦50,000 60 15.6
₦50,001 - ₦100,000 120 31.3
₦100,001 - ₦200,000 144 37.5
Above ₦200,000 60 15.6
Place of Residence
Urban 280 72.9
Rural 104 27.1
Years since Diagnosis
1 to 5 180 46.9
6 to 10 120 31.3
Above 10 64 21.9
Depressive Episodes
Yes 324 84.4
No 60 15.6
Family Members with
Bipolar Disorder
Yes 180 46.9
No 204 53.1

Table 4.1 presents a detailed profile of the socio-demographic characteristics of respondents.

Age distribution among respondents shows a notable concentration in the 31-45 years category,

comprising 39.1% of the sample, followed closely by those aged 18-30 years at 31.3%. This

26
demographic skew towards younger and middle-aged adults aligns with clinical observations that

bipolar disorder often manifests in early adulthood and can persist through middle age.

Gender distribution indicates a higher representation of females, constituting 60.9% of

respondents compared to males at 39.1%. Marital status reveals that a significant majority of

respondents are married (62.5%), with smaller percentages identifying as single (23.4%),

divorced (9.4%), or widowed (4.7%). Ethnicity and religious affiliation highlight a predominant

Yoruba ethnic background (78.1%) and a majority practicing Christianity (72.9%). Educational

attainment among respondents shows a considerable proportion with tertiary education (50.5%)

and secondary education (39.1%). Educational level is often linked to socioeconomic status and

can influence access to healthcare resources, understanding of medical advice, and ability to

manage chronic conditions effectively.

Employment status indicates a diverse distribution, with 46.9% employed full-time, 28.1%

unemployed, and smaller percentages in part-time employment, student status, or retirement.

Employment status impacts financial stability, access to healthcare, and overall quality of life for

individuals managing bipolar disorder.

Analysis of monthly household income reveals that the majority (84.4%) fall within income

brackets of ₦50,001 to ₦200,000. Urban residence predominates (72.9%), potentially facilitating

better access to healthcare services compared to rural settings.

Years since diagnosis shows a significant proportion (46.9%) diagnosed within the past 5 years,

indicating a cohort early in their treatment journey. The high prevalence of depressive episodes

(84.4%) and family history of bipolar disorder (46.9%) highlights the genetic and environmental

factors influencing the disorder's manifestation and course.

Table 4.2: Level of Knowledge

27
 Variable Yes No
Do you believe that socio-demographic variables such as age, gender, 180 204
socioeconomic status, and cultural background can influence the (46.9%) (53.1%)
development of bipolar disorder among patients?
Have you received any information or education about the potential 120 264
impact of socio-demographic variables on the development of bipolar (31.3%) (68.8%)
disorder?
Do you think understanding socio-demographic factors is important for 160 224
effectively managing bipolar disorder among patients? (41.7%) (58.3%)
Do you believe that addressing socio-demographic factors can improve 140 244
outcomes for individuals with bipolar disorder? (36.5%) (63.5%)
Do you believe that age can be a predictive factor in the development 150 234
of bipolar disorder? (39.1%) (60.9%)
Do you think gender plays a role in the development of bipolar 120 264
disorder? (31.3%) (68.8%)
Are you aware of any cultural factors that may contribute to the 90 294
development of bipolar disorder? (23.4%) (76.6%)
Do you believe that socioeconomic status can impact the development 160 224
of bipolar disorder? (41.7%) (58.3%)

Approximately 46.9% of respondents acknowledge that socio-demographic variables like age,

gender, socioeconomic status, and cultural background can influence the development of bipolar

disorder. Only 31.3% of respondents report having received specific information or education

about how socio-demographic variables impact bipolar disorder. A notable 41.7% of respondents

believe that understanding socio-demographic factors is crucial for effectively managing bipolar

disorder.

Around 36.5% of respondents believe that addressing socio-demographic factors can positively

impact outcomes for individuals with bipolar disorder.

Regarding specific factors, such as age and gender, significant proportions of respondents

express beliefs in their relevance to bipolar disorder. For instance, 39.1% believe that age can be

a predictive factor, while 31.3% perceive gender as playing a role in the disorder's development.

However, awareness about cultural factors contributing to bipolar disorder is lower, with only

23.4% of respondents indicating awareness. Similarly, while 41.7% recognize the impact of

28
socioeconomic status, a significant proportion (58.3%) may not fully appreciate how economic

factors can intersect with mental health outcomes.

