Facing Life in Old Age: Exploring Resilience in Older Adults with Bipolar Disorder
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Participants
2.2. Assessments
2.2.1. Demographic and Clinical Assessment
2.2.2. Psychosocial Functioning
2.2.3. Cognitive Reserve (CR)
2.2.4. Assessment of Resilience
2.3. Statistical Analysis
3. Results
3.1. Sample Characteristics
3.2. Evaluation of Resilience
3.2.1. Correlations of Resilience with Clinical and Psychosocial Variables
3.2.2. Group Analysis of Resilience
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Carvalho, A.F.; Firth, J.; Vieta, E. Bipolar Disorder. N. Engl. J. Med. 2020, 383, 58–66. [Google Scholar] [CrossRef] [PubMed]
- McIntyre, R.S.; Calabrese, J.R. Bipolar Depression: The Clinical Characteristics and Unmet Needs of a Complex Disorder. Curr. Med. Res. Opin. 2019, 35, 1993–2005. [Google Scholar] [CrossRef] [PubMed]
- Brietzke, E.; Cerqueira, R.O.; Soares, C.N.; Kapczinski, F. Is Bipolar Disorder Associated with Premature Aging? Trends Psychiatry Psychother. 2019, 41, 315–317. [Google Scholar] [CrossRef] [PubMed]
- Sajatovic, M.; Strejilevich, S.A.; Gildengers, A.G.; Dols, A.; Al Jurdi, R.K.; Forester, B.P.; Kessing, L.V.; Beyer, J.; Manes, F.; Rej, S.; et al. A Report on Older-Age Bipolar Disorder from the International Society for Bipolar Disorders Task Force. Bipolar Disord. 2015, 17, 689–704. [Google Scholar] [CrossRef] [PubMed]
- Dols, A.; Sajatovic, M. What Is Really Different about Older Age Bipolar Disorder? Eur. Neuropsychopharmacol. 2024, 82, 3–5. [Google Scholar] [CrossRef] [PubMed]
- Vasudev, A.; Thomas, A. “Bipolar Disorder” in the Elderly: What’s in a Name? Maturitas 2010, 66, 231–235. [Google Scholar] [CrossRef] [PubMed]
- Lavin, P.; Rej, S.; Olagunju, A.T.; Teixeira, A.L.; Dols, A.; Alda, M.; Almeida, O.P.; Altinbas, K.; Balanzá-Martínez, V.; Barbosa, I.G.; et al. Essential Data Dimensions for Prospective International Data Collection in Older Age Bipolar Disorder (OABD): Recommendations from the GAGE-BD Group. Bipolar Disord. 2023, 25, 554–563. [Google Scholar] [CrossRef] [PubMed]
- Sajatovic, M.; Eyler, L.T.; Rej, S.; Almeida, O.P.; Blumberg, H.P.; Forester, B.P.; Forlenza, O.V.; Gildengers, A.; Mulsant, B.H.; Strejilevich, S.; et al. The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) Project: Understanding Older-Age Bipolar Disorder by Combining Multiple Datasets. Bipolar Disord. 2019, 21, 642–649. [Google Scholar] [CrossRef] [PubMed]
- Beunders, A.J.M.; Orhan, M.; Dols, A. Older Age Bipolar Disorder. Curr. Opin. Psychiatry 2023, 36, 397–404. [Google Scholar] [CrossRef] [PubMed]
- Sajatovic, M.; Rej, S.; Almeida, O.P.; Altinbas, K.; Balanzá-Martínez, V.; Barbosa, I.G.; Beunders, A.J.M.; Blumberg, H.P.; Briggs, F.B.S.; Dols, A.; et al. Bipolar Symptoms, Somatic Burden and Functioning in Older-Age Bipolar Disorder: A Replication Study from the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) Project. Int. J. Geriatr. Psychiatry 2024, 39, e6057. [Google Scholar] [CrossRef]
- Eyler, L.T.; Briggs, F.B.S.; Dols, A.; Rej, S.; Almeida, O.P.; Beunders, A.J.M.; Blumberg, H.P.; Forester, B.P.; Patrick, R.E.; Forlenza, O.V.; et al. Symptom Severity Mixity in Older-Age Bipolar Bisorder: Analyses From the Global Aging and Geriatric Experiments in Bipolar Disorder Database (GAGE-BD). Am. J. Geriatr. Psychiatry 2022, 30, 1096–1107. [Google Scholar] [CrossRef] [PubMed]
