AustralieFrV1, Pmc, Corpus, bibRecord, 000D37

Online information seeking by patients with bipolar disorder: results from an international multisite survey

Identifieur interne : 000D37 ( Pmc/Corpus ); précédent : 000D36; suivant : 000D38

Online information seeking by patients with bipolar disorder: results from an international multisite survey

Auteurs : Jörn Conell ; Rita Bauer ; Tasha Glenn ; Martin Alda ; Raffaella Ardau ; Bernhard T. Baune ; Michael Berk ; Yuly Bersudsky ; Amy Bilderbeck ; Alberto Bocchetta ; Letizia Bossini ; Angela Marianne Paredes Castro ; Eric Yat Wo Cheung ; Caterina Chillotti ; Sabine Choppin ; Maria Del Zompo ; Rodrigo Dias ; Seetal Dodd ; Anne Duffy ; Bruno Etain ; Andrea Fagiolini ; Julie Garnham ; John Geddes ; Jonas Gildebro ; Ana Gonzalez-Pinto ; Guy M. Goodwin ; Paul Grof ; Hirohiko Harima ; Stefanie Hassel ; Chantal Henry ; Diego Hidalgo-Mazzei ; Vaisnvy Kapur ; Girish Kunigiri ; Beny Lafer ; Chun Lam ; Erik Roj Larsen ; Ute Lewitzka ; Rasmus Licht ; Anne Hvenegaard Lund ; Blazej Misiak ; Patryk Piotrowski ; Scott Monteith ; Rodrigo Munoz ; Takako Nakanotani ; René E. Nielsen ; Claire O Onovan ; Yasushi Okamura ; Yamima Osher ; Andreas Reif ; Philipp Ritter ; Janusz K. Rybakowski ; Kemal Sagduyu ; Brett Sawchuk ; Elon Schwartz ; Ângela Miranda Scippa ; Claire Slaney ; Ahmad Hatim Sulaiman ; Kirsi Suominen ; Aleksandra Suwalska ; Peter Tam ; Yoshitaka Tatebayashi ; Leonardo Tondo ; Eduard Vieta ; Maj Vinberg ; Biju Viswanath ; Julia Volkert ; Mark Zetin ; I Aki Zorrilla ; Peter C. Whybrow ; Michael Bauer

Source :

International Journal of Bipolar Disorders [ 2194-7511 ] ; 2016.

RBID : PMC:4995194

Abstract

Background

Information seeking is an important coping mechanism for dealing with chronic illness. Despite a growing number of mental health websites, there is little understanding of how patients with bipolar disorder use the Internet to seek information.

Methods

A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries as a convenience sample between March 2014 and January 2016. All patients had a diagnosis of bipolar disorder from a psychiatrist. Data were analyzed using descriptive statistics and generalized estimating equations to account for correlated data.

Results

976 (81 % of 1212 valid responses) of the patients used the Internet, and of these 750 (77 %) looked for information on bipolar disorder. When looking online for information, 89 % used a computer rather than a smartphone, and 79 % started with a general search engine. The primary reasons for searching were drug side effects (51 %), to learn anonymously (43 %), and for help coping (39 %). About 1/3 rated their search skills as expert, and 2/3 as basic or intermediate. 59 % preferred a website on mental illness and 33 % preferred Wikipedia. Only 20 % read or participated in online support groups. Most patients (62 %) searched a couple times a year. Online information seeking helped about 2/3 to cope (41 % of the entire sample). About 2/3 did not discuss Internet findings with their doctor.

Conclusion

Online information seeking helps many patients to cope although alternative information sources remain important. Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand limitations of online privacy. More patient education about online information searching is needed and physicians should recommend a few high quality websites.

Electronic supplementary material

The online version of this article (doi:10.1186/s40345-016-0058-0) contains supplementary material, which is available to authorized users.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995194