Figure 4.1: Summary of Respondents Knowledge

54%

52%

53%

50%

47%

48%

46%

44%

42%
Good Poor

Knowledge score

Figure 4.1 showed summary respondents’ knowledge of Health Risk Behaviors.

Cumulatively, majority 46.9% of the respondents demonstrated good knowledge while only 67.6

(53.1%) demonstrated poor knowledge on health risk behaviors.

Table 4.3: Specific Socio-Demographic Factors as Predictive Indicators for Bipolar

Disorder

Variable Agree Strongl Neutral Disagree Strongly

y Agree Disagree
Lack of social support contributes to 180 60 90 36 18

29
 the severity of bipolar disorder. (46.9%) (15.6%) (23.4%) (9.4%) (4.7%)
Financial instability is a significant 120 30 144 60 30
predictor for the onset of bipolar (31.3%) (7.8%) (37.5%) (15.6%) (7.8%)
disorder.
Relationship conflicts exacerbate the 200 40 100 30 14
symptoms of bipolar disorder. (52.1%) (10.4%) (26.0%) (7.8%) (3.6%)
Educational attainment influences the 150 60 120 42 12
management of bipolar disorder (39.1%) (15.6%) (31.3%) (10.9%) (3.1%)
symptoms.
Employment status affects the 160 50 110 50 14
likelihood of experiencing bipolar (41.7%) (13.0%) (28.6%) (13.0%) (3.6%)
disorder episodes.
Age plays a role in the severity of 180 70 90 36 8 (2.1%)
bipolar disorder symptoms. (46.9%) (18.2%) (23.4%) (9.4%)
Gender differences impact the 140 45 110 70 19
manifestation of bipolar disorder (36.5%) (11.7%) (28.6%) (18.2%) (4.9%)
symptoms.
Marital status influences the onset and 130 55 100 80 19
severity of bipolar disorder episodes. (33.9%) (14.3%) (26.0%) (20.8%) (4.9%)

A combined total of 62.5% of respondents believe that lack of social support contributes to the

severity of bipolar disorder. 23.4% of respondents were neutral on this statement, a minority of

respondents (14.1% combined) disagreed with the notion that lack of social support affects

bipolar disorder, indicating a smaller proportion with a contrary view.

About 39.1% of respondents see financial instability as a significant predictor for the onset of

bipolar disorder. A sizable portion of respondents (37.5%) were neutral, indicating uncertainty or

mixed opinions regarding the impact of financial instability. Together, 23.4% of respondents

disagreed with the statement.

A majority (62.5%) of respondents perceive that relationship conflicts exacerbate bipolar

disorder symptoms. 26.0% of respondents were neutral, suggesting mixed opinions. Only 11.4%

of respondents disagreed with the statement, indicating a minority with a contrary view.

A combined total of 54.7% of respondents believe that educational attainment influences the

management of bipolar disorder symptoms. 31.3% of respondents were neutral, 14.0% of

30
respondents disagreed with the statement. About 54.7% of respondents perceive that

employment status affects the likelihood of experiencing bipolar disorder episodes. 28.6% of

respondents were neutral, 16.6% of respondents disagreed with the statement. A combined total

of 65.1% of respondents believe that age plays a role in the severity of bipolar disorder

symptoms. 23.4% of respondents were neutral. Only, 11.5% of respondents disagreed with the

statement.

About 48.2% of respondents believe that gender differences impact the manifestation of bipolar

disorder symptoms. 28.6% of respondents were neutral, Together, 23.1% of respondents

disagreed with the statement.

A combined total of 48.2% of respondents feel that marital status influences the onset and

severity of bipolar disorder episodes. 26.0% of respondents were neutral, 25.7% of respondents

disagreed with the statement.

Table 4.4: Impact of Socio-Demographic Variables on Bipolar Disorder

Variable Agree Strongl Neutral Disagree Strongly

y Agree Disagree
I feel that my socio-economic status 150 60 90 54 30
influences the severity of my bipolar (39.1%) (15.6%) (23.4%) (14.1%) (7.8%)
disorder symptoms.
The level of social support I receive 200 50 80 40 14
significantly impacts my ability to (52.1%) (13.0%) (20.8%) (10.4%) (3.6%)
cope with bipolar disorder.
The cultural background I belong to 120 70 100 64 30
affects how I perceive and manage (31.3%) (18.2%) (26.0%) (16.7%) (7.8%)
bipolar disorder.
Access to healthcare facilities and 180 45 100 44 15
resources plays a crucial role in (46.9%) (11.7%) (26.0%) (11.5%) (3.9%)
managing my bipolar disorder.
Socio-demographic factors such as 160 55 95 60 14
age, gender, and marital status (41.7%) (14.3%) (24.7%) (15.6%) (3.6%)
influence the frequency of bipolar
disorder episodes I experience.
The level of education I have attained 140 65 110 54 15
affects my understanding of bipolar (36.5%) (16.9%) (28.6%) (14.1%) (3.9%)