- Montejo, L.; Torrent, C.; Jiménez, E.; Martínez-Arán, A.; Blumberg, H.P.; Burdick, K.E.; Chen, P.; Dols, A.; Eyler, L.T.; Forester, B.P.; et al. Cognition in Older Adults with Bipolar Disorder: An ISBD Task Force Systematic Review and Meta-Analysis Based on a Comprehensive Neuropsychological Assessment. Bipolar Disord. 2022, 24, 115–136. [Google Scholar] [CrossRef] [PubMed]
- Orhan, M.; Huijser, J.; Korten, N.; Paans, N.; Regeer, E.; Sonnenberg, C.; van Oppen, P.; Stek, M.; Kupka, R.; Dols, A. The Influence of Social, Psychological, and Cognitive Factors on the Clinical Course in Older Patients with Bipolar Disorder. Int. J. Geriatr. Psychiatry 2021, 36, 342–348. [Google Scholar] [CrossRef] [PubMed]
- Velosa, J.; Delgado, A.; Finger, E.; Berk, M.; Kapczinski, F.; de Azevedo Cardoso, T. Risk of Dementia in Bipolar Disorder and the Interplay of Lithium: A Systematic Review and Meta-Analyses. Acta Psychiatr. Scand. 2020, 141, 510–521. [Google Scholar] [CrossRef] [PubMed]
- Dols, A.; Beekman, A. Older Age Bipolar Disorder. Clin. Geriatr. Med. 2020, 36, 281–296. [Google Scholar] [CrossRef] [PubMed]
- Subramaniam, H.; Dennis, M.S.; Byrne, E.J. The Role of Vascular Risk Factors in Late Onset Bipolar Disorder. Int. J. Geriatr. Psychiatry 2007, 22, 733–737. [Google Scholar] [CrossRef] [PubMed]
- Färber, F.; Rosendahl, J. Trait Resilience and Mental Health in Older Adults: A Meta-Analytic Review. Pers. Ment. Health 2020, 14, 361–375. [Google Scholar] [CrossRef] [PubMed]
- Laird, K.T.; Lavretsky, H.; Paholpak, P.; Vlasova, R.M.; Roman, M.; St Cyr, N.; Siddarth, P. Clinical Correlates of Resilience Factors in Geriatric Depression. Int. Psychogeriatr. 2019, 31, 193–202. [Google Scholar] [CrossRef] [PubMed]
- Verdolini, N.; Vieta, E. Resilience, Prevention and Positive Psychiatry. Acta Psychiatr. Scand. 2021, 143, 281–283. [Google Scholar] [CrossRef] [PubMed]
- Feldman, R. What Is Resilience: An Affiliative Neuroscience Approach. World Psychiatry 2020, 19, 132–150. [Google Scholar] [CrossRef] [PubMed]
- Chan, M.K.; Chew, Q.H.; Sim, K. Resilience in Bipolar Disorder and Interrelationships With Psychopathology, Clinical Features, Psychosocial Functioning, and Mediational Roles: A Systematic Review. J. Clin. Psychiatry 2023, 84, 45783. [Google Scholar] [CrossRef]
- Angeler, D.G.; Allen, C.R.; Persson, M.L. Resilience Concepts in Psychiatry Demonstrated with Bipolar Disorder. Int. J. Bipolar Disord. 2018, 6, 2. [Google Scholar] [CrossRef] [PubMed]
- Choi, J.W.; Cha, B.; Jang, J.; Park, C.S.; Kim, B.J.; Lee, C.S.; Lee, S.J. Resilience and Impulsivity in Euthymic Patients with Bipolar Disorder. J. Affect. Disord. 2015, 170, 172–177. [Google Scholar] [CrossRef]
- Şenormancı, G.; Güçlü, O.; Özben, İ.; Karakaya, F.N.; Şenormancı, Ö. Resilience and Insight in Euthymic Patients with Bipolar Disorder. J. Affect. Disord. 2020, 266, 402–412. [Google Scholar] [CrossRef] [PubMed]
- Echezarraga, A.; Calvete, E.; Orue, I.; Las Hayas, C. Resilience Moderates the Associations between Bipolar Disorder Mood Episodes and Mental Health. Clin. Health 2022, 33, 83–90. [Google Scholar] [CrossRef]
