Lived Experiences of Bipolar Disorder and Family Caregiving in Pakistan

Background: Bipolar disorder (BD) is associated with substantial disability and caregiver burden.In Pakistan, the prevalence is unusually high, and limited mental health services place families at the centre of care.Cultural and religious beliefs strongly shape how the illness is recognized, understood, and managed.This study explored how individuals living with BD and their caregivers understand and navigate the illness within this context. Methods:Semi-structured interviews were conducted with 12 adults diagnosed with BD (type I or II) and 12 caregivers recruited through a national registry.Open-ended questions explored illness understanding, caregiving challenges, cultural influences, and preferences for a family intervention.Interviews were conducted in Roman Urdu, audio-recorded, transcribed verbatim, and analysed using Braun and Clarke's reflexive thematic analysis.Purposive and snowball sampling were used to ensure diversity in gender, socioeconomic status, and place of residence.Results: Patients described blended biomedical and cultural explanations of BD, major disruptions caused by symptoms, barriers to treatment, stigma, and coping through routines and religious practices.Caregivers reported confusion at illness onset, substantial financial and emotional burden, inconsistent support, and the need to navigate both biomedical and spiritual care pathways.Both groups emphasized the need for accessible, family-inclusive intervention options.Conclusions: Experiences of BD in Pakistan are shaped by interconnected patient and caregiver perspectives, as well as by stigma, cultural explanatory models, and limited service availability.The findings support the development of culturally tailored, scalable, and faith-sensitive family interventions.