31
 disorder and its management.
Employment status has an impact on 130 70 105 60 19
the severity and course of my bipolar (33.9%) (18.2%) (27.3%) (15.6%) (4.9%)
disorder symptoms.
Family dynamics and relationships 170 60 85 54 15
significantly contribute to the (44.3%) (15.6%) (22.1%) (14.1%) (3.9%)
management of my bipolar disorder.

Firstly, regarding socio-economic status, 39.1% of respondents agreed and 15.6% strongly

agreed that their socio-economic status impacts the severity of their bipolar disorder symptoms.

This indicates a substantial portion of respondents attributing their economic situation to

influencing their mental health challenges. Conversely, 23.4% were neutral, suggesting

uncertainty, while 21.9% disagreed or strongly disagreed with this influence.

Secondly, social support was widely recognized as impactful, with 52.1% agreeing and 13.0%

strongly agreeing that it significantly affects their ability to cope with bipolar disorder.

Conversely, 20.8% were neutral, and 17.6% disagreed or strongly disagreed with this notion.

Cultural background was considered influential by 31.3% and 18.2% who agreed or strongly

agreed, respectively, that it affects how they perceive and manage bipolar disorder. 26.0% were

neutral, and 24.5% disagreed or strongly disagreed with this belief.

Access to healthcare facilities was deemed crucial by 46.9% and 11.7% who agreed or strongly

agreed that it plays a critical role in managing their bipolar disorder. However, 26.0% were

neutral, and 19.3% disagreed or strongly disagreed with this perspective.

Socio-demographic factors such as age, gender, and marital status were perceived to influence

the frequency of bipolar disorder episodes by 41.7% and 14.3% who agreed or strongly agreed.

Meanwhile, 24.7% were neutral, and 19.2% disagreed or strongly disagreed.

32
Education level was seen as influential by 36.5% and 16.9% who agreed or strongly agreed that

it affects their understanding and management of bipolar disorder. Nevertheless, 28.6% were

neutral, and 21.9% disagreed or strongly disagreed.

Employment status was viewed as impactful by 33.9% and 18.2% who agreed or strongly agreed

that it affects the severity and course of their bipolar disorder symptoms. Still, 27.3% were

neutral, and 25.4% disagreed or strongly disagreed.

Family dynamics were acknowledged as significant contributors to managing bipolar disorder by

44.3% and 15.6% who agreed or strongly agreed. Conversely, 22.1% were neutral, and 21.9%

disagreed or strongly disagreed.

Table 4.5: Implications of Socio-Demographic Factors on Treatment Outcomes

Variable Agree Strongl Neutral Disagree Strongly

y Agree Disagree
Access to healthcare services in my 160 70 90 50 14
community is easy. (41.7%) (18.2%) (23.4%) (13.0%) (3.6%)
I have had delays in receiving 180 50 80 54 20
healthcare due to financial constraints. (46.9%) (13.0%) (20.8%) (14.1%) (5.2%)
My cultural background has influenced 140 60 100 64 20
my healthcare-seeking behavior. (36.5%) (15.6%) (26.0%) (16.7%) (5.2%)
I believe that people from different 110 80 120 54 20
socio-demographic backgrounds (28.6%) (20.8%) (31.3%) (14.1%) (5.2%)
receive equal quality of healthcare.
I trust healthcare providers to make 180 65 90 34 15
decisions in my best interest regardless (46.9%) (16.9%) (23.4%) (8.9%) (3.9%)
of my socio-demographic background.
I have experienced discrimination or 200 40 70 50 24
bias in healthcare settings based on my (52.1%) (10.4%) (18.2%) (13.0%) (6.3%)
socio-demographic background.
Employment status has an impact on 130 75 100 60 19
the severity and course of my bipolar (33.9%) (19.5%) (26.0%) (15.6%) (4.9%)
disorder symptoms.
Family dynamics and relationships 170 55 95 50 14
significantly contribute to the (44.3%) (14.3%) (24.7%) (13.0%) (3.6%)
management of my bipolar disorder.

33
Firstly, regarding access to healthcare services, 41.7% of respondents agreed, and 18.2%

strongly agreed that they find it easy to access healthcare in their community. However, a

significant proportion (23.4%) remained neutral, indicating a mixed perception of accessibility,

while 16.6% disagreed or strongly disagreed with ease of access.