- Friedberg, A.; Malefakis, D. Resilience, Trauma, and Coping. Psychodyn. Psychiatry 2022, 50, 382–409. [Google Scholar] [CrossRef] [PubMed]
- Min, J.A.; Lee, C.U.; Chae, J.H. Resilience Moderates the Risk of Depression and Anxiety Symptoms on Suicidal Ideation in Patients with Depression and/or Anxiety Disorders. Compr. Psychiatry 2015, 56, 103–111. [Google Scholar] [CrossRef]
- Marulanda, S.; Addington, J. Resilience in Individuals at Clinical High Risk for Psychosis. Early Interv. Psychiatry 2016, 10, 212–219. [Google Scholar] [CrossRef] [PubMed]
- Johnson, J.; Gooding, P.A.; Wood, A.M.; Tarrier, N. Resilience as Positive Coping Appraisals: Testing the Schematic Appraisals Model of Suicide (SAMS). Behav. Res. Ther. 2010, 48, 179–186. [Google Scholar] [CrossRef] [PubMed]
- Chuang, S.P.; Wu, J.Y.W.; Wang, C.S. Resilience and Quality of Life in People with Mental Illness: A Systematic Review and Meta-Analysis. Neuropsychiatr. Dis. Treat. 2023, 19, 507–514. [Google Scholar] [CrossRef] [PubMed]
- Imran, A.; Tariq, S.; Kapczinski, F.; de Azevedo Cardoso, T. Psychological Resilience and Mood Disorders: A Systematic Review and Meta-Analysis. Trends Psychiatry Psychother. 2024, 46, e20220524. [Google Scholar] [CrossRef]
- Sajatovic, M.; Dols, A.; Rej, S.; Almeida, O.P.; Beunders, A.J.M.; Blumberg, H.P.; Briggs, F.B.S.; Forester, B.P.; Patrick, R.E.; Forlenza, O.V.; et al. Bipolar Symptoms, Somatic Burden, and Functioning in Older-Age Bipolar Disorder: Analyses from the Global Aging & Geriatric Experiments in Bipolar Disorder Database Project. Bipolar Disord. 2021, 24, 195–206. [Google Scholar] [CrossRef] [PubMed]
- First, M.B.; Spitzer, R.L.; Gibbon, M.; Williams, J.B.W. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I); Biometrics Research: New York, NY, USA, 1997. [Google Scholar]
- First, M.; Gibbon, M.; Spitzer, R.; Benjamin, L. Structured Clinical Interview for DSM-IV® Axis II Personality Disorders SCID-II.; American Psychiatric Association: Washington, DC, USA, 1997. [Google Scholar]
- Young, R.C.; Biggs, J.T.; Ziegler, V.E.; Meyer, D.A. A Rating Scale for Mania: Reliability, Validity and Sensitivity. Br. J. Psychiatry 1978, 133, 429–435. [Google Scholar] [CrossRef] [PubMed]
- Hamilton, M. A rating scale for depression. J. Neurol. Neurosurg. Psychiatry 1960, 23, 56. [Google Scholar] [CrossRef] [PubMed]
- Rosa, A.R.; Sánchez-Moreno, J.; Martínez-Aran, A.; Salamero, M.; Torrent, C.; Reinares, M.; Comes, M.; Colom, F.; Van Riel, W.; Ayuso-Mateos, J.L.; et al. Validity and Reliability of the Functioning Assessment Short Test (FAST) in Bipolar Disorder. Clin. Pract. Epidemiol. Ment. Health 2007, 3, 5. [Google Scholar] [CrossRef] [PubMed]
- Bonnín, C.M.; Martínez-Arán, A.; Reinares, M.; Valentí, M.; Solé, B.; Jiménez, E.; Montejo, L.; Vieta, E.; Rosa, A.R. Thresholds for Severity, Remission and Recovery Using the Functioning Assessment Short Test (FAST) in Bipolar Disorder. J. Affect. Disord. 2018, 240, 57–62. [Google Scholar] [CrossRef] [PubMed]
- Amoretti, S.; Cabrera, B.; Torrent, C.; Bonnín, C.D.M.; Mezquida, G.; Garriga, M.; Jiménez, E.; Martínez-Arán, A.; Solé, B.; Reinares, M.; et al. Cognitive Reserve Assessment Scale in Health (CRASH): Its Validity and Reliability. J. Clin. Med. 2019, 8, 586. [Google Scholar] [CrossRef]