DOI: 10.1186/s40345-016-0058-0
PubMed: 27552813
PubMed Central: 4995194

Links to Exploration step

PMC:4995194

Le document en format XML

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<author><name sortKey="Garnham, Julie" sort="Garnham, Julie" uniqKey="Garnham J" first="Julie" last="Garnham">Julie Garnham</name>
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Halifax, Nova Scotia Canada</nlm:aff>
</affiliation>
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<author><name sortKey="Geddes, John" sort="Geddes, John" uniqKey="Geddes J" first="John" last="Geddes">John Geddes</name>
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</affiliation>
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<author><name sortKey="Gildebro, Jonas" sort="Gildebro, Jonas" uniqKey="Gildebro J" first="Jonas" last="Gildebro">Jonas Gildebro</name>
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Aarhus, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Gonzalez Pinto, Ana" sort="Gonzalez Pinto, Ana" uniqKey="Gonzalez Pinto A" first="Ana" last="Gonzalez-Pinto">Ana Gonzalez-Pinto</name>
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Vitoria, Spain</nlm:aff>
</affiliation>
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<author><name sortKey="Goodwin, Guy M" sort="Goodwin, Guy M" uniqKey="Goodwin G" first="Guy M." last="Goodwin">Guy M. Goodwin</name>
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Warneford Hospital, Oxford, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Grof, Paul" sort="Grof, Paul" uniqKey="Grof P" first="Paul" last="Grof">Paul Grof</name>
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</affiliation>
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Ontario, Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Harima, Hirohiko" sort="Harima, Hirohiko" uniqKey="Harima H" first="Hirohiko" last="Harima">Hirohiko Harima</name>
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</affiliation>
</author>
<author><name sortKey="Hassel, Stefanie" sort="Hassel, Stefanie" uniqKey="Hassel S" first="Stefanie" last="Hassel">Stefanie Hassel</name>
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Birmingham, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Henry, Chantal" sort="Henry, Chantal" uniqKey="Henry C" first="Chantal" last="Henry">Chantal Henry</name>
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Créteil, France</nlm:aff>
</affiliation>
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<institution></institution>
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F-75015 Paris, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hidalgo Mazzei, Diego" sort="Hidalgo Mazzei, Diego" uniqKey="Hidalgo Mazzei D" first="Diego" last="Hidalgo-Mazzei">Diego Hidalgo-Mazzei</name>
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<institution>Bipolar Disorders Program, Hospital Clinic,</institution>
<institution>University of Barcelona, IDIBAPS, CIBERSAM,</institution>
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Barcelona, Catalonia Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kapur, Vaisnvy" sort="Kapur, Vaisnvy" uniqKey="Kapur V" first="Vaisnvy" last="Kapur">Vaisnvy Kapur</name>
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<institution>Department of Clinical Psychology,</institution>
<institution>NIMHANS,</institution>
</institution-wrap>
Bangalore, 560029 India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kunigiri, Girish" sort="Kunigiri, Girish" uniqKey="Kunigiri G" first="Girish" last="Kunigiri">Girish Kunigiri</name>
<affiliation><nlm:aff id="Aff29"><institution-wrap><institution-id institution-id-type="GRID">grid.420868.0</institution-id>
<institution></institution>
<institution>Leicestershire Partnership NHS Trust,</institution>
</institution-wrap>
Leicester, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lafer, Beny" sort="Lafer, Beny" uniqKey="Lafer B" first="Beny" last="Lafer">Beny Lafer</name>
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<institution-id institution-id-type="GRID">grid.11899.38</institution-id>
<institution>Bipolar Disorder Research Program, Department of Psychiatry,</institution>
<institution>University of São Paulo Medical School,</institution>
</institution-wrap>
São Paulo, Brazil</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lam, Chun" sort="Lam, Chun" uniqKey="Lam C" first="Chun" last="Lam">Chun Lam</name>
<affiliation><nlm:aff id="Aff30"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1794 2766</institution-id>
<institution-id institution-id-type="GRID">grid.415504.1</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Kowloon Hospital,</institution>
</institution-wrap>
Hong Kong, China</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Larsen, Erik Roj" sort="Larsen, Erik Roj" uniqKey="Larsen E" first="Erik Roj" last="Larsen">Erik Roj Larsen</name>
<affiliation><nlm:aff id="Aff20"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0512 597X</institution-id>
<institution-id institution-id-type="GRID">grid.154185.c</institution-id>
<institution>Department of Affective Disorders, Q, Mood Disorders Research Unit,</institution>
<institution>Aarhus University Hospital,</institution>
</institution-wrap>
Aarhus, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lewitzka, Ute" sort="Lewitzka, Ute" uniqKey="Lewitzka U" first="Ute" last="Lewitzka">Ute Lewitzka</name>
<affiliation><nlm:aff id="Aff1">Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Licht, Rasmus" sort="Licht, Rasmus" uniqKey="Licht R" first="Rasmus" last="Licht">Rasmus Licht</name>
<affiliation><nlm:aff id="Aff31"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0646 7349</institution-id>
<institution-id institution-id-type="GRID">grid.27530.33</institution-id>
<institution></institution>
<institution>Aalborg University Hospital, Psychiatry,</institution>
</institution-wrap>
Aalborg, Denmark</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff32"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0742 471X</institution-id>
<institution-id institution-id-type="GRID">grid.5117.2</institution-id>
<institution>Department of Clinical Medicine,</institution>
<institution>Aalborg University,</institution>
</institution-wrap>
Aalborg, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lund, Anne Hvenegaard" sort="Lund, Anne Hvenegaard" uniqKey="Lund A" first="Anne Hvenegaard" last="Lund">Anne Hvenegaard Lund</name>
<affiliation><nlm:aff id="Aff20"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0512 597X</institution-id>
<institution-id institution-id-type="GRID">grid.154185.c</institution-id>
<institution>Department of Affective Disorders, Q, Mood Disorders Research Unit,</institution>
<institution>Aarhus University Hospital,</institution>
</institution-wrap>
Aarhus, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Misiak, Blazej" sort="Misiak, Blazej" uniqKey="Misiak B" first="Blazej" last="Misiak">Blazej Misiak</name>
<affiliation><nlm:aff id="Aff33"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1090 049X</institution-id>
<institution-id institution-id-type="GRID">grid.4495.c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Wroclaw Medical University,</institution>
</institution-wrap>
Wroclaw, Poland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Piotrowski, Patryk" sort="Piotrowski, Patryk" uniqKey="Piotrowski P" first="Patryk" last="Piotrowski">Patryk Piotrowski</name>
<affiliation><nlm:aff id="Aff33"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1090 049X</institution-id>
<institution-id institution-id-type="GRID">grid.4495.c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Wroclaw Medical University,</institution>
</institution-wrap>
Wroclaw, Poland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Monteith, Scott" sort="Monteith, Scott" uniqKey="Monteith S" first="Scott" last="Monteith">Scott Monteith</name>
<affiliation><nlm:aff id="Aff34">Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Munoz, Rodrigo" sort="Munoz, Rodrigo" uniqKey="Munoz R" first="Rodrigo" last="Munoz">Rodrigo Munoz</name>
<affiliation><nlm:aff id="Aff35"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2107 4242</institution-id>
<institution-id institution-id-type="GRID">grid.266100.3</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of California San Diego,</institution>
</institution-wrap>
San Diego, CA USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Nakanotani, Takako" sort="Nakanotani, Takako" uniqKey="Nakanotani T" first="Takako" last="Nakanotani">Takako Nakanotani</name>
<affiliation><nlm:aff id="Aff36"><institution-wrap><institution-id institution-id-type="GRID">grid.272456.0</institution-id>
<institution>Affective Disorders Research Project,</institution>
<institution>Tokyo Metropolitan Institute of Medical Science,</institution>
</institution-wrap>
Setagaya, Tokyo Japan</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Nielsen, Rene E" sort="Nielsen, Rene E" uniqKey="Nielsen R" first="René E." last="Nielsen">René E. Nielsen</name>
<affiliation><nlm:aff id="Aff31"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0646 7349</institution-id>
<institution-id institution-id-type="GRID">grid.27530.33</institution-id>
<institution></institution>
<institution>Aalborg University Hospital, Psychiatry,</institution>
</institution-wrap>
Aalborg, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="O Onovan, Claire" sort="O Onovan, Claire" uniqKey="O Onovan C" first="Claire" last="O Onovan">Claire O Onovan</name>
<affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8200</institution-id>
<institution-id institution-id-type="GRID">grid.55602.34</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Dalhousie University,</institution>
</institution-wrap>
Halifax, Nova Scotia Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Okamura, Yasushi" sort="Okamura, Yasushi" uniqKey="Okamura Y" first="Yasushi" last="Okamura">Yasushi Okamura</name>
<affiliation><nlm:aff id="Aff24"><institution-wrap><institution-id institution-id-type="GRID">grid.417102.1</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Tokyo Metropolitan Matsuzawa Hospital,</institution>
</institution-wrap>
Setagaya, Tokyo Japan</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Osher, Yamima" sort="Osher, Yamima" uniqKey="Osher Y" first="Yamima" last="Osher">Yamima Osher</name>
<affiliation><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0511</institution-id>
<institution-id institution-id-type="GRID">grid.7489.2</institution-id>
<institution>Department of Psychiatry, Faculty of Health Sciences,</institution>
<institution>Ben Gurion University of the Negev; Beer Sheva Mental Health Center,</institution>
</institution-wrap>
Beer Sheva, Israel</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Reif, Andreas" sort="Reif, Andreas" uniqKey="Reif A" first="Andreas" last="Reif">Andreas Reif</name>
<affiliation><nlm:aff id="Aff37"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0578 8220</institution-id>
<institution-id institution-id-type="GRID">grid.411088.4</institution-id>
<institution>Department of Psychiatry, Psychosomatic Medicine and Psychotherapy,</institution>
<institution>University Hospital Frankfurt, Goethe-University,</institution>
</institution-wrap>
Frankfurt am Main, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ritter, Philipp" sort="Ritter, Philipp" uniqKey="Ritter P" first="Philipp" last="Ritter">Philipp Ritter</name>
<affiliation><nlm:aff id="Aff1">Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Rybakowski, Janusz K" sort="Rybakowski, Janusz K" uniqKey="Rybakowski J" first="Janusz K." last="Rybakowski">Janusz K. Rybakowski</name>
<affiliation><nlm:aff id="Aff38"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2205 0971</institution-id>
<institution-id institution-id-type="GRID">grid.22254.33</institution-id>
<institution>Department of Adult Psychiatry,</institution>
<institution>Poznan University of Medical Sciences,,</institution>
</institution-wrap>
Poznan, Poland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sagduyu, Kemal" sort="Sagduyu, Kemal" uniqKey="Sagduyu K" first="Kemal" last="Sagduyu">Kemal Sagduyu</name>
<affiliation><nlm:aff id="Aff39"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2179 926X</institution-id>
<institution-id institution-id-type="GRID">grid.266756.6</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Missouri Kansas City School of Medicine,</institution>
</institution-wrap>
Kansas City, MO USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sawchuk, Brett" sort="Sawchuk, Brett" uniqKey="Sawchuk B" first="Brett" last="Sawchuk">Brett Sawchuk</name>
<affiliation><nlm:aff id="Aff18"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 7697</institution-id>
<institution-id institution-id-type="GRID">grid.22072.35</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Calgary,</institution>
</institution-wrap>
Calgary, Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Schwartz, Elon" sort="Schwartz, Elon" uniqKey="Schwartz E" first="Elon" last="Schwartz">Elon Schwartz</name>
<affiliation><nlm:aff id="Aff40">Croton on Hudson, NY USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Scippa, Angela Miranda" sort="Scippa, Angela Miranda" uniqKey="Scippa A" first="Ângela Miranda" last="Scippa">Ângela Miranda Scippa</name>
<affiliation><nlm:aff id="Aff41"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0372 8259</institution-id>
<institution-id institution-id-type="GRID">grid.8399.b</institution-id>
<institution>Department of Neuroscience and Mental Health,</institution>
<institution>Federal University of Bahia,</institution>
</institution-wrap>
Salvador, Brazil</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Slaney, Claire" sort="Slaney, Claire" uniqKey="Slaney C" first="Claire" last="Slaney">Claire Slaney</name>
<affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8200</institution-id>
<institution-id institution-id-type="GRID">grid.55602.34</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Dalhousie University,</institution>
</institution-wrap>
Halifax, Nova Scotia Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sulaiman, Ahmad Hatim" sort="Sulaiman, Ahmad Hatim" uniqKey="Sulaiman A" first="Ahmad Hatim" last="Sulaiman">Ahmad Hatim Sulaiman</name>
<affiliation><nlm:aff id="Aff42"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2308 5949</institution-id>
<institution-id institution-id-type="GRID">grid.10347.31</institution-id>
<institution>Department of Psychological Medicine, Faculty of Medicine,</institution>
<institution>University of Malaya,</institution>
</institution-wrap>
Kuala Lumpur, Malaysia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Suominen, Kirsi" sort="Suominen, Kirsi" uniqKey="Suominen K" first="Kirsi" last="Suominen">Kirsi Suominen</name>
<affiliation><nlm:aff id="Aff43">City of Helsinki, Department of Social Services and Health Care, Psychiatry, Helsinki, Finland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Suwalska, Aleksandra" sort="Suwalska, Aleksandra" uniqKey="Suwalska A" first="Aleksandra" last="Suwalska">Aleksandra Suwalska</name>
<affiliation><nlm:aff id="Aff38"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2205 0971</institution-id>
<institution-id institution-id-type="GRID">grid.22254.33</institution-id>
<institution>Department of Adult Psychiatry,</institution>
<institution>Poznan University of Medical Sciences,,</institution>
</institution-wrap>
Poznan, Poland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tam, Peter" sort="Tam, Peter" uniqKey="Tam P" first="Peter" last="Tam">Peter Tam</name>
<affiliation><nlm:aff id="Aff44"><institution-wrap><institution-id institution-id-type="ISNI">0000000121742757</institution-id>
<institution-id institution-id-type="GRID">grid.194645.b</institution-id>
<institution>Department of Psychiatry, Department of Medicine,</institution>
<institution>University of Hong Kong,</institution>
</institution-wrap>
Hong Kong, China</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tatebayashi, Yoshitaka" sort="Tatebayashi, Yoshitaka" uniqKey="Tatebayashi Y" first="Yoshitaka" last="Tatebayashi">Yoshitaka Tatebayashi</name>
<affiliation><nlm:aff id="Aff36"><institution-wrap><institution-id institution-id-type="GRID">grid.272456.0</institution-id>
<institution>Affective Disorders Research Project,</institution>
<institution>Tokyo Metropolitan Institute of Medical Science,</institution>
</institution-wrap>
Setagaya, Tokyo Japan</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tondo, Leonardo" sort="Tondo, Leonardo" uniqKey="Tondo L" first="Leonardo" last="Tondo">Leonardo Tondo</name>
<affiliation><nlm:aff id="Aff45"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8795 072X</institution-id>
<institution-id institution-id-type="GRID">grid.240206.2</institution-id>
<institution></institution>
<institution>Harvard Medical School–McLean Hospital,</institution>
</institution-wrap>
Boston, MA USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff46">Lucio Bini Center, Cagliari e Roma, Italy</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Vieta, Eduard" sort="Vieta, Eduard" uniqKey="Vieta E" first="Eduard" last="Vieta">Eduard Vieta</name>
<affiliation><nlm:aff id="Aff27"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0247</institution-id>
<institution-id institution-id-type="GRID">grid.5841.8</institution-id>
<institution>Bipolar Disorders Program, Hospital Clinic,</institution>
<institution>University of Barcelona, IDIBAPS, CIBERSAM,</institution>
</institution-wrap>
Barcelona, Catalonia Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Vinberg, Maj" sort="Vinberg, Maj" uniqKey="Vinberg M" first="Maj" last="Vinberg">Maj Vinberg</name>
