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Thesis Format



Doctor of Philosophy




Webster, Fiona


There is a paucity of literature concerning how youth living with bipolar disorder understand and experience spirituality. The management of bipolar disorder through psychosocial interventions such as spirituality is critical due to the chronic and complex nature of the illness and the fact that pharmacotherapy has not been found to fully restore mood and quality of life (Michalak et al., 2016; Miller et al., 2014; Sanchez-Moreno et al., 2009; Stroppa & Moreira-Almeida, 2013). Spirituality has been defined as being concerned with the ultimate questions in life; the meaning in life that a person gains in relation to something bigger than themselves (Huguelet et al., 2016; Mizuno et al., 2018). It is associated with improved physical and psychological well-being, lowered rates of depression, substance abuse, and suicide rates (Lowry, 2012; Stroppa & Moreira-Almeida, 2013). This is relevant as suicide is the second leading cause of death among Canadian youth between 15 and 34 years; and bipolar disorder has been found to have the highest rates of suicide compared to other psychiatric diagnoses (Miller & Black, 2020; Public Agency of Canada, 2023). The purpose of this study is to gain an understanding of how youth living with bipolar disorder describe their understanding of and experiences of spirituality to better support their mental health. Using photovoice methodology introduced by Caroline Wang and Mary Ann Burris (1994), seven youth in Ontario between 18 and 30 years living with bipolar disorder took photos of their understanding and experiences of spirituality. Photos were co-analyzed in individual interviews and five main themes were generated, spirituality as: connection, meaning in life, deciding who to be, changing with mood, and the work done to find balance. Through thematic analysis, value-added, and visual research analysis, and reflexivity, findings showed that youth are struggling with search for meaning in the face of mental illness, and photovoice is an important way to capture their experiences. Nursing implications are for a person-centered approach to spiritual development where metaphysical beliefs and values are identified, and youth are supported in psychological, emotional, and relational work to help transcend bipolar experiences and find stability in mood.

Summary for Lay Audience

Spirituality has been found to lessen depression rates, substance use rates, and suicide rates (Lowry, 2012; Stroppa & Moreira-Almeida, 2013); however, there isn’t a good understanding of how spirituality is experienced by young people in Canada. Youth living with a diagnosis of bipolar disorder die by suicide more than youth with other psychiatric diagnoses (Miller & Black, 2020). Because medication may not fully provide recovery from bipolar symptoms or quality of life, understanding the spiritual beliefs of youth could help health care providers and people living with bipolar disorder gain additional skills to cope with the illness. The purpose of this study, therefore, was to gain a better understanding of how spirituality is understood by youth living with bipolar disorder. Seven youth in Ontario between the ages of 18-30 with a bipolar disorder diagnosis took pictures of what spirituality meant to them. They answered three research questions while taking photos: What does spirituality mean to you? How do you experience spirituality every day?, and How does your mood relate to your spirituality? They then participated in interviews about their photos. Five themes were generated by the twenty-one photos, photo captions, and interview transcripts that were collected for data. Findings showed that youth experienced spirituality as: connection, meaning in life, deciding who to be, changing with mood, and the work done to find balance. Implications suggest that learning one’s beliefs and values, therapy, emotional work, and positive relationships with self, others, nature, and something bigger than oneself, can help young people better manage bipolar disorder and overcome its challenges.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.