- Campbell-Sills, L.; Stein, M.B. Psychometric Analysis and Refinement of the Connor–Davidson Resilience Scale (CD-RISC): Validation of a 10-Item Measure of Resilience. J. Trauma. Stress 2007, 20, 1019–1028. [Google Scholar] [CrossRef] [PubMed]
- Connor, K.M.; Davidson, J.R.T. Development of a New Resilience Scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress. Anxiety 2003, 18, 76–82. [Google Scholar] [CrossRef] [PubMed]
- Notario-Pacheco, B.; Solera-Martínez, M.; Serrano-Parra, M.D.; Bartolomé-Gutiérrez, R.; García-Campayo, J.; Martínez-Vizcaíno, V. Reliability and Validity of the Spanish Version of the 10-Item Connor-Davidson Resilience Scale (10-Item CD-RISC) in Young Adults. Health Qual Life Outcomes 2011, 9, 63. [Google Scholar] [CrossRef] [PubMed]
- Dolores Serrano-Parra, M.; Garrido-Abejar, M.; Notario-Pacheco, B.; Bartolomé-Gutiérrez, R.; Solera-Martínez, M.; Martínez-Vizcaíno, V. Validez de La Escala de Resiliencia de Connor-Davidson(10 Ítems) En Una Población de Mayores No Institucionalizados. Enferm. Clin. 2013, 23, 14–21. [Google Scholar] [CrossRef] [PubMed]
- Zhao, X.; Zhang, D.; Wu, M.; Yang, Y.; Xie, H.; Li, Y.; Jia, J.; Su, Y. Loneliness and Depression Symptoms among the Elderly in Nursing Homes: A Moderated Mediation Model of Resilience and Social Support. Psychiatry Res. 2018, 268, 143–151. [Google Scholar] [CrossRef] [PubMed]
- Han, M.H.; Nestler, E.J. Neural Substrates of Depression and Resilience. Neurotherapeutics 2017, 14, 677–686. [Google Scholar] [CrossRef] [PubMed]
- Denckla, C.A.; Cicchetti, D.; Kubzansky, L.D.; Seedat, S.; Teicher, M.H.; Williams, D.R.; Koenen, K.C. Psychological Resilience: An Update on Definitions, a Critical Appraisal, and Research Recommendations. Eur. J. Psychotraumatol. 2020, 11, 1822064. [Google Scholar] [CrossRef] [PubMed]
- Sánchez-Torres, A.M.; Amoretti, S.; Enguita-Germán, M.; Mezquida, G.; Moreno-Izco, L.; Panadero-Gómez, R.; Rementería, L.; Toll, A.; Rodriguez-Jimenez, R.; Roldán, A.; et al. Relapse, Cognitive Reserve, and Their Relationship with Cognition in First Episode Schizophrenia: A 3-Year Follow-up Study. Eur. Neuropsychopharmacol. 2023, 67, 53–65. [Google Scholar] [CrossRef]
- Stern, Y. Cognitive Reserve. Neuropsychologia 2009, 47, 2015–2028. [Google Scholar] [CrossRef] [PubMed]
- Amoretti, S.; Ramos-Quiroga, J.A. Cognitive Reserve in Mental Disorders. Eur. Neuropsychopharmacol. 2021, 49, 113–115. [Google Scholar] [CrossRef] [PubMed]
- Anaya, C.; Torrent, C.; Caballero, F.F.; Vieta, E.; Bonnin, C.D.M.; Ayuso-Mateos, J.L. CIBERSAM Functional Remediation Group Cognitive Reserve in Bipolar Disorder: Relation to Cognition, Psychosocial Functioning and Quality of Life. Acta Psychiatr. Scand. 2016, 133, 386–398. [Google Scholar] [CrossRef] [PubMed]
- Stern, Y.; Albert, M.; Barnes, C.A.; Cabeza, R.; Pascual-Leone, A.; Rapp, P.R. A Framework for Concepts of Reserve and Resilience in Aging. Neurobiol. Aging 2023, 124, 100–103. [Google Scholar] [CrossRef] [PubMed]
- Arnold, I.; Dehning, J.; Grunze, A.; Hausmann, A. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina 2021, 57, 587. [Google Scholar] [CrossRef] [PubMed]