<affiliation><nlm:aff id="Aff47">Psychiatric Center Copenhagen, Copenhagen, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Viswanath, Biju" sort="Viswanath, Biju" uniqKey="Viswanath B" first="Biju" last="Viswanath">Biju Viswanath</name>
<affiliation><nlm:aff id="Aff48"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1516 2246</institution-id>
<institution-id institution-id-type="GRID">grid.416861.c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>NIMHANS,</institution>
</institution-wrap>
Bangalore, 560029 India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Volkert, Julia" sort="Volkert, Julia" uniqKey="Volkert J" first="Julia" last="Volkert">Julia Volkert</name>
<affiliation><nlm:aff id="Aff37"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0578 8220</institution-id>
<institution-id institution-id-type="GRID">grid.411088.4</institution-id>
<institution>Department of Psychiatry, Psychosomatic Medicine and Psychotherapy,</institution>
<institution>University Hospital Frankfurt, Goethe-University,</institution>
</institution-wrap>
Frankfurt am Main, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Zetin, Mark" sort="Zetin, Mark" uniqKey="Zetin M" first="Mark" last="Zetin">Mark Zetin</name>
<affiliation><nlm:aff id="Aff49"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9006 1798</institution-id>
<institution-id institution-id-type="GRID">grid.254024.5</institution-id>
<institution>Department of Psychology,</institution>
<institution>Chapman University,</institution>
</institution-wrap>
Orange, CA USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Zorrilla, I Aki" sort="Zorrilla, I Aki" uniqKey="Zorrilla I" first="I Aki" last="Zorrilla">I Aki Zorrilla</name>
<affiliation><nlm:aff id="Aff21"><institution-wrap><institution-id institution-id-type="ISNI">0000000121671098</institution-id>
<institution-id institution-id-type="GRID">grid.11480.3c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University Hospital of Alava, University of the Basque Country, CIBERSAM,</institution>
</institution-wrap>
Vitoria, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Whybrow, Peter C" sort="Whybrow, Peter C" uniqKey="Whybrow P" first="Peter C." last="Whybrow">Peter C. Whybrow</name>
<affiliation><nlm:aff id="Aff50"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9632 6718</institution-id>
<institution-id institution-id-type="GRID">grid.19006.3e</institution-id>
<institution>Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior,</institution>
<institution>University of California Los Angeles (UCLA),</institution>
</institution-wrap>
Los Angeles, CA USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bauer, Michael" sort="Bauer, Michael" uniqKey="Bauer M" first="Michael" last="Bauer">Michael Bauer</name>
<affiliation><nlm:aff id="Aff1">Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany</nlm:aff>
</affiliation>
</author>
</titleStmt>
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<idno type="pmc">4995194</idno>
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<idno type="RBID">PMC:4995194</idno>
<idno type="doi">10.1186/s40345-016-0058-0</idno>
<date when="2016">2016</date>
<idno type="wicri:Area/Pmc/Corpus">000D37</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Online information seeking by patients with bipolar disorder: results from an international multisite survey</title>
<author><name sortKey="Conell, Jorn" sort="Conell, Jorn" uniqKey="Conell J" first="Jörn" last="Conell">Jörn Conell</name>
<affiliation><nlm:aff id="Aff1">Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bauer, Rita" sort="Bauer, Rita" uniqKey="Bauer R" first="Rita" last="Bauer">Rita Bauer</name>
<affiliation><nlm:aff id="Aff1">Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Glenn, Tasha" sort="Glenn, Tasha" uniqKey="Glenn T" first="Tasha" last="Glenn">Tasha Glenn</name>
<affiliation><nlm:aff id="Aff2">ChronoRecord Association, Fullerton, CA USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Alda, Martin" sort="Alda, Martin" uniqKey="Alda M" first="Martin" last="Alda">Martin Alda</name>
<affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8200</institution-id>
<institution-id institution-id-type="GRID">grid.55602.34</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Dalhousie University,</institution>
</institution-wrap>
Halifax, Nova Scotia Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ardau, Raffaella" sort="Ardau, Raffaella" uniqKey="Ardau R" first="Raffaella" last="Ardau">Raffaella Ardau</name>
<affiliation><nlm:aff id="Aff4">Unit of Clinical Pharmacology, University Hospital of Cagliari, Cagliari, Italy</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Baune, Bernhard T" sort="Baune, Bernhard T" uniqKey="Baune B" first="Bernhard T." last="Baune">Bernhard T. Baune</name>
<affiliation><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 7304</institution-id>
<institution-id institution-id-type="GRID">grid.1010.0</institution-id>
<institution>Discipline of Psychiatry, School of Medicine,</institution>
<institution>University of Adelaide,</institution>
</institution-wrap>
Adelaide, SA Australia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Berk, Michael" sort="Berk, Michael" uniqKey="Berk M" first="Michael" last="Berk">Michael Berk</name>
<affiliation><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0526 7079</institution-id>
<institution-id institution-id-type="GRID">grid.1021.2</institution-id>
<institution>IMPACT Strategic Research Centre, School of Medicine,</institution>
<institution>Deakin University,</institution>
</institution-wrap>
Geelong, VIC Australia</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff7">University Hospital Geelong, Barwon Health, Geelong, VIC Australia</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff8"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2179 088X</institution-id>
<institution-id institution-id-type="GRID">grid.1008.9</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>The University of Melbourne,</institution>
</institution-wrap>
Parkville, VIC Australia</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff9"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0606 5526</institution-id>
<institution-id institution-id-type="GRID">grid.418025.a</institution-id>
<institution></institution>
<institution>Florey Institute of Neuroscience and Mental Health,</institution>
</institution-wrap>
Parkville, VIC Australia</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff10"><institution-wrap><institution-id institution-id-type="GRID">grid.431240.0</institution-id>
<institution></institution>
<institution>Orygen Youth Health Research Centre,</institution>
</institution-wrap>
Parkville, VIC Australia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bersudsky, Yuly" sort="Bersudsky, Yuly" uniqKey="Bersudsky Y" first="Yuly" last="Bersudsky">Yuly Bersudsky</name>
<affiliation><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0511</institution-id>
<institution-id institution-id-type="GRID">grid.7489.2</institution-id>
<institution>Department of Psychiatry, Faculty of Health Sciences,</institution>
<institution>Ben Gurion University of the Negev; Beer Sheva Mental Health Center,</institution>
</institution-wrap>
Beer Sheva, Israel</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bilderbeck, Amy" sort="Bilderbeck, Amy" uniqKey="Bilderbeck A" first="Amy" last="Bilderbeck">Amy Bilderbeck</name>
<affiliation><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8948</institution-id>
<institution-id institution-id-type="GRID">grid.4991.5</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Oxford,</institution>
</institution-wrap>
Warneford Hospital, Oxford, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bocchetta, Alberto" sort="Bocchetta, Alberto" uniqKey="Bocchetta A" first="Alberto" last="Bocchetta">Alberto Bocchetta</name>
<affiliation><nlm:aff id="Aff13"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1755 3242</institution-id>
<institution-id institution-id-type="GRID">grid.7763.5</institution-id>
<institution>Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences,</institution>
<institution>University of Cagliari,</institution>
</institution-wrap>
Sardinia, Italy</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bossini, Letizia" sort="Bossini, Letizia" uniqKey="Bossini L" first="Letizia" last="Bossini">Letizia Bossini</name>
<affiliation><nlm:aff id="Aff14"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1757 4641</institution-id>
<institution-id institution-id-type="GRID">grid.9024.f</institution-id>
<institution>Department of Molecular Medicine, Department of Mental Health (DAI),</institution>
<institution>University of Siena, University of Siena Medical Center (AOUS),</institution>
</institution-wrap>
Siena, Italy</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Paredes Castro, Angela Marianne" sort="Paredes Castro, Angela Marianne" uniqKey="Paredes Castro A" first="Angela Marianne" last="Paredes Castro">Angela Marianne Paredes Castro</name>
<affiliation><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0526 7079</institution-id>
<institution-id institution-id-type="GRID">grid.1021.2</institution-id>
<institution>IMPACT Strategic Research Centre, School of Medicine,</institution>
<institution>Deakin University,</institution>
</institution-wrap>
Geelong, VIC Australia</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff7">University Hospital Geelong, Barwon Health, Geelong, VIC Australia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cheung, Eric Yat Wo" sort="Cheung, Eric Yat Wo" uniqKey="Cheung E" first="Eric Yat Wo" last="Cheung">Eric Yat Wo Cheung</name>
<affiliation><nlm:aff id="Aff15"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1764 5745</institution-id>
<institution-id institution-id-type="GRID">grid.460827.f</institution-id>
<institution>Department of General Adult Psychiatry,</institution>
<institution>Castle Peak Hospital,</institution>
</institution-wrap>
Hong Kong, China</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Chillotti, Caterina" sort="Chillotti, Caterina" uniqKey="Chillotti C" first="Caterina" last="Chillotti">Caterina Chillotti</name>
<affiliation><nlm:aff id="Aff4">Unit of Clinical Pharmacology, University Hospital of Cagliari, Cagliari, Italy</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Choppin, Sabine" sort="Choppin, Sabine" uniqKey="Choppin S" first="Sabine" last="Choppin">Sabine Choppin</name>
<affiliation><nlm:aff id="Aff16"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2292 1474</institution-id>
<institution-id institution-id-type="GRID">grid.412116.1</institution-id>
<institution></institution>
<institution>AP–HP, Hôpitaux Universitaires Henri-Mondor,</institution>
</institution-wrap>
Créteil, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Del Zompo, Maria" sort="Del Zompo, Maria" uniqKey="Del Zompo M" first="Maria" last="Del Zompo">Maria Del Zompo</name>
<affiliation><nlm:aff id="Aff13"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1755 3242</institution-id>
<institution-id institution-id-type="GRID">grid.7763.5</institution-id>
<institution>Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences,</institution>
<institution>University of Cagliari,</institution>
</institution-wrap>
Sardinia, Italy</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Dias, Rodrigo" sort="Dias, Rodrigo" uniqKey="Dias R" first="Rodrigo" last="Dias">Rodrigo Dias</name>
<affiliation><nlm:aff id="Aff17"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0722</institution-id>
<institution-id institution-id-type="GRID">grid.11899.38</institution-id>
<institution>Bipolar Disorder Research Program, Department of Psychiatry,</institution>
<institution>University of São Paulo Medical School,</institution>
</institution-wrap>
São Paulo, Brazil</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Dodd, Seetal" sort="Dodd, Seetal" uniqKey="Dodd S" first="Seetal" last="Dodd">Seetal Dodd</name>
<affiliation><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0526 7079</institution-id>
<institution-id institution-id-type="GRID">grid.1021.2</institution-id>
<institution>IMPACT Strategic Research Centre, School of Medicine,</institution>
<institution>Deakin University,</institution>
</institution-wrap>
Geelong, VIC Australia</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff7">University Hospital Geelong, Barwon Health, Geelong, VIC Australia</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff8"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2179 088X</institution-id>
<institution-id institution-id-type="GRID">grid.1008.9</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>The University of Melbourne,</institution>
</institution-wrap>
Parkville, VIC Australia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Duffy, Anne" sort="Duffy, Anne" uniqKey="Duffy A" first="Anne" last="Duffy">Anne Duffy</name>
<affiliation><nlm:aff id="Aff18"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 7697</institution-id>
<institution-id institution-id-type="GRID">grid.22072.35</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Calgary,</institution>
</institution-wrap>
Calgary, Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Etain, Bruno" sort="Etain, Bruno" uniqKey="Etain B" first="Bruno" last="Etain">Bruno Etain</name>
<affiliation><nlm:aff id="Aff19"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2292 1474</institution-id>
<institution-id institution-id-type="GRID">grid.412116.1</institution-id>
<institution></institution>
<institution>AP–HP, Hôpitaux Universitaires Henri-Mondor, INSERM U955 (IMRB), Université Paris Est,</institution>
</institution-wrap>
Créteil, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Fagiolini, Andrea" sort="Fagiolini, Andrea" uniqKey="Fagiolini A" first="Andrea" last="Fagiolini">Andrea Fagiolini</name>
<affiliation><nlm:aff id="Aff14"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1757 4641</institution-id>
<institution-id institution-id-type="GRID">grid.9024.f</institution-id>
<institution>Department of Molecular Medicine, Department of Mental Health (DAI),</institution>
<institution>University of Siena, University of Siena Medical Center (AOUS),</institution>
</institution-wrap>
Siena, Italy</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Garnham, Julie" sort="Garnham, Julie" uniqKey="Garnham J" first="Julie" last="Garnham">Julie Garnham</name>
<affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8200</institution-id>
<institution-id institution-id-type="GRID">grid.55602.34</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Dalhousie University,</institution>
</institution-wrap>
Halifax, Nova Scotia Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Geddes, John" sort="Geddes, John" uniqKey="Geddes J" first="John" last="Geddes">John Geddes</name>
<affiliation><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8948</institution-id>
<institution-id institution-id-type="GRID">grid.4991.5</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Oxford,</institution>
</institution-wrap>
Warneford Hospital, Oxford, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Gildebro, Jonas" sort="Gildebro, Jonas" uniqKey="Gildebro J" first="Jonas" last="Gildebro">Jonas Gildebro</name>
<affiliation><nlm:aff id="Aff20"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0512 597X</institution-id>
<institution-id institution-id-type="GRID">grid.154185.c</institution-id>
<institution>Department of Affective Disorders, Q, Mood Disorders Research Unit,</institution>
<institution>Aarhus University Hospital,</institution>
</institution-wrap>
Aarhus, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Gonzalez Pinto, Ana" sort="Gonzalez Pinto, Ana" uniqKey="Gonzalez Pinto A" first="Ana" last="Gonzalez-Pinto">Ana Gonzalez-Pinto</name>
<affiliation><nlm:aff id="Aff21"><institution-wrap><institution-id institution-id-type="ISNI">0000000121671098</institution-id>
<institution-id institution-id-type="GRID">grid.11480.3c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University Hospital of Alava, University of the Basque Country, CIBERSAM,</institution>
</institution-wrap>
Vitoria, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Goodwin, Guy M" sort="Goodwin, Guy M" uniqKey="Goodwin G" first="Guy M." last="Goodwin">Guy M. Goodwin</name>
<affiliation><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8948</institution-id>
<institution-id institution-id-type="GRID">grid.4991.5</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Oxford,</institution>
</institution-wrap>
Warneford Hospital, Oxford, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Grof, Paul" sort="Grof, Paul" uniqKey="Grof P" first="Paul" last="Grof">Paul Grof</name>
<affiliation><nlm:aff id="Aff22">Mood Disorders Center of Ottawa, Ottawa, Canada</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff23"><institution-wrap><institution-id institution-id-type="GRID">grid.17063.33</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Toronto,</institution>
</institution-wrap>
Ontario, Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Harima, Hirohiko" sort="Harima, Hirohiko" uniqKey="Harima H" first="Hirohiko" last="Harima">Hirohiko Harima</name>
<affiliation><nlm:aff id="Aff24"><institution-wrap><institution-id institution-id-type="GRID">grid.417102.1</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Tokyo Metropolitan Matsuzawa Hospital,</institution>
</institution-wrap>
Setagaya, Tokyo Japan</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hassel, Stefanie" sort="Hassel, Stefanie" uniqKey="Hassel S" first="Stefanie" last="Hassel">Stefanie Hassel</name>