Financial constraints emerged as a prevalent issue affecting healthcare, with 46.9% agreeing and

13.0% strongly agreeing that they have experienced delays in receiving healthcare due to

financial reasons. 20.8% were neutral, suggesting uncertainty or varying experiences, and 19.3%

disagreed or strongly disagreed.

Cultural background was acknowledged by 36.5% and 15.6% who agreed or strongly agreed,

respectively, that it influences their healthcare-seeking behavior. Nevertheless, a quarter of

respondents (26.0%) were neutral, while 21.9% disagreed or strongly disagreed with this

assertion, underscoring diverse attitudes towards cultural influences on healthcare choices.

Perceptions of healthcare equality across socio-demographic backgrounds varied significantly,

with only 28.6% agreeing and 20.8% strongly agreeing that different socio-demographic groups

receive equal quality healthcare. Meanwhile, 31.3% were neutral, and 19.3% disagreed or

strongly disagreed, reflecting skepticism or perceived disparities in healthcare quality.

Trust in healthcare providers irrespective of socio-demographic background was prevalent

among respondents, as 46.9% agreed and 16.9% strongly agreed that they trust healthcare

providers to make decisions in their best interest. Nonetheless, 23.4% were neutral, and 12.8%

disagreed or strongly disagreed with this trust.

A substantial majority (52.1%) agreed that they have experienced discrimination or bias in

healthcare settings based on their socio-demographic background, with only 10.4% strongly

34
agreeing. In contrast, 18.2% were neutral, and 19.3% disagreed or strongly disagreed,

highlighting significant concerns about equity in healthcare experiences.

Employment status was perceived to impact bipolar disorder symptoms by 33.9% agreeing and

19.5% strongly agreeing with this notion. However, a quarter of respondents (26.0%) were

neutral, and 20.5% disagreed or strongly disagreed, suggesting varying beliefs about the role of

employment in managing the disorder.

Finally, family dynamics were seen as significant contributors to bipolar disorder management

by 44.3% agreeing and 14.3% strongly agreeing. Yet, 24.7% were neutral, and 17.3% disagreed

or strongly disagreed, indicating mixed perceptions regarding the extent of family influence.

4.2 Test of Hypothesis

Hypothesis 1:

There is no significant relationship between socioeconomic status and the development of

bipolar disorder among patients in FMC, Owo, Ondo State.

Table 4.6: Socioeconomic status and the development of bipolar disorder among patients in

FMC, Owo, Ondo State.

Socioeconomic
Total Df X2 P-value
Status Yes No

Believes it Impacts 160 224 384

1 313.55 p< 0.001

Total 160 224 384

Since the chi-square value is very high, we reject the null hypothesis (H0) and conclude that

there is a significant relationship between socioeconomic status and the development of bipolar

disorder among patients in FMC, Owo, Ondo State.

35
4.3 Answering Research Questions

1. Level of knowledge on socio-demographic variables as predictive factors in bipolar

disorder development

According to Table 4.2, the level of knowledge among patients at FMC, Owo, Ondo State varies.

For instance, 46.9% believe that socio-demographic variables such as age, gender,

socioeconomic status, and cultural background can influence the development of bipolar

disorder. However, a substantial portion (53.1%) does not share this belief.

2. Specific socio-demographic factors associated with onset and severity of bipolar

disorder:

Table 4.3 provides insights into the perceived associations of various socio-demographic factors

with bipolar disorder. For instance, lack of social support (62.5% agree or strongly agree) and

relationship conflicts (62.5% agree or strongly agree) are strongly linked to exacerbating

symptoms. Additionally, employment status (54.7% agree or strongly agree) and age (65.1%

agree or strongly agree) are also considered influential. These findings suggest that social

support, relationship, employment status, and age play significant roles in the onset and severity

of bipolar disorder symptoms among patients at FMC, Owo.

3. Impact of socio-demographic variables on clinical presentation and trajectory of

bipolar disorder:

Table 4.3 further indicates that socio-demographic variables such as lack of social support,

financial instability, and relationship conflicts are perceived to exacerbate symptoms (e.g., 46.9%

agree or strongly agree for lack of social support). Educational attainment is believed to

influence symptom management (54.7% agree or strongly agree). These factors collectively

36
impact how bipolar disorder is presented clinically and its trajectory among patients in FMC,

Owo.

