Culturally adapted psychoeducation for African and Caribbean persons with bipolar disorder in the UK: A feasibility study

Research question: Is Culturally adapted Psychoeducation (CaPE) feasible and acceptable for African/Caribbean persons living with bipolar disorder in the UK? Background: Bipolar disorder constitutes major public health risk characterised by severe mood and cognitive fluctuations. Approximately 40% of bipolar patients do not receive mental healthcare within a year of their diagnosis. People with bipolar disorder have higher suicide rates and a life expectancy of 10-20 years shorter than the general population. In the UK, Bipolar disorder has an economic burden of £6.4 billion annually. Black people are 173 times more likely than their White counterparts to receive a diagnosis of bipolar disorder. Bipolar disorder is under-researched, particularly within African/Caribbean communities. This research focuses on African/Caribbean individuals who self-identify as Black British, Black African, Caribbean, or of mixed African or Caribbean heritage. Aims and Objectives: This study aims to investigate the feasibility and acceptability of CaPE for African/Caribbean persons living with bipolar disorder. Methods: We will recruit 64 persons of African/Caribbean descent with bipolar disorder. Participants will be randomly assigned to two groups: one group will receive the CaPE intervention with NHS Treatment As Usual (TAU), while the other will receive only NHS TAU. CaPE is manualised with twelve sessions (60 minutes each) covering bipolar disorder, cultural beliefs, stigma, medications, side effects, recurrence factors, and management strategies while promoting a productive lifestyle and healthy practices. Trained therapists will deliver the intervention remotely, supervised by psychiatrists/clinical psychologists. Participants will complete questionnaires before the intervention, at its conclusion, and three months later. Timeline for Delivery: 24 months. Patient and Public Involvement (PPI): We reviewed the CaPE draft manual and study protocol in the October 2024 and March 2025 PPI events. A co-investigator has lived experience of bipolar disorder. The research team collaborates with third-sector organisations like the Bipolar UK and Ethnic Forum. We have established a PPI team called Research Advisory Group (RAG), which will meet bi-monthly to assess project progress and suggest improvements. The RAG members have contributed to the study design and work packages (WPs). The project comprises four Work Packages (WPs): (WP1) Conduct participatory action research with 11 participants (n=3 persons with lived experience of bipolar disorder, n=3 family caregivers, n=3 members of the public, and n=2 therapists), also known as the RAG members to ensure CaPE s intervention relevance. (WP2) Assess the feasibility and acceptability of CaPE with 64 African/Caribbean persons living with bipolar disorder. (WP3) Integrate PPI and Theory of Change activities at each project stage. Anticipated Impact and Dissemination: Our project aligns with the NIHR s 2022-2027 strategy to promote equality, diversity, and inclusion through inclusive research and healthcare. Our project anticipates addressing disparities affecting African/Caribbean persons living with bipolar disorders as per the Race Relations and Mental Health Acts. (WP4) We will share findings with stakeholders through workshops and academic journals. We will create awareness on platforms like YouTube and Facebook using easy-to-understand animated videos. If CaPE proves feasible for African/Caribbean persons living with bipolar disorder in the UK, it will further be tested for clinical and cost-effectiveness.