<affiliation><nlm:aff id="Aff25"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0376 4727</institution-id>
<institution-id institution-id-type="GRID">grid.7273.1</institution-id>
<institution>Department of Psychology & Aston Brain Centre,</institution>
<institution>Aston University,</institution>
</institution-wrap>
Birmingham, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Henry, Chantal" sort="Henry, Chantal" uniqKey="Henry C" first="Chantal" last="Henry">Chantal Henry</name>
<affiliation><nlm:aff id="Aff19"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2292 1474</institution-id>
<institution-id institution-id-type="GRID">grid.412116.1</institution-id>
<institution></institution>
<institution>AP–HP, Hôpitaux Universitaires Henri-Mondor, INSERM U955 (IMRB), Université Paris Est,</institution>
</institution-wrap>
Créteil, France</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff26"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2353 6535</institution-id>
<institution-id institution-id-type="GRID">grid.428999.7</institution-id>
<institution></institution>
<institution>Institut Pasteur, Unité Perception et Mémoire,</institution>
</institution-wrap>
F-75015 Paris, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hidalgo Mazzei, Diego" sort="Hidalgo Mazzei, Diego" uniqKey="Hidalgo Mazzei D" first="Diego" last="Hidalgo-Mazzei">Diego Hidalgo-Mazzei</name>
<affiliation><nlm:aff id="Aff27"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0247</institution-id>
<institution-id institution-id-type="GRID">grid.5841.8</institution-id>
<institution>Bipolar Disorders Program, Hospital Clinic,</institution>
<institution>University of Barcelona, IDIBAPS, CIBERSAM,</institution>
</institution-wrap>
Barcelona, Catalonia Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kapur, Vaisnvy" sort="Kapur, Vaisnvy" uniqKey="Kapur V" first="Vaisnvy" last="Kapur">Vaisnvy Kapur</name>
<affiliation><nlm:aff id="Aff28"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1516 2246</institution-id>
<institution-id institution-id-type="GRID">grid.416861.c</institution-id>
<institution>Department of Clinical Psychology,</institution>
<institution>NIMHANS,</institution>
</institution-wrap>
Bangalore, 560029 India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kunigiri, Girish" sort="Kunigiri, Girish" uniqKey="Kunigiri G" first="Girish" last="Kunigiri">Girish Kunigiri</name>
<affiliation><nlm:aff id="Aff29"><institution-wrap><institution-id institution-id-type="GRID">grid.420868.0</institution-id>
<institution></institution>
<institution>Leicestershire Partnership NHS Trust,</institution>
</institution-wrap>
Leicester, UK</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lafer, Beny" sort="Lafer, Beny" uniqKey="Lafer B" first="Beny" last="Lafer">Beny Lafer</name>
<affiliation><nlm:aff id="Aff17"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0722</institution-id>
<institution-id institution-id-type="GRID">grid.11899.38</institution-id>
<institution>Bipolar Disorder Research Program, Department of Psychiatry,</institution>
<institution>University of São Paulo Medical School,</institution>
</institution-wrap>
São Paulo, Brazil</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lam, Chun" sort="Lam, Chun" uniqKey="Lam C" first="Chun" last="Lam">Chun Lam</name>
<affiliation><nlm:aff id="Aff30"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1794 2766</institution-id>
<institution-id institution-id-type="GRID">grid.415504.1</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Kowloon Hospital,</institution>
</institution-wrap>
Hong Kong, China</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Larsen, Erik Roj" sort="Larsen, Erik Roj" uniqKey="Larsen E" first="Erik Roj" last="Larsen">Erik Roj Larsen</name>
<affiliation><nlm:aff id="Aff20"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0512 597X</institution-id>
<institution-id institution-id-type="GRID">grid.154185.c</institution-id>
<institution>Department of Affective Disorders, Q, Mood Disorders Research Unit,</institution>
<institution>Aarhus University Hospital,</institution>
</institution-wrap>
Aarhus, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lewitzka, Ute" sort="Lewitzka, Ute" uniqKey="Lewitzka U" first="Ute" last="Lewitzka">Ute Lewitzka</name>
<affiliation><nlm:aff id="Aff1">Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Licht, Rasmus" sort="Licht, Rasmus" uniqKey="Licht R" first="Rasmus" last="Licht">Rasmus Licht</name>
<affiliation><nlm:aff id="Aff31"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0646 7349</institution-id>
<institution-id institution-id-type="GRID">grid.27530.33</institution-id>
<institution></institution>
<institution>Aalborg University Hospital, Psychiatry,</institution>
</institution-wrap>
Aalborg, Denmark</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff32"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0742 471X</institution-id>
<institution-id institution-id-type="GRID">grid.5117.2</institution-id>
<institution>Department of Clinical Medicine,</institution>
<institution>Aalborg University,</institution>
</institution-wrap>
Aalborg, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lund, Anne Hvenegaard" sort="Lund, Anne Hvenegaard" uniqKey="Lund A" first="Anne Hvenegaard" last="Lund">Anne Hvenegaard Lund</name>
<affiliation><nlm:aff id="Aff20"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0512 597X</institution-id>
<institution-id institution-id-type="GRID">grid.154185.c</institution-id>
<institution>Department of Affective Disorders, Q, Mood Disorders Research Unit,</institution>
<institution>Aarhus University Hospital,</institution>
</institution-wrap>
Aarhus, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Misiak, Blazej" sort="Misiak, Blazej" uniqKey="Misiak B" first="Blazej" last="Misiak">Blazej Misiak</name>
<affiliation><nlm:aff id="Aff33"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1090 049X</institution-id>
<institution-id institution-id-type="GRID">grid.4495.c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Wroclaw Medical University,</institution>
</institution-wrap>
Wroclaw, Poland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Piotrowski, Patryk" sort="Piotrowski, Patryk" uniqKey="Piotrowski P" first="Patryk" last="Piotrowski">Patryk Piotrowski</name>
<affiliation><nlm:aff id="Aff33"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1090 049X</institution-id>
<institution-id institution-id-type="GRID">grid.4495.c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Wroclaw Medical University,</institution>
</institution-wrap>
Wroclaw, Poland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Monteith, Scott" sort="Monteith, Scott" uniqKey="Monteith S" first="Scott" last="Monteith">Scott Monteith</name>
<affiliation><nlm:aff id="Aff34">Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Munoz, Rodrigo" sort="Munoz, Rodrigo" uniqKey="Munoz R" first="Rodrigo" last="Munoz">Rodrigo Munoz</name>
<affiliation><nlm:aff id="Aff35"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2107 4242</institution-id>
<institution-id institution-id-type="GRID">grid.266100.3</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of California San Diego,</institution>
</institution-wrap>
San Diego, CA USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Nakanotani, Takako" sort="Nakanotani, Takako" uniqKey="Nakanotani T" first="Takako" last="Nakanotani">Takako Nakanotani</name>
<affiliation><nlm:aff id="Aff36"><institution-wrap><institution-id institution-id-type="GRID">grid.272456.0</institution-id>
<institution>Affective Disorders Research Project,</institution>
<institution>Tokyo Metropolitan Institute of Medical Science,</institution>
</institution-wrap>
Setagaya, Tokyo Japan</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Nielsen, Rene E" sort="Nielsen, Rene E" uniqKey="Nielsen R" first="René E." last="Nielsen">René E. Nielsen</name>
<affiliation><nlm:aff id="Aff31"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0646 7349</institution-id>
<institution-id institution-id-type="GRID">grid.27530.33</institution-id>
<institution></institution>
<institution>Aalborg University Hospital, Psychiatry,</institution>
</institution-wrap>
Aalborg, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="O Onovan, Claire" sort="O Onovan, Claire" uniqKey="O Onovan C" first="Claire" last="O Onovan">Claire O Onovan</name>
<affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8200</institution-id>
<institution-id institution-id-type="GRID">grid.55602.34</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Dalhousie University,</institution>
</institution-wrap>
Halifax, Nova Scotia Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Okamura, Yasushi" sort="Okamura, Yasushi" uniqKey="Okamura Y" first="Yasushi" last="Okamura">Yasushi Okamura</name>
<affiliation><nlm:aff id="Aff24"><institution-wrap><institution-id institution-id-type="GRID">grid.417102.1</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Tokyo Metropolitan Matsuzawa Hospital,</institution>
</institution-wrap>
Setagaya, Tokyo Japan</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Osher, Yamima" sort="Osher, Yamima" uniqKey="Osher Y" first="Yamima" last="Osher">Yamima Osher</name>
<affiliation><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0511</institution-id>
<institution-id institution-id-type="GRID">grid.7489.2</institution-id>
<institution>Department of Psychiatry, Faculty of Health Sciences,</institution>
<institution>Ben Gurion University of the Negev; Beer Sheva Mental Health Center,</institution>
</institution-wrap>
Beer Sheva, Israel</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Reif, Andreas" sort="Reif, Andreas" uniqKey="Reif A" first="Andreas" last="Reif">Andreas Reif</name>
<affiliation><nlm:aff id="Aff37"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0578 8220</institution-id>
<institution-id institution-id-type="GRID">grid.411088.4</institution-id>
<institution>Department of Psychiatry, Psychosomatic Medicine and Psychotherapy,</institution>
<institution>University Hospital Frankfurt, Goethe-University,</institution>
</institution-wrap>
Frankfurt am Main, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ritter, Philipp" sort="Ritter, Philipp" uniqKey="Ritter P" first="Philipp" last="Ritter">Philipp Ritter</name>
<affiliation><nlm:aff id="Aff1">Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Rybakowski, Janusz K" sort="Rybakowski, Janusz K" uniqKey="Rybakowski J" first="Janusz K." last="Rybakowski">Janusz K. Rybakowski</name>
<affiliation><nlm:aff id="Aff38"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2205 0971</institution-id>
<institution-id institution-id-type="GRID">grid.22254.33</institution-id>
<institution>Department of Adult Psychiatry,</institution>
<institution>Poznan University of Medical Sciences,,</institution>
</institution-wrap>
Poznan, Poland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sagduyu, Kemal" sort="Sagduyu, Kemal" uniqKey="Sagduyu K" first="Kemal" last="Sagduyu">Kemal Sagduyu</name>
<affiliation><nlm:aff id="Aff39"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2179 926X</institution-id>
<institution-id institution-id-type="GRID">grid.266756.6</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Missouri Kansas City School of Medicine,</institution>
</institution-wrap>
Kansas City, MO USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sawchuk, Brett" sort="Sawchuk, Brett" uniqKey="Sawchuk B" first="Brett" last="Sawchuk">Brett Sawchuk</name>
<affiliation><nlm:aff id="Aff18"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 7697</institution-id>
<institution-id institution-id-type="GRID">grid.22072.35</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Calgary,</institution>
</institution-wrap>
Calgary, Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Schwartz, Elon" sort="Schwartz, Elon" uniqKey="Schwartz E" first="Elon" last="Schwartz">Elon Schwartz</name>
<affiliation><nlm:aff id="Aff40">Croton on Hudson, NY USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Scippa, Angela Miranda" sort="Scippa, Angela Miranda" uniqKey="Scippa A" first="Ângela Miranda" last="Scippa">Ângela Miranda Scippa</name>
<affiliation><nlm:aff id="Aff41"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0372 8259</institution-id>
<institution-id institution-id-type="GRID">grid.8399.b</institution-id>
<institution>Department of Neuroscience and Mental Health,</institution>
<institution>Federal University of Bahia,</institution>
</institution-wrap>
Salvador, Brazil</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Slaney, Claire" sort="Slaney, Claire" uniqKey="Slaney C" first="Claire" last="Slaney">Claire Slaney</name>
<affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8200</institution-id>
<institution-id institution-id-type="GRID">grid.55602.34</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Dalhousie University,</institution>
</institution-wrap>
Halifax, Nova Scotia Canada</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sulaiman, Ahmad Hatim" sort="Sulaiman, Ahmad Hatim" uniqKey="Sulaiman A" first="Ahmad Hatim" last="Sulaiman">Ahmad Hatim Sulaiman</name>
<affiliation><nlm:aff id="Aff42"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2308 5949</institution-id>
<institution-id institution-id-type="GRID">grid.10347.31</institution-id>
<institution>Department of Psychological Medicine, Faculty of Medicine,</institution>
<institution>University of Malaya,</institution>
</institution-wrap>
Kuala Lumpur, Malaysia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Suominen, Kirsi" sort="Suominen, Kirsi" uniqKey="Suominen K" first="Kirsi" last="Suominen">Kirsi Suominen</name>
<affiliation><nlm:aff id="Aff43">City of Helsinki, Department of Social Services and Health Care, Psychiatry, Helsinki, Finland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Suwalska, Aleksandra" sort="Suwalska, Aleksandra" uniqKey="Suwalska A" first="Aleksandra" last="Suwalska">Aleksandra Suwalska</name>
<affiliation><nlm:aff id="Aff38"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2205 0971</institution-id>
<institution-id institution-id-type="GRID">grid.22254.33</institution-id>
<institution>Department of Adult Psychiatry,</institution>
<institution>Poznan University of Medical Sciences,,</institution>
</institution-wrap>
Poznan, Poland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tam, Peter" sort="Tam, Peter" uniqKey="Tam P" first="Peter" last="Tam">Peter Tam</name>
<affiliation><nlm:aff id="Aff44"><institution-wrap><institution-id institution-id-type="ISNI">0000000121742757</institution-id>
<institution-id institution-id-type="GRID">grid.194645.b</institution-id>
<institution>Department of Psychiatry, Department of Medicine,</institution>
<institution>University of Hong Kong,</institution>
</institution-wrap>
Hong Kong, China</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tatebayashi, Yoshitaka" sort="Tatebayashi, Yoshitaka" uniqKey="Tatebayashi Y" first="Yoshitaka" last="Tatebayashi">Yoshitaka Tatebayashi</name>
<affiliation><nlm:aff id="Aff36"><institution-wrap><institution-id institution-id-type="GRID">grid.272456.0</institution-id>
<institution>Affective Disorders Research Project,</institution>
<institution>Tokyo Metropolitan Institute of Medical Science,</institution>
</institution-wrap>
Setagaya, Tokyo Japan</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tondo, Leonardo" sort="Tondo, Leonardo" uniqKey="Tondo L" first="Leonardo" last="Tondo">Leonardo Tondo</name>
<affiliation><nlm:aff id="Aff45"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8795 072X</institution-id>
<institution-id institution-id-type="GRID">grid.240206.2</institution-id>
<institution></institution>
<institution>Harvard Medical School–McLean Hospital,</institution>
</institution-wrap>
Boston, MA USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff46">Lucio Bini Center, Cagliari e Roma, Italy</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Vieta, Eduard" sort="Vieta, Eduard" uniqKey="Vieta E" first="Eduard" last="Vieta">Eduard Vieta</name>
<affiliation><nlm:aff id="Aff27"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0247</institution-id>
<institution-id institution-id-type="GRID">grid.5841.8</institution-id>
<institution>Bipolar Disorders Program, Hospital Clinic,</institution>
<institution>University of Barcelona, IDIBAPS, CIBERSAM,</institution>
</institution-wrap>
Barcelona, Catalonia Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Vinberg, Maj" sort="Vinberg, Maj" uniqKey="Vinberg M" first="Maj" last="Vinberg">Maj Vinberg</name>
<affiliation><nlm:aff id="Aff47">Psychiatric Center Copenhagen, Copenhagen, Denmark</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Viswanath, Biju" sort="Viswanath, Biju" uniqKey="Viswanath B" first="Biju" last="Viswanath">Biju Viswanath</name>
<affiliation><nlm:aff id="Aff48"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1516 2246</institution-id>
<institution-id institution-id-type="GRID">grid.416861.c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>NIMHANS,</institution>
</institution-wrap>
Bangalore, 560029 India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Volkert, Julia" sort="Volkert, Julia" uniqKey="Volkert J" first="Julia" last="Volkert">Julia Volkert</name>
<affiliation><nlm:aff id="Aff37"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0578 8220</institution-id>
<institution-id institution-id-type="GRID">grid.411088.4</institution-id>
<institution>Department of Psychiatry, Psychosomatic Medicine and Psychotherapy,</institution>
<institution>University Hospital Frankfurt, Goethe-University,</institution>
</institution-wrap>