4. Implications of socio-demographic factors on treatment adherence, healthcare

utilization, and outcomes:

According to Table 4.5, perceptions regarding access to healthcare services vary, with 60.0%

facing delays due to financial constraints, while 89.0% disagree. Cultural background, such may

disparities perceptions regarding quality healthcare received. implications significant

socioeconomic status, statements experiences, know tackle challenge

CHAPTER FIVE

DISCUSSION OF FINDINGS

5.1 Discussion

37
Sociodemographic Characteristics

The study revealed a notable concentration of respondents in the 31-45 years (39.1%) and 18-30

years (31.3%) age categories. This distribution is consistent with clinical observations that

bipolar disorder often manifests in early adulthood (Jain & Mitra, 2023). Research by Solmi et

al. (2022) supports this finding, indicating a median age of onset for bipolar disorder around 25

years.

Gender distribution in this study showed a higher representation of females (60.9%) compared to

males (39.1%). This aligns with findings by Zhong et al. (2024), which reported a higher

prevalence of bipolar disorder in females.

The majority of respondents in this study were married (62.5%). This is consistent with findings

by Dou et al. (2022), who indicated that marital status impacts the social support available to

individuals with bipolar disorder, influencing their condition management. However, some

studies highlight higher rates of separation and divorce among individuals with bipolar disorder,

reflecting the stressors associated with the illness (Azorin et al. 2021).

A considerable proportion of respondents had tertiary education (50.5%) and secondary

education (39.1%). Higher educational attainment is linked to better management and outcomes

in bipolar disorder, as supported by Howe et al. (2023), due to increased access to information

and resources.

Most respondents fell within income brackets of ₦50,001 to ₦200,000. McMaughan et al.

(2020) link higher income levels to better access to healthcare and treatment adherence. Urban

residence predominates among respondents (72.9%), which typically facilitates better access to

healthcare services, as supported by Tessema et al. (2022). Rural residents often face barriers to

38
accessing mental health services, including fewer healthcare providers and longer travel

distances.

The high prevalence of depressive episodes (84.4%) and family history of bipolar disorder

(46.9%) found in this study aligns with genetic studies by Scott (2023), which support the

familial patterns in bipolar disorder.

Knowledge and Perceptions

Approximately 46.9% of respondents acknowledged the influence of socio-demographic

variables on bipolar disorder. Johnson and Weinberg (2022) support this finding, highlighting the

significant impact of socio-demographic factors on the course and management of bipolar

disorder. However, awareness levels vary, with some populations demonstrating lower

awareness and understanding of these influences.

Predictive Indicators and Perceived Impact

The study found that 62.5% of respondents believe lack of social support contributes to the

severity of bipolar disorder. Wang et al. (2021) emphasize the critical role of social support in

mitigating the impact of bipolar disorder. However, some individuals may underreport the

impact of social support due to stigma or cultural factors.

Financial instability (39.1%) and relationship conflicts (62.5%) were identified as significant

predictors of bipolar disorder severity. Guan et al. (2022) highlight financial stress and

interpersonal conflicts as major exacerbating factors for bipolar symptoms.

Implications on Treatment Outcomes

Access to healthcare was found to be easy by 41.7% of respondents, consistent with findings by

Wang et al. (2005) that access to healthcare is a significant determinant of treatment outcomes.

39
However, disparities in access remain a major issue, with some populations reporting significant

barriers.

Financial constraints (46.9%) and cultural influences (36.5%) were significant factors affecting

healthcare access. Financial barriers are a common theme in mental health research, as noted by

Pabayo et al. (2022). Cultural influences vary widely, with some studies indicating minimal

impact due to homogeneous study samples.

Mixed perceptions of healthcare equality and high trust in providers were observed. Trust in

healthcare providers is critical for adherence to treatment, supported by Duong et al. (2024).

However, perceived inequality in healthcare quality highlights ongoing issues in health

disparities.

5.2 Implications to Nursing

Nursing Practice

1. Personalized Care Plans:

The diverse socio-demographic factors identified in the study suggest the need for personalized

care plans. Nurses should consider age, gender, marital status, ethnicity, educational attainment,

employment status, and income levels when developing and implementing care plans for patients

with bipolar disorder. Tailored interventions can enhance treatment adherence and outcomes.

2. Enhanced Support Systems:

Given the significant impact of social support on the severity of bipolar disorder, nurses should

actively work to strengthen patients' support systems. This could involve coordinating with

social workers, family members, and community resources to ensure comprehensive support.

