The Relationship Between Dyadic Adjustment, Internalized Stigma, Psychological Inflexibility, and Playfulness in Bipolar Disorder: A Mediation Model

BACKGROUND AND OBJECTIVES: The study investigates the influence of patients' levels of psychological inflexibility, internalized stigma, and couple playfulness on their dyadic adjustment and proposes a novel model elucidating the interrelationships among these factors. METHODS: The study included 99 patients diagnosed with bipolar disorder who were in remission and receiving follow-up care. The interviewer filled out the Socio-demographic Data Form, Hamilton Depression Scale, and Young Mania Rating Scale. Afterward, the participants filled out the Revised Dyadic Adjustment Scale (RDAS), Internalized Stigma of Mental Illness Scale (ISMI), Acceptance and Action Questionnaire-II (AAQ-II), and Play Questionnaire II (PQ-II). RESULTS: The data from a total of 99 married participants diagnosed with bipolar disorder, including 41 men and 58 women, were examined in our study. Psychological inflexibility, internalized stigma, couple playfulness, and dyadic adjustment were all significantly correlated. Mediation analysis revealed that internalized stigma indirectly predicted dyadic adjustment negatively and that couple playfulness played a mediating role in this relationship. CONCLUSION: The hypothesis that couple playfulness mediates the effect of internalized stigma on dyadic adjustment was substantiated. However, psychological inflexibility did not mediate this relationship. These findings may inform the assessment of factors influencing dyadic adjustment in patients with bipolar disorder and the development of interventions to enhance it.