Frankfurt am Main, Germany</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Zetin, Mark" sort="Zetin, Mark" uniqKey="Zetin M" first="Mark" last="Zetin">Mark Zetin</name>
<affiliation><nlm:aff id="Aff49"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9006 1798</institution-id>
<institution-id institution-id-type="GRID">grid.254024.5</institution-id>
<institution>Department of Psychology,</institution>
<institution>Chapman University,</institution>
</institution-wrap>
Orange, CA USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Zorrilla, I Aki" sort="Zorrilla, I Aki" uniqKey="Zorrilla I" first="I Aki" last="Zorrilla">I Aki Zorrilla</name>
<affiliation><nlm:aff id="Aff21"><institution-wrap><institution-id institution-id-type="ISNI">0000000121671098</institution-id>
<institution-id institution-id-type="GRID">grid.11480.3c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University Hospital of Alava, University of the Basque Country, CIBERSAM,</institution>
</institution-wrap>
Vitoria, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Whybrow, Peter C" sort="Whybrow, Peter C" uniqKey="Whybrow P" first="Peter C." last="Whybrow">Peter C. Whybrow</name>
<affiliation><nlm:aff id="Aff50"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9632 6718</institution-id>
<institution-id institution-id-type="GRID">grid.19006.3e</institution-id>
<institution>Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior,</institution>
<institution>University of California Los Angeles (UCLA),</institution>
</institution-wrap>
Los Angeles, CA USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bauer, Michael" sort="Bauer, Michael" uniqKey="Bauer M" first="Michael" last="Bauer">Michael Bauer</name>
<affiliation><nlm:aff id="Aff1">Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">International Journal of Bipolar Disorders</title>
<idno type="eISSN">2194-7511</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Information seeking is an important coping mechanism for dealing with chronic illness. Despite a growing number of mental health websites, there is little understanding of how patients with bipolar disorder use the Internet to seek information.</p>
</sec>
<sec><title>Methods</title>
<p>A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries as a convenience sample between March 2014 and January 2016. All patients had a diagnosis of bipolar disorder from a psychiatrist. Data were analyzed using descriptive statistics and generalized estimating equations to account for correlated data.</p>
</sec>
<sec><title>Results</title>
<p>976 (81 % of 1212 valid responses) of the patients used the Internet, and of these 750 (77 %) looked for information on bipolar disorder. When looking online for information, 89 % used a computer rather than a smartphone, and 79 % started with a general search engine. The primary reasons for searching were drug side effects (51 %), to learn anonymously (43 %), and for help coping (39 %). About 1/3 rated their search skills as expert, and 2/3 as basic or intermediate. 59 % preferred a website on mental illness and 33 % preferred Wikipedia. Only 20 % read or participated in online support groups. Most patients (62 %) searched a couple times a year. Online information seeking helped about 2/3 to cope (41 % of the entire sample). About 2/3 did not discuss Internet findings with their doctor.</p>
</sec>
<sec><title>Conclusion</title>
<p>Online information seeking helps many patients to cope although alternative information sources remain important. Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand limitations of online privacy. More patient education about online information searching is needed and physicians should recommend a few high quality websites.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s40345-016-0058-0) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Bipolar Disord</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Bipolar Disord</journal-id>
<journal-title-group><journal-title>International Journal of Bipolar Disorders</journal-title>
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<issn pub-type="epub">2194-7511</issn>
<publisher><publisher-name>Springer Berlin Heidelberg</publisher-name>
<publisher-loc>Berlin/Heidelberg</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27552813</article-id>
<article-id pub-id-type="pmc">4995194</article-id>
<article-id pub-id-type="publisher-id">58</article-id>
<article-id pub-id-type="doi">10.1186/s40345-016-0058-0</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research</subject>
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</article-categories>
<title-group><article-title>Online information seeking by patients with bipolar disorder: results from an international multisite survey</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Conell</surname>
<given-names>Jörn</given-names>
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<address><email>Joern.Conell@uniklinikum-dresden.de</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bauer</surname>
<given-names>Rita</given-names>
</name>
<address><email>rita.bauer@uniklinikum-dresden.de</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Glenn</surname>
<given-names>Tasha</given-names>
</name>
<address><email>tglenn@chronorecord.org</email>
</address>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Alda</surname>
<given-names>Martin</given-names>
</name>
<address><email>malda@dal.ca</email>
</address>
<xref ref-type="aff" rid="Aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ardau</surname>
<given-names>Raffaella</given-names>
</name>
<address><email>ardau.raf@tiscali.it</email>
</address>
<xref ref-type="aff" rid="Aff4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Baune</surname>
<given-names>Bernhard T.</given-names>
</name>
<address><email>bernhard.baune@adelaide.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Berk</surname>
<given-names>Michael</given-names>
</name>
<address><email>MIKEBE@BarwonHealth.org.au</email>
</address>
<xref ref-type="aff" rid="Aff6">6</xref>
<xref ref-type="aff" rid="Aff7">7</xref>
<xref ref-type="aff" rid="Aff8">8</xref>
<xref ref-type="aff" rid="Aff9">9</xref>
<xref ref-type="aff" rid="Aff10">10</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bersudsky</surname>
<given-names>Yuly</given-names>
</name>
<address><email>yuly@bgu.ac.il</email>
</address>
<xref ref-type="aff" rid="Aff11">11</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bilderbeck</surname>
<given-names>Amy</given-names>
</name>
<address><email>abilderbeck@p1vital.com</email>
</address>
<xref ref-type="aff" rid="Aff12">12</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bocchetta</surname>
<given-names>Alberto</given-names>
</name>
<address><email>bocchett@unica.it</email>
</address>
<xref ref-type="aff" rid="Aff13">13</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bossini</surname>
<given-names>Letizia</given-names>
</name>
<address><email>letizia.bossini@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff14">14</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Paredes Castro</surname>
<given-names>Angela Marianne</given-names>
</name>
<address><email>angymarianne@hotmail.com</email>
</address>
<xref ref-type="aff" rid="Aff6">6</xref>
<xref ref-type="aff" rid="Aff7">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cheung</surname>
<given-names>Eric Yat Wo</given-names>
</name>
<address><email>a9840748@yahoo.com.hk</email>
</address>
<xref ref-type="aff" rid="Aff15">15</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chillotti</surname>
<given-names>Caterina</given-names>
</name>
<address><email>cchillotti@aoucagliari.it</email>
</address>
<xref ref-type="aff" rid="Aff4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Choppin</surname>
<given-names>Sabine</given-names>
</name>
<address><email>sabine.choppin@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff16">16</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Del Zompo</surname>
<given-names>Maria</given-names>
</name>
<address><email>delzompo@unica.it</email>
</address>
<xref ref-type="aff" rid="Aff13">13</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dias</surname>
<given-names>Rodrigo</given-names>
</name>
<address><email>dgdias@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff17">17</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dodd</surname>
<given-names>Seetal</given-names>
</name>
<address><email>SEETALD@BarwonHealth.org.au</email>
</address>
<xref ref-type="aff" rid="Aff6">6</xref>
<xref ref-type="aff" rid="Aff7">7</xref>
<xref ref-type="aff" rid="Aff8">8</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Duffy</surname>
<given-names>Anne</given-names>
</name>
<address><email>annecduffy@yahoo.com</email>
</address>
<xref ref-type="aff" rid="Aff18">18</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Etain</surname>
<given-names>Bruno</given-names>
</name>
<address><email>Bruno.Etain@inserm.fr</email>
</address>
<xref ref-type="aff" rid="Aff19">19</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Fagiolini</surname>
<given-names>Andrea</given-names>
</name>
<address><email>andreafagiolini@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff14">14</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Garnham</surname>
<given-names>Julie</given-names>
</name>
<address><email>Julie.Garnham@nshealth.ca</email>
</address>
<xref ref-type="aff" rid="Aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Geddes</surname>
<given-names>John</given-names>
</name>
<address><email>john.geddes@psych.ox.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff12">12</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gildebro</surname>
<given-names>Jonas</given-names>
</name>
<address><email>jonagild@rm.dk</email>
</address>
<xref ref-type="aff" rid="Aff20">20</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gonzalez-Pinto</surname>
<given-names>Ana</given-names>
</name>
<address><email>anapinto@telefonica.net</email>
</address>
<xref ref-type="aff" rid="Aff21">21</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Goodwin</surname>
<given-names>Guy M.</given-names>
</name>
<address><email>guy.goodwin@psych.ox.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff12">12</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Grof</surname>
<given-names>Paul</given-names>
</name>
<address><email>paulgrof75@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff22">22</xref>
<xref ref-type="aff" rid="Aff23">23</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Harima</surname>
<given-names>Hirohiko</given-names>
</name>
<address><email>harimahirohiko@mac.com</email>
</address>
<xref ref-type="aff" rid="Aff24">24</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hassel</surname>
<given-names>Stefanie</given-names>
</name>
<address><email>hassel.stefanie@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff25">25</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Henry</surname>
<given-names>Chantal</given-names>
</name>
<address><email>chantal.henry@inserm.fr</email>
</address>
<xref ref-type="aff" rid="Aff19">19</xref>
<xref ref-type="aff" rid="Aff26">26</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hidalgo-Mazzei</surname>
<given-names>Diego</given-names>
</name>
<address><email>DAHIDALG@clinic.ub.es</email>
</address>
<xref ref-type="aff" rid="Aff27">27</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kapur</surname>
<given-names>Vaisnvy</given-names>
</name>
<address><email>vaisnvynm@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff28">28</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kunigiri</surname>
<given-names>Girish</given-names>
</name>
<address><email>Girish.Kunigiri@leicspart.nhs.uk</email>
</address>
<xref ref-type="aff" rid="Aff29">29</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lafer</surname>
<given-names>Beny</given-names>
</name>
<address><email>benylafer@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff17">17</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lam</surname>
<given-names>Chun</given-names>
</name>
<address><email>drlamchun@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff30">30</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Larsen</surname>
<given-names>Erik Roj</given-names>
</name>
<address><email>eriklars@rm.dk</email>
</address>
<xref ref-type="aff" rid="Aff20">20</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lewitzka</surname>
<given-names>Ute</given-names>
</name>
<address><email>ute.lewitzka@uniklinikum-dresden.de</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Licht</surname>
<given-names>Rasmus</given-names>
</name>
<address><email>RASMUS.LICHT@RN.DK</email>
</address>
<xref ref-type="aff" rid="Aff31">31</xref>
<xref ref-type="aff" rid="Aff32">32</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lund</surname>
<given-names>Anne Hvenegaard</given-names>
</name>
<address><email>annmiels@rm.dk</email>
</address>
<xref ref-type="aff" rid="Aff20">20</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Misiak</surname>
<given-names>Blazej</given-names>
</name>
<address><email>mblazej@interia.eu</email>
</address>
<xref ref-type="aff" rid="Aff33">33</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Piotrowski</surname>
<given-names>Patryk</given-names>
</name>
<address><email>patryk.piotrowski@umed.wroc.pl</email>
</address>
<xref ref-type="aff" rid="Aff33">33</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Monteith</surname>
<given-names>Scott</given-names>
</name>
<address><email>monteit2@msu.edu</email>
</address>
<xref ref-type="aff" rid="Aff34">34</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Munoz</surname>
<given-names>Rodrigo</given-names>
</name>
<address><email>RMunozMD@aol.com</email>
</address>
<xref ref-type="aff" rid="Aff35">35</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nakanotani</surname>
<given-names>Takako</given-names>
</name>
<address><email>nakanotani-tk@igakuken.or.jp</email>
</address>
<xref ref-type="aff" rid="Aff36">36</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nielsen</surname>
<given-names>René E.</given-names>
</name>
<address><email>ren@rn.dk</email>
</address>
<xref ref-type="aff" rid="Aff31">31</xref>
</contrib>
<contrib contrib-type="author"><name><surname>O’Donovan</surname>
<given-names>Claire</given-names>
</name>
<address><email>Claire.ODonovan@cdha.nshealth.ca</email>
</address>
<xref ref-type="aff" rid="Aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Okamura</surname>
<given-names>Yasushi</given-names>
</name>
<address><email>oka221kaku@yahoo.co.jp</email>
</address>
<xref ref-type="aff" rid="Aff24">24</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Osher</surname>
<given-names>Yamima</given-names>
</name>
<address><email>yamy11@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff11">11</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Reif</surname>
<given-names>Andreas</given-names>
</name>
<address><email>andreas.reif@kgu.de</email>
</address>
<xref ref-type="aff" rid="Aff37">37</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ritter</surname>
<given-names>Philipp</given-names>
</name>
<address><email>Philipp.Ritter@uniklinikum-dresden.de</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rybakowski</surname>
<given-names>Janusz K.</given-names>
</name>
<address><email>janusz.rybakowski@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff38">38</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sagduyu</surname>
<given-names>Kemal</given-names>
</name>
<address><email>feelbetter@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff39">39</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sawchuk</surname>
<given-names>Brett</given-names>
</name>
<address><email>brettsawchuk@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff18">18</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Schwartz</surname>
<given-names>Elon</given-names>
</name>
<address><email>lons6@optonline.net</email>
</address>
<xref ref-type="aff" rid="Aff40">40</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Scippa</surname>
<given-names>Ângela Miranda</given-names>
</name>
<address><email>amscippa@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff41">41</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Slaney</surname>
<given-names>Claire</given-names>
</name>
<address><email>Claire.slaney@nshealth.ca</email>
</address>
<xref ref-type="aff" rid="Aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sulaiman</surname>
<given-names>Ahmad Hatim</given-names>
</name>
<address><email>hatim@um.edu.my</email>
</address>
<xref ref-type="aff" rid="Aff42">42</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Suominen</surname>
<given-names>Kirsi</given-names>
</name>
<address><email>kirsisuominen@kolumbus.fi</email>
</address>
<xref ref-type="aff" rid="Aff43">43</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Suwalska</surname>
<given-names>Aleksandra</given-names>
</name>
<address><email>asuwalska@umed.poznan.pl</email>
</address>
<xref ref-type="aff" rid="Aff38">38</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tam</surname>
<given-names>Peter</given-names>
</name>
<address><email>ocdocd24@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff44">44</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tatebayashi</surname>
<given-names>Yoshitaka</given-names>
</name>
<address><email>tatebayashi-ys@igakuken.or.jp</email>
</address>
<xref ref-type="aff" rid="Aff36">36</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tondo</surname>
<given-names>Leonardo</given-names>
</name>
<address><email>leonardot@aol.com</email>
</address>
<xref ref-type="aff" rid="Aff45">45</xref>
<xref ref-type="aff" rid="Aff46">46</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vieta</surname>