- Lavin, P.; Buck, G.; Almeida, O.P.; Su, C.-L.; Eyler, L.T.; Dols, A.; Blumberg, H.P.; Forester, B.P.; Forlenza, O.V.; Gildengers, A.; et al. Clinical Correlates of Late-Onset versus Early-Onset Bipolar Disorder in a Global Sample of Older Adults. Int. J. Geriatr. Psychiatry 2022, 37. [Google Scholar] [CrossRef] [PubMed]
- De Prisco, M.; Vieta, E. The Never-Ending Problem: Sample Size Matters. Eur. Neuropsychopharmacol. 2024, 79, 17–18. [Google Scholar] [CrossRef] [PubMed]
- Ilzarbe, L.; Vieta, E. The Elephant in the Room: Medication as Confounder. Eur. Neuropsychopharmacol. 2023, 71, 6–8. [Google Scholar] [CrossRef] [PubMed]
Mean (SD) | Range [Min–Max] | |
---|---|---|
Age | 65.67 (6.55) | [54–79] |
Years of education | 15.21 (2.88) | [8–19] |
Number of psychiatric admissions | 1.61 (2.82) | [0–15] |
Total number of episodes | 16.40 (16.24) | [1–81] |
Number of manic episodes | 1.33 (2.25) | [0–11] |
Number of hypomanic episodes | 6.86 (8.97) | [0–41] |
Number of depressive episodes | 9.63 (9.73) | [2–40] |
Number of suicide attempts | 1.06 (1.47) | [0–5] |
Duration of illness (years) | 31.81 (14.69) | [2–53] |
Total YMRS | 1.17 (1.94) | [0–7] |
Total HDRS | 5.17 (3.07) | [0–11] |
Total FAST | 22.8 (12.12) | [2–42] |
Total CRASH | 44.23 (10.61) | [19.08–72.92] |
Frequency (%) | ||
Sex (female) | 19 (57.6) | |
Diagnosis | ||
BD-I | 19 (57.6) | |
BD-II | 11 (33.3) | |
Unspecified BD | 3 (9.1) | |
Type of onset (early onset) | 28 (84.8) | |
Type of first episode | ||
Depression | 27 (84.4) | |
Hypomania | 2 (6.3) | |
Mania | 3 (9.4) | |
Employment status | ||
Temporary sick leave | 4 (12.9) | |
Permanent sick leave | 12 (38.7) | |
Retired | 12 (38.7) | |
Active | 3 (9.7) | |
Family history of psychiatric disorders | 20 (62.5) | |
Suicidal ideation | 18 (58.1) | |
Suicide attempts | 9 (29.0) | |
Pharmacological treatment | ||
Mood stabilizers | 30 (93.8) | |
Antipsychotics | 21 (65.6) | |
Antidepressants | 14 (43.8) | |
Benzodiazepines | 10 (32.3) |
CD-RISC 10 | ||
---|---|---|
Spearman’s Correlation | p-Value | |
Age | −0.14 | 0.486 |
Years of education | 0.18 | 0.331 |
Number of psychiatric admissions | 0.07 | 0.721 |
Total number of episodes | −0.39 | 0.034 * |
Number of manic episodes | 0.07 | 0.721 |
Number of hypomanic episodes | −0.33 | 0.148 |
Number of depressive episodes | −0.62 | 0.001 * |
Number of suicide attempts | −0.16 | 0.532 |
Duration of illness (years) | −0.08 | 0.706 |
Total YMRS | −0.14 | 0.477 |
Total HDRS | −0.34 | 0.070 |
Total FAST | −0.61 | <0.001 * |
Total CRASH | 0.28 | 0.164 |
Mann-Whitney U test | p-value | |
Sex (female) | 113.50 | 0.477 |
Diagnosis | 90.50 | 0.546 |
Type of onset | 66.50 | 0.860 |
Family history of psychiatric disorders | 108.00 | 0.640 |
Suicidal ideation | 94.50 | 0.367 |
Suicide attempts | 86.50 | 0.586 |
Pharmacological treatment | ||
Mood stabilizers | 26.00 | 0.755 |
Antipsychotics | 110.00 | 0.827 |
Antidepressants | 111.00 | 0.568 |
Benzodiazepines | 88.50 | 0.485 |
Low Resilience M (SD) | Normal Resilience M (SD) | Mann–Whitney U Test | p-Value | ||
Age | 67.62 (6.95) | 63.82 (6.45) | 73.5 | 0.121 | |
Years of education | 14.77 (3.09) | 15.71 (6.45) | 89.0 | 0.362 | |
