Biopsychosocial predictors of resilience in bipolar disorder during a global crisis

Introduction

Resilience represents a critical protective factor in mental health, particularly among individuals vulnerable to stress-related symptom exacerbation, such as those with bipolar disorder. Periods of crisis, including global public health emergencies, can amplify psychological distress and challenge adaptive coping capacities. Despite its clinical relevance, the biopsychosocial determinants of resilience in individuals with bipolar disorder remain insufficiently understood. A better understanding may inform targeted interventions aimed at improving clinical outcomes. This study therefore investigated biological, psychological, and social predictors of subjective resilience in individuals with bipolar disorder compared with healthy controls during a period of global crisis, using the COVID-19 pandemic as a naturalistic model.

Aims

The primary aim of this study was to identify biopsychosocial predictors of subjective resilience in individuals with bipolar disorder. A secondary aim was to compare these predictors with those observed in healthy controls.

Methods

Participants were recruited from the ongoing BIPLONG (Bipolar Disorder in the Long-Term Course) study at the Medical University of Graz. The final sample comprised 37 individuals, including 15 individuals with bipolar disorder and 22 healthy controls. Socio-demographic, clinical and behavioural variables, as well as subjective resilience, were assessed using an online survey incorporating both self-developed and standardised questionnaires. Cognitive performance was assessed using a comprehensive battery of neuropsychological tests. Genetic liability for resilience was estimated using polygenic risk scores derived from genome-wide data. Genotyping was performed using the Illumina Global Screening Array version 3, with laboratory processing conducted at Life and Brain GmbH, Bonn, Germany. Standard quality control procedures were applied prior to analysis. Polygenic risk score analyses were conducted using PRSice software. Statistical analyses included group comparisons using independent samples tests, correlation analyses to assess associations between resilience and biopsychosocial variables, and multiple linear regression models to identify independent predictors of subjective resilience within each group.

Results

Individuals with bipolar disorder demonstrated significantly lower subjective resilience and poorer cognitive performance compared with healthy controls. Within the patient group, subjective resilience was negatively associated with depressive symptom severity and smoking behaviour, and positively associated with medication adherence, engagement in relaxation techniques, and adaptive changes in daily routines during the pandemic. Multiple linear regression analysis revealed that frequent use of relaxation techniques significantly predicted higher resilience, whereas smoking significantly predicted lower resilience. Together, these behavioural variables accounted for 56% of the variance in subjective resilience. No significant predictors of resilience were identified in the healthy control group. Furthermore, genetic liability, as indexed by polygenic risk scores, and cognitive performance measures were not significantly associated with subjective resilience in either group.

Conclusions

These findings suggest that modifiable behavioural factors may play an important role in shaping subjective resilience in individuals with bipolar disorder during periods of crisis. Interventions targeting adaptive coping strategies, including relaxation techniques, as well as health-related behaviours such as smoking cessation, may represent promising approaches to enhance resilience in this population. However, given the modest sample size and cross-sectional design, the findings should be interpreted with caution.

References

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