<given-names>Eduard</given-names>
</name>
<address><email>EVIETA@clinic.ub.es</email>
</address>
<xref ref-type="aff" rid="Aff27">27</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vinberg</surname>
<given-names>Maj</given-names>
</name>
<address><email>Maj.Vinberg@regionh.dk</email>
</address>
<xref ref-type="aff" rid="Aff47">47</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Viswanath</surname>
<given-names>Biju</given-names>
</name>
<address><email>bijuv1@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff48">48</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Volkert</surname>
<given-names>Julia</given-names>
</name>
<address><email>Volkert_J@ukw.de</email>
</address>
<xref ref-type="aff" rid="Aff37">37</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zetin</surname>
<given-names>Mark</given-names>
</name>
<address><email>mzetinmd2@mac.com</email>
</address>
<xref ref-type="aff" rid="Aff49">49</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zorrilla</surname>
<given-names>Iñaki</given-names>
</name>
<address><email>i.zorrilla@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff21">21</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Whybrow</surname>
<given-names>Peter C.</given-names>
</name>
<address><email>PWhybrow@MEDNET.ucla.edu</email>
</address>
<xref ref-type="aff" rid="Aff50">50</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-2666-859X</contrib-id>
<name><surname>Bauer</surname>
<given-names>Michael</given-names>
</name>
<address><email>Michael.Bauer@uniklinikum-dresden.de</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<aff id="Aff1"><label>1</label>
Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany</aff>
<aff id="Aff2"><label>2</label>
ChronoRecord Association, Fullerton, CA USA</aff>
<aff id="Aff3"><label>3</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8200</institution-id>
<institution-id institution-id-type="GRID">grid.55602.34</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Dalhousie University,</institution>
</institution-wrap>
Halifax, Nova Scotia Canada</aff>
<aff id="Aff4"><label>4</label>
Unit of Clinical Pharmacology, University Hospital of Cagliari, Cagliari, Italy</aff>
<aff id="Aff5"><label>5</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 7304</institution-id>
<institution-id institution-id-type="GRID">grid.1010.0</institution-id>
<institution>Discipline of Psychiatry, School of Medicine,</institution>
<institution>University of Adelaide,</institution>
</institution-wrap>
Adelaide, SA Australia</aff>
<aff id="Aff6"><label>6</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0526 7079</institution-id>
<institution-id institution-id-type="GRID">grid.1021.2</institution-id>
<institution>IMPACT Strategic Research Centre, School of Medicine,</institution>
<institution>Deakin University,</institution>
</institution-wrap>
Geelong, VIC Australia</aff>
<aff id="Aff7"><label>7</label>
University Hospital Geelong, Barwon Health, Geelong, VIC Australia</aff>
<aff id="Aff8"><label>8</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2179 088X</institution-id>
<institution-id institution-id-type="GRID">grid.1008.9</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>The University of Melbourne,</institution>
</institution-wrap>
Parkville, VIC Australia</aff>
<aff id="Aff9"><label>9</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0606 5526</institution-id>
<institution-id institution-id-type="GRID">grid.418025.a</institution-id>
<institution></institution>
<institution>Florey Institute of Neuroscience and Mental Health,</institution>
</institution-wrap>
Parkville, VIC Australia</aff>
<aff id="Aff10"><label>10</label>
<institution-wrap><institution-id institution-id-type="GRID">grid.431240.0</institution-id>
<institution></institution>
<institution>Orygen Youth Health Research Centre,</institution>
</institution-wrap>
Parkville, VIC Australia</aff>
<aff id="Aff11"><label>11</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0511</institution-id>
<institution-id institution-id-type="GRID">grid.7489.2</institution-id>
<institution>Department of Psychiatry, Faculty of Health Sciences,</institution>
<institution>Ben Gurion University of the Negev; Beer Sheva Mental Health Center,</institution>
</institution-wrap>
Beer Sheva, Israel</aff>
<aff id="Aff12"><label>12</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8948</institution-id>
<institution-id institution-id-type="GRID">grid.4991.5</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Oxford,</institution>
</institution-wrap>
Warneford Hospital, Oxford, UK</aff>
<aff id="Aff13"><label>13</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1755 3242</institution-id>
<institution-id institution-id-type="GRID">grid.7763.5</institution-id>
<institution>Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences,</institution>
<institution>University of Cagliari,</institution>
</institution-wrap>
Sardinia, Italy</aff>
<aff id="Aff14"><label>14</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1757 4641</institution-id>
<institution-id institution-id-type="GRID">grid.9024.f</institution-id>
<institution>Department of Molecular Medicine, Department of Mental Health (DAI),</institution>
<institution>University of Siena, University of Siena Medical Center (AOUS),</institution>
</institution-wrap>
Siena, Italy</aff>
<aff id="Aff15"><label>15</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1764 5745</institution-id>
<institution-id institution-id-type="GRID">grid.460827.f</institution-id>
<institution>Department of General Adult Psychiatry,</institution>
<institution>Castle Peak Hospital,</institution>
</institution-wrap>
Hong Kong, China</aff>
<aff id="Aff16"><label>16</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2292 1474</institution-id>
<institution-id institution-id-type="GRID">grid.412116.1</institution-id>
<institution></institution>
<institution>AP–HP, Hôpitaux Universitaires Henri-Mondor,</institution>
</institution-wrap>
Créteil, France</aff>
<aff id="Aff17"><label>17</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0722</institution-id>
<institution-id institution-id-type="GRID">grid.11899.38</institution-id>
<institution>Bipolar Disorder Research Program, Department of Psychiatry,</institution>
<institution>University of São Paulo Medical School,</institution>
</institution-wrap>
São Paulo, Brazil</aff>
<aff id="Aff18"><label>18</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 7697</institution-id>
<institution-id institution-id-type="GRID">grid.22072.35</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Calgary,</institution>
</institution-wrap>
Calgary, Canada</aff>
<aff id="Aff19"><label>19</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2292 1474</institution-id>
<institution-id institution-id-type="GRID">grid.412116.1</institution-id>
<institution></institution>
<institution>AP–HP, Hôpitaux Universitaires Henri-Mondor, INSERM U955 (IMRB), Université Paris Est,</institution>
</institution-wrap>
Créteil, France</aff>
<aff id="Aff20"><label>20</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0512 597X</institution-id>
<institution-id institution-id-type="GRID">grid.154185.c</institution-id>
<institution>Department of Affective Disorders, Q, Mood Disorders Research Unit,</institution>
<institution>Aarhus University Hospital,</institution>
</institution-wrap>
Aarhus, Denmark</aff>
<aff id="Aff21"><label>21</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000000121671098</institution-id>
<institution-id institution-id-type="GRID">grid.11480.3c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University Hospital of Alava, University of the Basque Country, CIBERSAM,</institution>
</institution-wrap>
Vitoria, Spain</aff>
<aff id="Aff22"><label>22</label>
Mood Disorders Center of Ottawa, Ottawa, Canada</aff>
<aff id="Aff23"><label>23</label>
<institution-wrap><institution-id institution-id-type="GRID">grid.17063.33</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Toronto,</institution>
</institution-wrap>
Ontario, Canada</aff>
<aff id="Aff24"><label>24</label>
<institution-wrap><institution-id institution-id-type="GRID">grid.417102.1</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Tokyo Metropolitan Matsuzawa Hospital,</institution>
</institution-wrap>
Setagaya, Tokyo Japan</aff>
<aff id="Aff25"><label>25</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0376 4727</institution-id>
<institution-id institution-id-type="GRID">grid.7273.1</institution-id>
<institution>Department of Psychology & Aston Brain Centre,</institution>
<institution>Aston University,</institution>
</institution-wrap>
Birmingham, UK</aff>
<aff id="Aff26"><label>26</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2353 6535</institution-id>
<institution-id institution-id-type="GRID">grid.428999.7</institution-id>
<institution></institution>
<institution>Institut Pasteur, Unité Perception et Mémoire,</institution>
</institution-wrap>
F-75015 Paris, France</aff>
<aff id="Aff27"><label>27</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1937 0247</institution-id>
<institution-id institution-id-type="GRID">grid.5841.8</institution-id>
<institution>Bipolar Disorders Program, Hospital Clinic,</institution>
<institution>University of Barcelona, IDIBAPS, CIBERSAM,</institution>
</institution-wrap>
Barcelona, Catalonia Spain</aff>
<aff id="Aff28"><label>28</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1516 2246</institution-id>
<institution-id institution-id-type="GRID">grid.416861.c</institution-id>
<institution>Department of Clinical Psychology,</institution>
<institution>NIMHANS,</institution>
</institution-wrap>
Bangalore, 560029 India</aff>
<aff id="Aff29"><label>29</label>
<institution-wrap><institution-id institution-id-type="GRID">grid.420868.0</institution-id>
<institution></institution>
<institution>Leicestershire Partnership NHS Trust,</institution>
</institution-wrap>
Leicester, UK</aff>
<aff id="Aff30"><label>30</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1794 2766</institution-id>
<institution-id institution-id-type="GRID">grid.415504.1</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Kowloon Hospital,</institution>
</institution-wrap>
Hong Kong, China</aff>
<aff id="Aff31"><label>31</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0646 7349</institution-id>
<institution-id institution-id-type="GRID">grid.27530.33</institution-id>
<institution></institution>
<institution>Aalborg University Hospital, Psychiatry,</institution>
</institution-wrap>
Aalborg, Denmark</aff>
<aff id="Aff32"><label>32</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0742 471X</institution-id>
<institution-id institution-id-type="GRID">grid.5117.2</institution-id>
<institution>Department of Clinical Medicine,</institution>
<institution>Aalborg University,</institution>
</institution-wrap>
Aalborg, Denmark</aff>
<aff id="Aff33"><label>33</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1090 049X</institution-id>
<institution-id institution-id-type="GRID">grid.4495.c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>Wroclaw Medical University,</institution>
</institution-wrap>
Wroclaw, Poland</aff>
<aff id="Aff34"><label>34</label>
Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI USA</aff>
<aff id="Aff35"><label>35</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2107 4242</institution-id>
<institution-id institution-id-type="GRID">grid.266100.3</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of California San Diego,</institution>
</institution-wrap>
San Diego, CA USA</aff>
<aff id="Aff36"><label>36</label>
<institution-wrap><institution-id institution-id-type="GRID">grid.272456.0</institution-id>
<institution>Affective Disorders Research Project,</institution>
<institution>Tokyo Metropolitan Institute of Medical Science,</institution>
</institution-wrap>
Setagaya, Tokyo Japan</aff>
<aff id="Aff37"><label>37</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0578 8220</institution-id>
<institution-id institution-id-type="GRID">grid.411088.4</institution-id>
<institution>Department of Psychiatry, Psychosomatic Medicine and Psychotherapy,</institution>
<institution>University Hospital Frankfurt, Goethe-University,</institution>
</institution-wrap>
Frankfurt am Main, Germany</aff>
<aff id="Aff38"><label>38</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2205 0971</institution-id>
<institution-id institution-id-type="GRID">grid.22254.33</institution-id>
<institution>Department of Adult Psychiatry,</institution>
<institution>Poznan University of Medical Sciences,,</institution>
</institution-wrap>
Poznan, Poland</aff>
<aff id="Aff39"><label>39</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2179 926X</institution-id>
<institution-id institution-id-type="GRID">grid.266756.6</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>University of Missouri Kansas City School of Medicine,</institution>
</institution-wrap>
Kansas City, MO USA</aff>
<aff id="Aff40"><label>40</label>
Croton on Hudson, NY USA</aff>
<aff id="Aff41"><label>41</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0372 8259</institution-id>
<institution-id institution-id-type="GRID">grid.8399.b</institution-id>
<institution>Department of Neuroscience and Mental Health,</institution>
<institution>Federal University of Bahia,</institution>
</institution-wrap>
Salvador, Brazil</aff>
<aff id="Aff42"><label>42</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2308 5949</institution-id>
<institution-id institution-id-type="GRID">grid.10347.31</institution-id>
<institution>Department of Psychological Medicine, Faculty of Medicine,</institution>
<institution>University of Malaya,</institution>
</institution-wrap>
Kuala Lumpur, Malaysia</aff>
<aff id="Aff43"><label>43</label>
City of Helsinki, Department of Social Services and Health Care, Psychiatry, Helsinki, Finland</aff>
<aff id="Aff44"><label>44</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000000121742757</institution-id>
<institution-id institution-id-type="GRID">grid.194645.b</institution-id>
<institution>Department of Psychiatry, Department of Medicine,</institution>
<institution>University of Hong Kong,</institution>
</institution-wrap>
Hong Kong, China</aff>
<aff id="Aff45"><label>45</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8795 072X</institution-id>
<institution-id institution-id-type="GRID">grid.240206.2</institution-id>
<institution></institution>
<institution>Harvard Medical School–McLean Hospital,</institution>
</institution-wrap>
Boston, MA USA</aff>
<aff id="Aff46"><label>46</label>
Lucio Bini Center, Cagliari e Roma, Italy</aff>
<aff id="Aff47"><label>47</label>
Psychiatric Center Copenhagen, Copenhagen, Denmark</aff>
<aff id="Aff48"><label>48</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1516 2246</institution-id>
<institution-id institution-id-type="GRID">grid.416861.c</institution-id>
<institution>Department of Psychiatry,</institution>
<institution>NIMHANS,</institution>
</institution-wrap>
Bangalore, 560029 India</aff>
<aff id="Aff49"><label>49</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9006 1798</institution-id>
<institution-id institution-id-type="GRID">grid.254024.5</institution-id>
<institution>Department of Psychology,</institution>
<institution>Chapman University,</institution>
</institution-wrap>
Orange, CA USA</aff>
<aff id="Aff50"><label>50</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9632 6718</institution-id>
<institution-id institution-id-type="GRID">grid.19006.3e</institution-id>
<institution>Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior,</institution>
<institution>University of California Los Angeles (UCLA),</institution>
</institution-wrap>
Los Angeles, CA USA</aff>
</contrib-group>
<pub-date pub-type="epub"><day>24</day>
<month>8</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>24</day>
<month>8</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><year>2016</year>
</pub-date>
<volume>4</volume>
<elocation-id>17</elocation-id>
<history><date date-type="received"><day>25</day>
<month>6</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>9</day>
<month>8</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>© The Author(s) 2016</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>Information seeking is an important coping mechanism for dealing with chronic illness. Despite a growing number of mental health websites, there is little understanding of how patients with bipolar disorder use the Internet to seek information.</p>
</sec>
<sec><title>Methods</title>
<p>A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries as a convenience sample between March 2014 and January 2016. All patients had a diagnosis of bipolar disorder from a psychiatrist. Data were analyzed using descriptive statistics and generalized estimating equations to account for correlated data.</p>
</sec>
<sec><title>Results</title>
<p>976 (81 % of 1212 valid responses) of the patients used the Internet, and of these 750 (77 %) looked for information on bipolar disorder. When looking online for information, 89 % used a computer rather than a smartphone, and 79 % started with a general search engine. The primary reasons for searching were drug side effects (51 %), to learn anonymously (43 %), and for help coping (39 %). About 1/3 rated their search skills as expert, and 2/3 as basic or intermediate. 59 % preferred a website on mental illness and 33 % preferred Wikipedia. Only 20 % read or participated in online support groups. Most patients (62 %) searched a couple times a year. Online information seeking helped about 2/3 to cope (41 % of the entire sample). About 2/3 did not discuss Internet findings with their doctor.</p>