Number of psychiatric hospital admissions | 1.17 (1.40) | 2.06 (3.70) | 87.0 | 0.663 | |
Total number of episodes | 20.42 (21.76) | 15.53 (11.40) | 84.0 | 0.769 | |
Number of manic episodes | 1.00 (1.49) | 1.64 (2.82) | 58.5 | 0.462 | |
Number of hypomanic episodes | 9.86 (14.25) | 6.36 (4.95) | 38.0 | 0.964 | |
Number of depressive episodes | 14.36 (12.71) | 7.38 (5.49) | 48.0 | 0.169 | |
Number of suicide attempts | 0.83 (0.98) | 1.30 (1.77) | 27.5 | 0.771 | |
Duration of illness (years) | 29.55 (15.99) | 27.62 (10.48) | 49.0 | 0.192 | |
Total YMRS | 1.33 (2.19) | 1.29 (1.94) | 81.0 | 0.866 | |
Total HDRS | 5.92 (3.23) | 4.80 (2.93) | 69.5 | 0.315 | |
Total FAST | 27.54 (8.49) | 19 (13.47) | 58 | 0.044 * | |
Total CRASH | 39.63 (10.45) | 49.62 (9.66) | 33.5 | 0.026 * | |
Low Resilience N (%) | Normal Resilience N (%) | Chi-Squared Test | p-Value | ||
Sex (female) | 8 (61.5) | 10 (58.8) | 0.02 | 0.880 | |
Diagnosis | BD I | 6 (46.2) | 12 (70.6) | 3.53 | 0.171 |
BD II | 5 (38.5) | 5 (29.4) | |||
Unspecified BD | 2 (15.4) | 0 (0.0) | |||
Onset type (early onset) | 10 (76.9) | 17 (100.0) | 4.36 | 0.037 * | |
Type of first episode | Depression | 10 (76.9) | 14 (87.5) | 2.72 | 0.257 |
Hypomania | 2 (15.4) | 0 (0.0) | |||
Mania | 1 (7.7) | 2 (12.5) | |||
Employment status | Temporary sick leave | 2 (16.7) | 2 (12.5) | 2.57 | 0.462 |
Permanent sick leave | 5 (41.7) | 6 (37.5) | |||
Retired | 5 (41.7) | 5 (31.3) | |||
Active | 0 (0.0) | 3 (18.8) | |||
Family history of psychiatric disorders | 6 (50.0) | 13 (76.5) | 2.18 | 0.140 | |
Suicidal ideation | 8 (61.5) | 9 (60.0) | 0.01 | 0.934 | |
Suicide attempts | 4 (30.8) | 5 (33.3) | 0.02 | 0.885 | |
Mood stabilizers | 12 (92.3) | 15 (93.8) | 0.02 | 0.879 | |
Antipsychotics | 9 (69.2) | 10 (62.5) | 0.14 | 0.705 | |
Antidepressants | 6 (46.2) | 8 (50.0) | 0.04 | 0.837 | |
Benzodiazepines | 4 (30.8) | 5 (33.3) | 0.02 | 0.885 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Montejo, L.; Retuerto, M.; Solé, B.; Martín, S.; Ruiz, A.; Clougher, D.; Bort, M.; Sánchez-Moreno, J.; Martínez-Arán, A.; Vieta, E.; et al. Facing Life in Old Age: Exploring Resilience in Older Adults with Bipolar Disorder. J. Clin. Med. 2024, 13, 3942. https://doi.org/10.3390/jcm13133942
Montejo L, Retuerto M, Solé B, Martín S, Ruiz A, Clougher D, Bort M, Sánchez-Moreno J, Martínez-Arán A, Vieta E, et al. Facing Life in Old Age: Exploring Resilience in Older Adults with Bipolar Disorder. Journal of Clinical Medicine. 2024; 13(13):3942. https://doi.org/10.3390/jcm13133942
Chicago/Turabian StyleMontejo, Laura, Mònica Retuerto, Brisa Solé, Sara Martín, Andrea Ruiz, Derek Clougher, Marta Bort, Jose Sánchez-Moreno, Anabel Martínez-Arán, Eduard Vieta, and et al. 2024. "Facing Life in Old Age: Exploring Resilience in Older Adults with Bipolar Disorder" Journal of Clinical Medicine 13, no. 13: 3942. https://doi.org/10.3390/jcm13133942
APA StyleMontejo, L., Retuerto, M., Solé, B., Martín, S., Ruiz, A., Clougher, D., Bort, M., Sánchez-Moreno, J., Martínez-Arán, A., Vieta, E., & Torrent, C. (2024). Facing Life in Old Age: Exploring Resilience in Older Adults with Bipolar Disorder. Journal of Clinical Medicine, 13(13), 3942. https://doi.org/10.3390/jcm13133942