Observational Study
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World J Psychiatry. Jun 19, 2022; 12(6): 814-826
Published online Jun 19, 2022. doi: 10.5498/wjp.v12.i6.814
Composition of treatment alliance in bipolar disorder: A cross-sectional study of patients’ perspectives
Rajeet Kumar, Subho Chakrabarti, Abhishek Ghosh
Rajeet Kumar, Subho Chakrabarti, Abhishek Ghosh, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: All authors were involved in preparing the study protocol; Rajeet K carried out assessments; Subho C and Abhishek G contributed to the supervision; all authors were involved in data analysis and preparation of manuscripts; and all authors have approved the final version of the manuscript for submission.
Institutional review board statement: This study was reviewed & approved by the Institutional review Board (thesis & ethics committees) of the PGIMER, Chandigarh, India (Reference no. - letter from Convenor, IRB has been provided).
Informed consent statement: Written informed consent was sought from the participants before inclusion and other ethical safeguards were also followed throughout the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data of this study is available from the authors upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items. The checklist has been included.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Subho Chakrabarti, MD, Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. subhochd@yahoo.com
Received: July 13, 2021
Peer-review started: July 13, 2021
First decision: October 4, 2021
Revised: October 8, 2021
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: June 19, 2022
Processing time: 335 Days and 15.7 Hours
Abstract
BACKGROUND

Treatment alliance has an impact on several key patient outcomes in all psychiatric disorders, including bipolar disorder (BD). It has been suggested that the construct of treatment alliance is different among patients from routine psychiatric settings compared to psychotherapeutic settings. However, research on the composition of treatment alliance in psychiatric disorders, such as BD, is relatively limited.

AIM

To determine whether a broader construct of treatment alliance was prevalent among outpatients with BD.

METHODS

This is a cross-sectional study, conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (September 2018 to September 2019). A consecutive sample of 160 remitted adult outpatients with BD on mood stabilizers for at least a year were selected. The principal instrument to assess treatment alliance was the Working Alliance Inventory-client version (WAI-Client). Other potential constituents of the alliance explored were perceived trust in clinicians assessed by the Trust in Physicians (TRIP) scale, perceived support from clinicians assessed by the Psychosocial Care by Physicians (PCP) scale, and perceived treatment satisfaction assessed by the Patient Satisfaction Questionnaire (PSQ). Associations between scores on all scales were determined by correlational and multiple regression analyses. Exploratory factor analysis of combined items of all scales was conducted using a principal components analysis.

RESULTS

Scores on all the three WAI-Client subscales were significantly correlated with each other (r = 0.66-0.81; P < 0.0001). The total TRIP scores were associated with the total WAI-Client scores (r = 0.28; P < 0.01). The total TRIP scores and the total PCP scores were also significantly associated with the WAI-Client scores on the Task subscale (r = 0.28-0.29; P < 0.01). The total TRIP scores were significantly associated with the total PSQ scores (r = 0.45; P < 0.0001). Factor analysis yielded two independent and coherent factors, which explained 69% of the variance in data. Factor-1 (“alliance and support”), which explained about 41% of the variance, was comprised of a combined WAI-Client goal-task-bond component as well as the PCP support items. Factor-2 (“trust and satisfaction”), which explained about 28% of the variance, consisted of all the TRIP trust and the PSQ treatment satisfaction items.

CONCLUSION

A broader construct of treatment alliance in BD was found. Apart from collaborative components, this construct included patients’ perceptions regarding trust in clinicians, support from clinicians, and treatment satisfaction.

Keywords: Treatment alliance; Bipolar disorder; Composition; Factor-analysis

Core Tip: Research on the composition of treatment alliance in bipolar disorder (BD) is relatively limited. This study examined its composition in 160 remitted adult outpatients with BD using four different scales. Factor analysis yielded two independent factors explaining 69% of the variance. Factor-1 comprised of a combined Working Alliance Inventory goal-task-bond component and perceived clinicians’ support. Factor-2 consisted of items relating to the perceptions of trust in clinicians and satisfaction with treatment. This study suggested that in addition to collaborative components, treatment alliance among patients with BD also includes patients’ perceptions of clinicians’ trust, clinicians’ support, and treatment satisfaction.