</sec>
<sec><title>Conclusion</title>
<p>Online information seeking helps many patients to cope although alternative information sources remain important. Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand limitations of online privacy. More patient education about online information searching is needed and physicians should recommend a few high quality websites.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s40345-016-0058-0) contains supplementary material, which is available to authorized users.</p>
</sec>
</abstract>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2016</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
<body><sec id="Sec1"><title>Background</title>
<p>Information seeking is an important aspect of coping with chronic illness (Lambert and Loiselle <xref ref-type="bibr" rid="CR58">2007</xref>
; Brashers et al. <xref ref-type="bibr" rid="CR11">2002</xref>
) and many patients with bipolar disorder want to learn more (Hallett et al. <xref ref-type="bibr" rid="CR39">2013</xref>
; Giacco et al. <xref ref-type="bibr" rid="CR33">2014</xref>
). The majority of patients with bipolar disorder would prefer to learn about their illness through a face-to-face conversation with their physician, as do patients with other mental and physical illness (Hallett et al. <xref ref-type="bibr" rid="CR39">2013</xref>
; Gaglio et al. <xref ref-type="bibr" rid="CR31">2012</xref>
; Hesse et al. <xref ref-type="bibr" rid="CR43">2005</xref>
; Horgan and Sweeney <xref ref-type="bibr" rid="CR46">2010</xref>
). This is often not feasible due to the large number of questions that will arise over the long term and the limited access to the treating psychiatrist. Due to the unique properties of the Internet, both patients and providers view it as an important source of all medical information, including information about bipolar disorder. The Internet is available globally, can be accessed on the patient’s schedule and content can be read at the patient’s pace (Korp <xref ref-type="bibr" rid="CR56">2006</xref>
). Another unique aspect is that healthcare web sites are often viewed by patients in many countries (Leon and Fontelo <xref ref-type="bibr" rid="CR61">2016</xref>
; Heilman and West <xref ref-type="bibr" rid="CR42">2015</xref>
). For healthcare providers, large numbers of patients can be reached at a reasonable cost with a website.</p>
<p>The goal of this study was to better understand online information seeking by patients with bipolar disorder. This was investigated using an anonymous patient survey completed by 1222 patients with bipolar disorder in 17 countries. Our initial findings, reported previously, were that the patients used the Internet at a percentage that was similar to the general public (81 %), and that 78 % of the Internet users looked online for information on bipolar disorder or 63 % of the total sample (Bauer et al. <xref ref-type="bibr" rid="CR5">2016</xref>
). The patients who looked online for information also consulted medical professionals plus other information sources, such as printed media, physician handouts, television, and other patients with bipolar disorder. This analysis will focus on the patterns of online information seeking, including why and how patients with bipolar disorder find information online, what information they are looking for, and the impact of information seeking.</p>
</sec>
<sec id="Sec2"><title>Methods</title>
<p>An anonymous, one-time survey was completed by patients with bipolar disorder. To maximize participation and minimize bias, the survey was paper-based and was translated into the local language. With a paper-based survey, patients without Internet skills or online access could be included. The treating psychiatrist provided the diagnosis, age of onset, and years of education for each patient. This study was approved by institutional review boards in accordance with local requirements.</p>
<sec id="Sec3"><title>Survey</title>
<p>The survey contained 39 questions and took about 20 min to complete. The complete survey in English is available in the Additional file <xref rid="MOESM1" ref-type="media">1</xref>
. The survey topics included questions about demographics, living with bipolar disorder, Internet use, online information seeking, and participation in online support groups. Questions 21–35 about online information seeking were analyzed here. The questions on Internet access were analyzed previously (Bauer et al. <xref ref-type="bibr" rid="CR5">2016</xref>
). The survey was translated into 12 local languages: Chinese, Danish, Finnish, French, German, Hebrew, Italian, Japanese, Polish, Portuguese, Spanish, and English (versions for US/Canada, UK and Australia). A convenience sample was collected between March 2014 and January 2016. In total, 1222 surveys were received: from Australia (<italic>N</italic>
 = 22), Brazil (<italic>N</italic>
 = 100), Canada (<italic>N</italic>
 = 109), Denmark (<italic>N</italic>
 = 209), Finland (<italic>N</italic>
 = 16), France (<italic>N</italic>
 = 50), Germany (<italic>N</italic>
 = 82), Hong Kong (<italic>N</italic>
 = 91), India (<italic>N</italic>
 = 30), Israel (<italic>N</italic>
 = 46), Italy (<italic>N</italic>
 = 80), Japan (<italic>N</italic>
 = 35), Malaysia (<italic>N</italic>
 = 25), Poland (<italic>N</italic>
 = 125), Spain (<italic>N</italic>
 = 82), UK (<italic>N</italic>
 = 50), and the US (<italic>N</italic>
 = 70). The treatment settings included private practice, university clinics, and community mental health centers.</p>
<p>Duplicate data entry was used for quality control with the paper-based surveys (Kawado et al. <xref ref-type="bibr" rid="CR52">2003</xref>
; Neaton et al. <xref ref-type="bibr" rid="CR82">1990</xref>
). Automated logic checking of numeric fields was implemented as appropriate. More details about the survey methodology and validation were published previously (Bauer et al. <xref ref-type="bibr" rid="CR5">2016</xref>
).</p>
</sec>
<sec id="Sec4"><title>Country variables</title>
<p>Since this was an international sample, country specific variables as well as the individual survey responses were included in the analysis. The county specific variables include the mean years of education for adults age ≥25 years (UNESCO <xref ref-type="bibr" rid="CR107">2015</xref>
), education ratio (for those age ≥25 years, patient years of education compared to the mean years of education for general population), telecommunications data, and Hofstede’s cultural dimensions (Hofstsede <xref ref-type="bibr" rid="CR45">2016</xref>
). The Hofstede’s power distance index (PDI) is a measure of social inequality where a lower number means that societies are questioning authority and striving to equalize the distribution of power.</p>
</sec>
<sec id="Sec5"><title>Statistics</title>
<p>Explanatory models were estimated to gain insight into relationships among survey responses, external variables and demographics. The generalized estimating equation (GEE) statistical technique was selected to overcome the imbalance in the number of responses from the collection sites, and to account for the correlation in survey responses among the collection sites. The GEE models were estimated using a binomial distribution, independent working correlation matrix and a logit link function. Many individual and country specific variables were similar and correlated. The potential variables from univariate analyses that were significant at a level of 0.05 were entered into multivariate models, and the corrected quasi-likelihood independence model criterion was used to assist with multivariate model fitting (Pan <xref ref-type="bibr" rid="CR87">2001</xref>
). The odds ratios and confidence intervals generated by the GEEs are reported.</p>
<p>Descriptive statistics are reported for demographic variables. Survey responses are also summarized as the mean value of the individual country means. SPSS version 23.0 was used for all analyses.</p>
</sec>
</sec>
<sec id="Sec6"><title>Results</title>
<p>The survey was completed by 1222 patients, with 51 more surveys received since the first analysis (Bauer et al. <xref ref-type="bibr" rid="CR5">2016</xref>
). With 1212 valid responses, 976 (81 %) patients used the Internet. Of the 972 valid responses, 750 (77 %) used the Internet to look up information about bipolar disorder or 61 % of the total sample. The demographics for all patients who completed the survey and for the patients who used the Internet to find information about bipolar disorder are shown in Table <xref rid="Tab1" ref-type="table">1</xref>
. The 750 patients who used the Internet to find information on bipolar disorder had a mean age of 41 years ± 12.5, were 62 % female, and had a mean of 14 ± 3.0 years of education.<table-wrap id="Tab1"><label>Table 1</label>
<caption><p>Patient demographics</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2">Variable</th>
<th align="left" rowspan="2">Value</th>
<th align="left" colspan="2">All patients (<italic>N</italic>
 = 1222)</th>
<th align="left" colspan="2">Used Internet to find out about bipolar disorder (BP) (<italic>N</italic>
 = 750)</th>
</tr>
<tr><th align="left"><italic>N</italic>
<sup>a</sup>
</th>
<th align="left">%</th>
<th align="left"><italic>N</italic>
<sup>a</sup>
</th>
<th align="left">%</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="3">Diagnosis</td>
<td align="left">BP I</td>
<td char="." align="char">768</td>
<td char="." align="char">63.7</td>
<td char="." align="char">440</td>
<td char="." align="char">59.7</td>
</tr>
<tr><td align="left">BP II</td>
<td char="." align="char">380</td>
<td char="." align="char">31.6</td>
<td char="." align="char">256</td>
<td char="." align="char">34.7</td>
</tr>
<tr><td align="left">BP NOS</td>
<td char="." align="char">57</td>
<td char="." align="char">4.7</td>
<td char="." align="char">41</td>
<td char="." align="char">5.6</td>
</tr>
<tr><td align="left" rowspan="2">Gender</td>
<td align="left">Female</td>
<td char="." align="char">759</td>
<td char="." align="char">62.3</td>
<td char="." align="char">465</td>
<td char="." align="char">62.2</td>
</tr>
<tr><td align="left">Male</td>
<td char="." align="char">459</td>
<td char="." align="char">37.7</td>
<td char="." align="char">283</td>
<td char="." align="char">37.8</td>
</tr>
<tr><td align="left" rowspan="3">Area of residence</td>
<td align="left">Urban</td>
<td char="." align="char">744</td>
<td char="." align="char">61.2</td>
<td char="." align="char">451</td>
<td char="." align="char">60.3</td>
</tr>
<tr><td align="left">Suburban</td>
<td char="." align="char">291</td>
<td char="." align="char">23.9</td>
<td char="." align="char">196</td>
<td char="." align="char">26.2</td>
</tr>
<tr><td align="left">Rural</td>
<td char="." align="char">181</td>
<td char="." align="char">14.9</td>
<td char="." align="char">101</td>
<td char="." align="char">13.5</td>
</tr>
<tr><td align="left" rowspan="2">Employment status</td>
<td align="left">Full-time</td>
<td char="." align="char">560</td>
<td char="." align="char">46.6</td>
<td char="." align="char">396</td>
<td char="." align="char">53.6</td>
</tr>
<tr><td align="left">Not full-time</td>
<td char="." align="char">641</td>
<td char="." align="char">53.4</td>
<td char="." align="char">343</td>
<td char="." align="char">46.4</td>
</tr>
<tr><td align="left" rowspan="2">Marital status</td>
<td align="left">Married</td>
<td char="." align="char">593</td>
<td char="." align="char">48.9</td>
<td char="." align="char">359</td>
<td char="." align="char">48.3</td>
</tr>
<tr><td align="left">Not married</td>
<td char="." align="char">619</td>
<td char="." align="char">51.1</td>
<td char="." align="char">385</td>
<td char="." align="char">51.7</td>
</tr>
<tr><td align="left" rowspan="3">Income group</td>
<td align="left">Upper income</td>
<td char="." align="char">80</td>
<td char="." align="char">6.6</td>
<td char="." align="char">60</td>
<td char="." align="char">8.1</td>
</tr>
<tr><td align="left">Middle income</td>
<td char="." align="char">594</td>
<td char="." align="char">49.1</td>
<td char="." align="char">363</td>
<td char="." align="char">48.9</td>
</tr>
<tr><td align="left">Lower income</td>
<td char="." align="char">535</td>
<td char="." align="char">44.3</td>
<td char="." align="char">320</td>
<td char="." align="char">43.1</td>
</tr>
<tr><td align="left" rowspan="2">Live alone</td>
<td align="left">Yes</td>
<td char="." align="char">299</td>
<td char="." align="char">24.7</td>
<td char="." align="char">190</td>
<td char="." align="char">25.5</td>
</tr>
<tr><td align="left">No</td>
<td char="." align="char">913</td>
<td char="." align="char">75.3</td>
<td char="." align="char">556</td>
<td char="." align="char">74.5</td>
</tr>
<tr><td align="left" rowspan="2">Mood in last six months</td>
<td align="left">Mostly normal</td>
<td char="." align="char">581</td>
<td char="." align="char">47.9</td>
<td char="." align="char">317</td>
<td char="." align="char">42.6</td>
</tr>
<tr><td align="left">Mostly not normal</td>
<td char="." align="char">632</td>
<td char="." align="char">52.1</td>
<td char="." align="char">428</td>
<td char="." align="char">57.4</td>
</tr>
<tr><td align="left" rowspan="2">BP interfered with regular activities</td>
<td align="left">Frequently or sometimes</td>
<td char="." align="char">768</td>
<td char="." align="char">63.2</td>
<td char="." align="char">524</td>
<td char="." align="char">70.1</td>
</tr>
<tr><td align="left">Rarely or never</td>
<td char="." align="char">448</td>
<td char="." align="char">36.8</td>
<td char="." align="char">223</td>
<td char="." align="char">29.9</td>
</tr>
<tr><td align="left" rowspan="2">Confident managing living</td>
<td align="left">Very confident</td>
<td char="." align="char">454</td>
<td char="." align="char">37.5</td>
<td char="." align="char">259</td>
<td char="." align="char">34.8</td>
</tr>
<tr><td align="left">Not very confident</td>
<td char="." align="char">757</td>
<td char="." align="char">62.5</td>
<td char="." align="char">486</td>
<td char="." align="char">65.2</td>
</tr>
<tr><td align="left" rowspan="2">Confident when to see doctor about BP</td>
<td align="left">Very confident</td>
<td char="." align="char">698</td>
<td char="." align="char">57.4</td>
<td char="." align="char">418</td>
<td char="." align="char">56.0</td>
</tr>
<tr><td align="left">Not very confident</td>
<td char="." align="char">518</td>
<td char="." align="char">42.6</td>
<td char="." align="char">328</td>
<td char="." align="char">44.0</td>
</tr>
</tbody>
</table>
<table frame="hsides" rules="groups"><thead><tr><th align="left" colspan="2">Means</th>
<th align="left">N<sup>a</sup>
</th>
<th align="left">Mean (SD)</th>
<th align="left">N<sup>a</sup>
</th>
<th align="left">Mean (SD)</th>
</tr>
</thead>
<tbody><tr><td align="left" colspan="2">Age</td>
<td char="." align="char">1217</td>
<td char="(" align="char">44.4 (13.8)</td>
<td char="." align="char">748</td>
<td char="(" align="char">41.1 (12.5)</td>
</tr>
<tr><td align="left" colspan="2">Years of education</td>
<td char="." align="char">1199</td>
<td char="(" align="char">14.0 (3.2)</td>
<td char="." align="char">737</td>
<td char="(" align="char">14.4 (3.0)</td>
</tr>
<tr><td align="left" colspan="2">Age of onset</td>
<td char="." align="char">1201</td>
<td char="(" align="char">27.1 (10.9)</td>
<td char="." align="char">734</td>
<td char="(" align="char">25.6 (10.1)</td>
</tr>
<tr><td align="left" colspan="2">Years of Illness</td>
<td char="." align="char">1194</td>
<td char="(" align="char">17.4 (12.2)</td>
<td char="." align="char">730</td>
<td char="(" align="char">15.6 (11.6)</td>
</tr>
</tbody>
</table>
<table-wrap-foot><p><sup>a</sup>
Missing values not included</p>
</table-wrap-foot>
</table-wrap>
</p>
<sec id="Sec7"><title>Survey responses</title>
<p>The most common responses to the questions are shown as the mean value of the individual country means in Table <xref rid="Tab2" ref-type="table">2</xref>
. When looking for information about bipolar disorder, 89 % used a computer and 11 % used a smartphone or tablet. When online, 79 % started looking with a general search engine. 69 % of the patients rated their Internet search skills as basic or intermediate, and 31 % as expert. When searching, 16 % indicated that they always find what they are looking for, 57 % most of the time, 19 % half of the time, 8 % less than half, and 0.3 % never. The primary reasons that patients searched included side effects from prescription drugs (51 %), to learn anonymously (43 %), and because they need help coping (39 %). 62 % of the patients looked for information a couple of times a year, and 38 % looked monthly or more frequently.<table-wrap id="Tab2"><label>Table 2</label>
<caption><p>Summary of responses from the patients who used the Internet to find information on bipolar disorder (<italic>N</italic>
 = 750)</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left">Question number</th>
<th align="left">Question<sup>a</sup>
</th>
<th align="left">Valid responses <italic>N</italic>
</th>
<th align="left">Variable</th>
<th align="left">Mean percent<sup>b</sup>
 (%)</th>
<th align="left">SD<sup>c</sup>
</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="2">21<sup>d</sup>
</td>
<td align="left" rowspan="2">How do you access the Internet?</td>
<td char="." align="char">607</td>
<td align="left">From a computer</td>
<td align="left">89</td>
<td char="." align="char">0.1221</td>
</tr>
<tr><td char="." align="char">607</td>
<td align="left">From a smartphone or tablet</td>
<td align="left">11</td>
<td char="." align="char">0.1221</td>
</tr>
<tr><td align="left" rowspan="2">22</td>