3. Focus on Socio-economic Factors:

40
Financial instability and employment status significantly affect the management of bipolar

disorder. Nurses should assess these factors during patient evaluations and provide appropriate

referrals to financial counseling services or employment support programs.

4. Cultural Competency:

With the predominant Yoruba ethnic background in the study, nurses should develop cultural

competence to better understand and address the specific needs and preferences of patients from

different ethnic backgrounds. This includes being aware of cultural stigmas and beliefs about

mental health that may influence patients' attitudes towards treatment.

Nursing Education

1. Curriculum Development:

Nursing curricula should include comprehensive training on the socio-demographic factors

affecting mental health, particularly bipolar disorder. This would equip nursing students with the

knowledge to understand and address these factors in their practice.

2. Cultural Sensitivity Training:

Incorporating cultural sensitivity training into nursing education is crucial. This training should

cover how cultural backgrounds influence health behaviors and treatment adherence, preparing

nurses to provide culturally appropriate care.

3. Interdisciplinary Learning:

Nursing education programs should encourage interdisciplinary learning, integrating insights

from sociology, psychology, and public health. This holistic approach can help future nurses

understand the multifaceted nature of mental health issues and the socio-demographic factors

that influence them.

4. Field Experience:

41
Clinical placements and field experiences should be diversified to include urban and rural

settings, exposing nursing students to the different challenges and resources available in these

environments. This will prepare them to address access disparities in various settings.

Nursing Research

1. Focus on Socio-Demographic Influences:

Further research is needed to explore the specific ways socio-demographic factors influence the

development and management of bipolar disorder. This includes longitudinal studies that track

these influences over time and their impact on treatment outcomes.

2. Intervention Studies:

Research should focus on developing and testing interventions that address the socio-economic

and cultural factors identified. For example, studies could investigate the effectiveness of

financial counseling or culturally tailored therapy programs for improving patient outcomes.

3. Community-Based Research:

Conducting community-based participatory research can help identify unique local needs and

resources, ensuring that interventions are relevant and effective for specific populations. This

approach also fosters collaboration between researchers and community members.

4. Policy-Oriented Research:

Research should also aim to inform policy changes that address the socio-demographic barriers

to effective mental health care. This includes advocating for policies that improve access to

healthcare, enhance social support systems, and reduce financial barriers to treatment.

5.3 Limitations of Study

The limitations encountered in the course of this study were:

 Tight academic schedule

42
  Time

 Finance

5.4 Summary

This study investigated the influence of socio-demographic factors on the development and

management of bipolar disorder.. The study adopted a descriptive cross-sectional design. A

sample of 384 members were recruited to participate in the study using simple random sampling

technique. A self-structured questionnaire was used to collect data which was analyzed using

frequency and percentages and presented in tables and charts.

Findings from the study revealed significant proportion of respondents (46.9%) had been

diagnosed with bipolar disorder within the past five years. The prevalence of depressive episodes

was high, reported by 84.4% of respondents. Furthermore, 46.9% of respondents had a family

history of bipolar disorder, highlighting the genetic and environmental factors influencing the

disorder's manifestation. Approximately 46.9% of respondents acknowledged that socio-

demographic variables like age, gender, socioeconomic status, and cultural background could

influence the development of bipolar disorder.

5.5 Conclusion

The study conducted at the Federal Medical Centre (FMC) in Owo, Ondo State, shows the

significant influence of socio-demographic factors on the development and management of

bipolar disorder. Key findings reveal a demographic concentration of younger and middle-aged

adults, a higher representation of females, and a predominant Yoruba ethnic background,

reflecting specific regional characteristics. Educational attainment, employment status, financial

43
stability, and social support emerged as critical factors impacting the severity and management

of bipolar disorder.

These findings have important implications for nursing practice, education, and research. In

practice, nurses must develop personalized care plans that consider each patient’s unique socio-

demographic context, enhance support systems, address socio-economic challenges, and

cultivate cultural competence. Nursing education must evolve to include comprehensive training

on socio-demographic influences, cultural sensitivity, interdisciplinary learning, and diverse

clinical experiences. In research, there is a need for focused studies on the impact of socio-

demographic factors, intervention studies tailored to these influences, community-based

participatory research, and policy-oriented research to address systemic barriers.

By integrating these insights into practice, education, and research, the nursing profession can

improve the management and outcomes of bipolar disorder, ensuring more personalized,

effective, and equitable care for all patients.

5.6 Recommendations

Based on the findings from the study conducted at the Federal Medical Centre (FMC) in Owo,

Ondo State, the following recommendations are proposed for nursing practice, education, and

research:

Nursing Practice

1. Develop Personalized Care Plans:

Nurses should create individualized care plans that take into account the patient's age, gender,

marital status, ethnicity, educational attainment, employment status, and income levels.

Personalized interventions can improve treatment adherence and outcomes.

2. Strengthen Support Systems:

44
Nurses should actively work to enhance the social support networks of patients with bipolar

disorder. This involves coordinating with social workers, family members, and community

resources to provide comprehensive support.

3. Address Socio-Economic Challenges:

Nurses should assess patients' financial stability and employment status during evaluations and

provide referrals to financial counseling services or employment support programs as needed.

4. Enhance Cultural Competence:

Nursing practitioners should undergo cultural competency training to better understand and

address the needs and preferences of patients from diverse ethnic backgrounds, particularly

focusing on the predominant Yoruba population in the study area.

Nursing Education

1. Integrate Socio-Demographic Training:

Nursing curricula should include comprehensive training on the socio-demographic factors that

affect mental health, particularly bipolar disorder. This will equip nursing students with the

knowledge to address these factors effectively in their practice.

2. Implement Cultural Sensitivity Training:

Incorporate cultural sensitivity training into nursing education to help future nurses understand

how cultural backgrounds influence health behaviors and treatment adherence, enabling them to

provide culturally appropriate care.

3. Promote Interdisciplinary Learning:

Encourage interdisciplinary learning in nursing education by integrating insights from sociology,

psychology, and public health to offer a holistic understanding of mental health issues and the

socio-demographic factors that influence them.

45
 4. Expand Field Experiences:

Provide diverse clinical placements and field experiences, including urban and rural settings, to

expose nursing students to different challenges and resources available in these environments,

preparing them to address access disparities effectively.

Nursing Research

1. Focus on Socio-Demographic Influences:

Conduct further research to explore the specific ways socio-demographic factors influence the

development and management of bipolar disorder. Longitudinal studies that track these

influences over time and their impact on treatment outcomes are particularly needed.

2. Develop and Test Interventions:

Research should focus on developing and testing interventions that address socio-economic and

cultural factors identified in the study. This includes investigating the effectiveness of financial

counseling, culturally tailored therapy programs, and other targeted interventions.

3. Engage in Community-Based Research:

Conduct community-based participatory research to identify unique local needs and resources,

ensuring that interventions are relevant and effective for specific populations. This approach

fosters collaboration between researchers and community members.

4. Inform Policy Changes:

Undertake policy-oriented research to inform changes that address socio-demographic barriers to

effective mental health care. This includes advocating for policies that improve access to

healthcare, enhance social support systems, and reduce financial barriers to treatment.

By implementing these recommendations, the nursing profession can improve the management

and outcomes of bipolar disorder, ensuring that care is more personalized, effective, and

46
equitable. This holistic approach acknowledges the complex interplay of socio-demographic

factors in mental health and aims to foster better-informed healthcare policies and practices.

5.7 Suggestions for Further Studies

1. Conduct longitudinal studies to track the long-term impact of socio-demographic factors

on the development and progression of bipolar disorder.

2. Investigate the role of educational attainment in mental health literacy and its impact on

the management of bipolar disorder.

47
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 APPENDIX I

INFORMED CONSENT

You are invited to participate in a research study. The purpose of this study is to investigate how

socio-demographic factors may influence the development of bipolar disorder among patients at

the Federal Medical Centre (FMC) in Owo, Ondo State.

If you agree to participate in this study, you will be asked to provide information about your

socio-demographic background and your experiences with bipolar disorder. Your participation

will involve completing a questionnaire.

There are minimal risks associated with participating in this study. Some questions in the

questionnaire may evoke emotional discomfort or distress, particularly if you have personal

experiences with bipolar disorder. However, you are free to skip any questions that you do not

wish to answer, and you may withdraw from the study at any time without penalty.

There are no direct benefits to you for participating in this study. However, your participation

will contribute to a better understanding of the factors influencing the development of bipolar

disorder, which may ultimately help in improving healthcare services and support for individuals

affected by this condition.

Your participation in this study will be kept strictly confidential.

I have read the above information and understand the purpose of the study, the procedures

involved, and my rights as a participant. By continuing with this questionnaire, I voluntarily

consent to participate in this research study.

Participant's Signature: ________________________ Date: _______________

53
 APPENDIX II

QUESTIONNAIRE

SECTION A: SOCIODEMOGRAPHIC DATA

1. Age: _______

2. Gender:

Male ( ) Female ( )

3. Marital Status:

Single ( ) Married ( ) Divorced ( ) Widowed ( )

4. Ethnicity

Yoruba ( ) Igbo ( ) Hausa ( ) Others ( )

5. Religion

Christianity ( ) Islam ( ) Traditional ( )

6. Educational Level:

No formal education ( ) Primary education ( )

Secondary education ( ) Tertiary education ( )

7. Employment Status:

Employed (full-time) ( ) Employed (part-time) ( ) Unemployed ( )

Student ( ) Retired ( )

8. Monthly Household Income:

Less than ₦50,000 ( ) ₦50,001 - ₦100,000 ( ) ₦100,001 - ₦200,000 ( )

Above ₦200,000 ( )

9. Place of Residence:

54
 Urban ( ) Rural ( )

10. How long ago were you diagnosed with bipolar disorder?

_______ years

11. Have you experienced any depressive episodes related to bipolar disorder?

Yes ( ) No ( )

12. Do you have any family members diagnosed with bipolar disorder or other mental

health conditions?

Yes ( ) No ( )

SECTION B: LEVEL OF KNOWLEDGE

Variable Yes No
13.Do you believe that socio-demographic variables such as age, gender,
socioeconomic status, and cultural background can influence the development of
bipolar disorder among patients?

14.Have you received any information or education about the potential impact of
socio-demographic variables on the development of bipolar disorder?

15.Do you think understanding socio-demographic factors is important for effectively

managing bipolar disorder among patients?

16.Do you believe that addressing socio-demographic factors can improve outcomes
for individuals with bipolar disorder?

17.Do you believe that age can be a predictive factor in the development of bipolar
disorder?

18.Do you think gender plays a role in the development of bipolar disorder?

19.Are you aware of any cultural factors that may contribute to the development of
bipolar disorder?

20.Do you believe that socioeconomic status can impact the development of bipolar
disorder?

55
SECTION C: SPECIFIC SOCIO-DEMOGRAPHIC FACTORS THAT MAY SERVE AS

PREDICTIVE INDICATORS FOR THE ONSET AND SEVERITY OF BIPOLAR

DISORDER

Variable Agre Strongly Neutral Disagree Strongly

e Agree Disagree
21. Lack of social support contributes to the
severity of bipolar disorder.
22. Financial instability is a significant predictor
for the onset of bipolar disorder.
23. Relationship conflicts exacerbate the
symptoms of bipolar disorder.
24. Educational attainment influences the
management of bipolar disorder symptoms.
25. Employment status affects the likelihood of
experiencing bipolar disorder episodes.
26. Age plays a role in the severity of bipolar
disorder symptoms.
27. Gender differences impact the manifestation of
bipolar disorder symptoms.
28. Marital status influences the onset and severity
of bipolar disorder episodes.

SECTION D: IMPACT OF SOCIO-DEMOGRAPHIC VARIABLES ON THE CLINICAL

PRESENTATION AND COURSE OF BIPOLAR DISORDER

Variable Agre Strongly Neutral Disagree Strongly

e Agree Disagree
29.I feel that my socio-economic status influences
the severity of my bipolar disorder symptoms.
30.The level of social support I receive
significantly impacts my ability to cope with
bipolar disorder.

56
31.The cultural background I belong to affects
how I perceive and manage bipolar disorder.

32.Access to healthcare facilities and resources

plays a crucial role in managing my bipolar
disorder.

33.Socio-demographic factors such as age, gender,

and marital status influence the frequency of
bipolar disorder episodes I experience.

34.The level of education I have attained affects

my understanding of bipolar disorder and its
management.
35.Employment status has an impact on the
severity and course of my bipolar disorder
symptoms.
36.Family dynamics and relationships
significantly contribute to the management of my
bipolar disorder.

SECTION E: IMPLICATIONS OF SOCIO-DEMOGRAPHIC FACTORS ON

TREATMENT OUTCOMES

Variable Agre Strongly Neutral Disagree Strongly

e Agree Disagree
37. Access to healthcare services in my
community is easy.

38. I have had delays in receiving healthcare due

to financial constraints.
39. My cultural background has influenced my
healthcare-seeking behavior.

40. I believe that people from different socio-

demographic backgrounds receive equal quality of
healthcare.

57
41. I trust healthcare providers to make decisions
in my best interest regardless of my socio-
demographic background.
42. I have experienced discrimination or bias in
healthcare settings based on my socio-
demographic background.
43. Employment status has an impact on the
severity and course of my bipolar disorder
symptoms.
44. Family dynamics and relationships
significantly contribute to the management of my
bipolar disorder.

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