<td align="left" rowspan="2">How do you rate your Internet search skills?</td>
<td char="." align="char">746</td>
<td align="left">Basic or intermediate</td>
<td align="left">69</td>
<td char="." align="char">0.1288</td>
</tr>
<tr><td char="." align="char">746</td>
<td align="left">Expert</td>
<td align="left">31</td>
<td char="." align="char">0.1288</td>
</tr>
<tr><td align="left" rowspan="4">23</td>
<td align="left" rowspan="4">How do you start looking for information about bipolar disorder?</td>
<td char="." align="char">623</td>
<td align="left">General search engine</td>
<td align="left">79</td>
<td char="." align="char">0.0816</td>
</tr>
<tr><td char="." align="char">623</td>
<td align="left">Medical search engine</td>
<td align="left">6</td>
<td char="." align="char">0.0478</td>
</tr>
<tr><td char="." align="char">623</td>
<td align="left">Specific site on mental illness</td>
<td align="left">10</td>
<td char="." align="char">0.0640</td>
</tr>
<tr><td char="." align="char">623</td>
<td align="left">Other</td>
<td align="left">6</td>
<td char="." align="char">0.0475</td>
</tr>
<tr><td align="left" rowspan="5">24</td>
<td align="left" rowspan="5">Do you find what you are looking for?</td>
<td char="." align="char">733</td>
<td align="left">Always</td>
<td align="left">16</td>
<td char="." align="char">0.1094</td>
</tr>
<tr><td char="." align="char">733</td>
<td align="left">Most of the time</td>
<td align="left">57</td>
<td char="." align="char">0.1277</td>
</tr>
<tr><td char="." align="char">733</td>
<td align="left">About half the time</td>
<td align="left">19</td>
<td char="." align="char">0.0847</td>
</tr>
<tr><td char="." align="char">733</td>
<td align="left">Less than half the time</td>
<td align="left">8</td>
<td char="." align="char">0.0865</td>
</tr>
<tr><td char="." align="char">733</td>
<td align="left">Never</td>
<td align="left">0.3</td>
<td char="." align="char">0.0073</td>
</tr>
<tr><td align="left" rowspan="4">25</td>
<td align="left" rowspan="4">Do you look for these topics relating to bipolar disorder?<sup>e</sup>
</td>
<td char="." align="char">742</td>
<td align="left">Prescription drug information</td>
<td align="left">73</td>
<td char="." align="char">0.1363</td>
</tr>
<tr><td char="." align="char">742</td>
<td align="left">Symptoms</td>
<td align="left">83</td>
<td char="." align="char">0.1173</td>
</tr>
<tr><td char="." align="char">742</td>
<td align="left">General course of illness</td>
<td align="left">58</td>
<td char="." align="char">0.1268</td>
</tr>
<tr><td char="." align="char">742</td>
<td align="left">Coping strategies</td>
<td align="left">52</td>
<td char="." align="char">0.1774</td>
</tr>
<tr><td align="left" rowspan="3">26</td>
<td align="left" rowspan="3">Do you look for these topics relating to getting treatment for bipolar disorder?<sup>e</sup>
</td>
<td char="." align="char">542</td>
<td align="left">Clinic hours, location and directions</td>
<td align="left">52</td>
<td char="." align="char">0.2079</td>
</tr>
<tr><td char="." align="char">542</td>
<td align="left">Physician or therapist credentials</td>
<td align="left">31</td>
<td char="." align="char">0.1633</td>
</tr>
<tr><td char="." align="char">542</td>
<td align="left">Physician or therapist ratings</td>
<td align="left">24</td>
<td char="." align="char">0.1711</td>
</tr>
<tr><td align="left" rowspan="2">27</td>
<td align="left" rowspan="2">How frequently do you search for information about bipolar disorder?<sup>e</sup>
</td>
<td char="." align="char">738</td>
<td align="left">Monthly or more</td>
<td align="left">38</td>
<td char="." align="char">0.1620</td>
</tr>
<tr><td char="." align="char">738</td>
<td align="left">Couple of times a year</td>
<td align="left">62</td>
<td char="." align="char">0.1620</td>
</tr>
<tr><td align="left" rowspan="3">28</td>
<td align="left" rowspan="3">Why do you search for information about bipolar disorder on the Internet?<sup>e</sup>
</td>
<td char="." align="char">735</td>
<td align="left">To learn anonymously</td>
<td align="left">43</td>
<td char="." align="char">0.1600</td>
</tr>
<tr><td char="." align="char">735</td>
<td align="left">Side effects from prescription drugs</td>
<td align="left">51</td>
<td char="." align="char">0.1184</td>
</tr>
<tr><td char="." align="char">735</td>
<td align="left">Need help coping with the illness</td>
<td align="left">39</td>
<td char="." align="char">0.1706</td>
</tr>
<tr><td align="left" rowspan="3">29</td>
<td align="left" rowspan="3">What are your favorite sources of information about bipolar disorder?<sup>e</sup>
</td>
<td char="." align="char">727</td>
<td align="left">Specific sites on mental health or bipolar disorder</td>
<td align="left">59</td>
<td char="." align="char">0.1744</td>
</tr>
<tr><td char="." align="char">727</td>
<td align="left">Online encyclopedia such as Wikipedia</td>
<td align="left">33</td>
<td char="." align="char">0.0843</td>
</tr>
<tr><td char="." align="char">727</td>
<td align="left">Government sponsored sites</td>
<td align="left">21</td>
<td char="." align="char">0.2168</td>
</tr>
<tr><td align="left" rowspan="2">30</td>
<td align="left" rowspan="2">Do you discuss online information about bipolar disorder with your doctor?</td>
<td char="." align="char">737</td>
<td align="left">Sometimes or frequently</td>
<td align="left">33</td>
<td char="." align="char">0.1178</td>
</tr>
<tr><td char="." align="char">737</td>
<td align="left">Rarely</td>
<td align="left">67</td>
<td char="." align="char">0.1178</td>
</tr>
<tr><td align="left" rowspan="2">31</td>
<td align="left" rowspan="2">Does the online information help you cope with bipolar disorder?</td>
<td char="." align="char">733</td>
<td align="left">Sometimes for frequently</td>
<td align="left">67</td>
<td char="." align="char">0.1477</td>
</tr>
<tr><td char="." align="char">733</td>
<td align="left">Rarely</td>
<td align="left">33</td>
<td char="." align="char">0.1477</td>
</tr>
<tr><td align="left">32</td>
<td align="left">Do you attempt to verify online information?</td>
<td char="." align="char">735</td>
<td align="left">Yes</td>
<td align="left">66</td>
<td char="." align="char">0.1158</td>
</tr>
<tr><td align="left" rowspan="3">33</td>
<td align="left" rowspan="3">How do you attempt to verify online information?<sup>e,f</sup>
</td>
<td char="." align="char">428</td>
<td align="left">Discuss with doctor</td>
<td align="left">62</td>
<td char="." align="char">0.1633</td>
</tr>
<tr><td char="." align="char">428</td>
<td align="left">Discuss with family and friends</td>
<td align="left">37</td>
<td char="." align="char">0.1536</td>
</tr>
<tr><td char="." align="char">428</td>
<td align="left">Compare information on multiple sites</td>
<td align="left">56</td>
<td char="." align="char">0.1620</td>
</tr>
<tr><td align="left" rowspan="2">34</td>
<td align="left" rowspan="2">How concerned are you about privacy and confidentiality?</td>
<td char="." align="char">723</td>
<td align="left">Moderately or very concerned</td>
<td align="left">32</td>
<td char="." align="char">0.1788</td>
</tr>
<tr><td char="." align="char">723</td>
<td align="left">Slightly concerned</td>
<td align="left">68</td>
<td char="." align="char">0.1788</td>
</tr>
<tr><td align="left">35</td>
<td align="left">Do you participate in patient support groups?</td>
<td char="." align="char">746</td>
<td align="left">Yes</td>
<td align="left">20</td>
<td char="." align="char">0.0883</td>
</tr>
</tbody>
</table>
<table-wrap-foot><p><sup>a</sup>
See survey for details and exact wording</p>
<p><sup>b</sup>
Overall mean of country means</p>
<p><sup>c</sup>
Standard deviation of country means</p>
<p><sup>d</sup>
Survey questions 1–16 on demographics; questions 17-20 analyzed previously (Bauer et al. <xref ref-type="bibr" rid="CR5">2016</xref>
)</p>
<p><sup>e</sup>
More than one response allowed</p>
<p><sup>f</sup>
Only completed by those who attempt to verify information (<italic>N</italic>
 = 485)</p>
</table-wrap-foot>
</table-wrap>
</p>
<p>The patients looked frequently for a variety of topics related to bipolar disorder including symptoms (83 %), prescription drug information (73 %), general course of illness (58 %), coping strategies (52 %), and side effects from prescription drugs (51 %). The patients also looked for topics related to the healthcare system, although the percentage of missing responses differed among the countries. The patients looked frequently for clinic hours, location and driving instructions (52 %), physician credentials (31 %) and physician ratings (24 %). Patients looked less frequently for all remaining responses. For favorite sources of information, 59 % indicated a specific site on mental health or bipolar disorder, 33 % indicated Wikipedia and 21 % a government sponsored site. 66 % of the patients said they attempted to verify the information found online, primarily by discussing with a doctor (62 %) or comparing information on multiple sites (56 %).</p>
<p>67 % of the patients rarely or never discussed what they found online with their doctors, while 33 % sometimes or frequently did. 67 % of the patients said that information seeking online helped them to cope sometimes or frequently, while 33 % said rarely or never. Only 32 % of the patients were moderately or very concerned about privacy while 68 % were slightly or not concerned. Only 20 % of the patients read or participated in online support groups.</p>
</sec>
<sec id="Sec8"><title>Explanatory models</title>
<p>The details for the explanatory models are shown in Table <xref rid="Tab3" ref-type="table">3</xref>
. To explain Internet skills self-rated as expert, the estimated coefficients from the best fitting model suggested that a 1 year increase in age will decrease the odds of having expert skills by 3 %, having Wikipedia as a favorite source will increase the odds by 49 %, attempting to verify the information found online will increase the odds by 72 %, being male will increase the odds by 89 %, and feeling very confident about when to see the doctor about bipolar disorder will increase the odds by 89 %.<table-wrap id="Tab3"><label>Table 3</label>
<caption><p>Explanatory models based on responses from the patients who used the Internet to find information on bipolar disorder (<italic>N</italic>
 = 750)</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2">Question number</th>
<th align="left" colspan="2">Dependent variable</th>
<th align="left" rowspan="2"><italic>N</italic>
</th>
<th align="left" colspan="4">Independent variables</th>
</tr>
<tr><th align="left">Question<sup>a</sup>
</th>
<th align="left">Answer<sup>b</sup>
</th>
<th align="left">Parameter</th>
<th align="left">Significance</th>
<th align="left">OR</th>
<th align="left">95 % CI</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="6">22</td>
<td align="left" rowspan="6">How do you rate your Internet search skills?</td>
<td align="left" rowspan="6">Expert</td>
<td align="left" rowspan="6">725</td>
<td align="left">Intercept</td>
<td char="." align="char">0.010</td>
<td char="." align="char">0.463</td>
<td align="left">0.257, 0.835</td>
</tr>
<tr><td align="left">Age</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">0.970</td>
<td align="left">0.956,0.984</td>
</tr>
<tr><td align="left">Male</td>
<td char="." align="char">0.004</td>
<td char="." align="char">1.892</td>
<td align="left">1.221, 2.931</td>
</tr>
<tr><td align="left">Very confident when to see the doctor</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">1.891</td>
<td align="left">1.354, 2.639</td>
</tr>
<tr><td align="left">Favorite source Wikipedia</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">1.487</td>
<td align="left">1.221,1.812</td>
</tr>
<tr><td align="left">Attempt to verify the online information</td>
<td char="." align="char">0.003</td>
<td char="." align="char">1.717</td>
<td align="left">1.198, 2.460</td>
</tr>
<tr><td align="left" rowspan="2">24</td>
<td align="left" rowspan="2">Do you find what you are looking for?</td>
<td align="left" rowspan="2">Always</td>
<td align="left" rowspan="2">661</td>
<td align="left">Intercept</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">0.203</td>
<td align="left">0.127, 0.323</td>
</tr>
<tr><td align="left">Consult more than one medical professional (e.g., counselor or psychologist) plus psychiatrist</td>
<td char="." align="char">0.033</td>
<td char="." align="char">0.588</td>
<td align="left">0.361, 0.958</td>
</tr>
<tr><td align="left" rowspan="9">27</td>
<td align="left" rowspan="9">How frequently do you search for information about bipolar disorder?</td>
<td align="left" rowspan="9">Monthly or more often</td>
<td align="left" rowspan="9">703</td>
<td align="left">Intercept</td>
<td char="." align="char">0.006</td>
<td char="." align="char">0.310</td>
<td align="left">0.135, 0.709</td>
</tr>
<tr><td align="left">Education ratio</td>
<td char="." align="char">0.004</td>
<td char="." align="char">0.621</td>
<td align="left">0.448, 0.858</td>
</tr>
<tr><td align="left">Male</td>
<td char="." align="char">0.025</td>
<td char="." align="char">1.525</td>
<td align="left">1.054, 2.207</td>
</tr>
<tr><td align="left">Mostly normal last 6 months</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">0.395</td>
<td align="left">0.262, 0.596</td>
</tr>
<tr><td align="left">Bipolar disorder interferes frequently or sometimes</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">1.952</td>
<td align="left">1.406, 2.711</td>
</tr>
<tr><td align="left">Search for side effects from prescription drugs</td>
<td char="." align="char">0.021</td>
<td char="." align="char">1.465</td>
<td align="left">1.060, 2.024</td>
</tr>
<tr><td align="left">Favorite source are specific sites on mental health</td>
<td char="." align="char">0.021</td>
<td char="." align="char">1.292</td>
<td align="left">1.039, 1.607</td>
</tr>
<tr><td align="left">Online information helps to cope</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">2.699</td>
<td align="left">2.008, 3.627</td>
</tr>
<tr><td align="left">Participate in online support groups</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">2.286</td>
<td align="left">1.552, 3.367</td>
</tr>
<tr><td align="left" rowspan="4">29</td>
<td align="left" rowspan="6">What are your favorite sources of information about bipolar disorder?</td>
<td align="left" rowspan="6">Specific sites on mental health or bipolar disorder</td>
<td align="left">642</td>
<td align="left">Intercept</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">0.190</td>
<td align="left">0.087, 0.415</td>
</tr>
<tr><td align="left"></td>
<td align="left">Age</td>
<td char="." align="char">0.001</td>
<td char="." align="char">1.022</td>
<td align="left">1.009, 1.035</td>
</tr>
<tr><td align="left"></td>
<td align="left">Male</td>
<td char="." align="char">0.002</td>
<td char="." align="char">0.729</td>
<td align="left">0.595, 0.892</td>
</tr>
<tr><td align="left"></td>
<td align="left">Consult more than one medical professional</td>
<td char="." align="char">0.001</td>
<td char="." align="char">1.515</td>
<td align="left">1.197, 1.917</td>
</tr>
<tr><td align="left"></td>
<td align="left"></td>
<td align="left">Search monthly or more often</td>
<td char="." align="char">0.019</td>
<td char="." align="char">1.383</td>
<td align="left">1.054, 1.814</td>
</tr>
<tr><td align="left"></td>
<td align="left"></td>
<td align="left">Online information helps to cope</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">1.598</td>
<td align="left">1.284, 1.990</td>
</tr>
<tr><td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left">Attempt to verify the online information</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">2.670</td>
<td align="left">2.070, 3.445</td>
</tr>
<tr><td align="left" rowspan="3">29</td>
<td align="left" rowspan="3">What are your favorite sources of information about bipolar disorder?</td>
<td align="left" rowspan="3">Wikipedia</td>
<td align="left" rowspan="3">744</td>
<td align="left">Intercept</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">0.293</td>
<td align="left">0.211, 0.406</td>
</tr>
<tr><td align="left">Male</td>
<td char="." align="char">0.006</td>
<td char="." align="char">1.565</td>
<td align="left">1.135, 2.158</td>
</tr>
<tr><td align="left">Expert search skills</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">1.579</td>
<td align="left">1.271, 1.963</td>
</tr>
<tr><td align="left">30</td>
<td align="left">Do you discuss online information about bipolar disorder with your doctor?</td>
<td align="left">Sometimes or frequently</td>
<td align="left">715</td>
<td align="left">Intercept</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">0.068</td>
<td align="left">0.038, 0.123</td>
</tr>
<tr><td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left">Very confident when to see the doctor</td>
<td char="." align="char">0.001</td>
<td char="." align="char">1.936</td>
<td align="left">1.297, 2.891</td>
</tr>
<tr><td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left">Online information helps to cope</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">2.621</td>
<td align="left">1.827, 3.761</td>
</tr>
<tr><td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left">Attempt to verify the online information</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">3.149</td>
<td align="left">2.374, 4.177</td>
</tr>
<tr><td align="left" rowspan="3">31</td>
<td align="left" rowspan="6">Does the online information help you cope with bipolar disorder?</td>
<td align="left" rowspan="4">Sometimes or frequently</td>
<td align="left" rowspan="3">711</td>
<td align="left">Intercept</td>
<td char="." align="char">0.005</td>
<td char="." align="char">0.610</td>
<td align="left">0.433, 0.861</td>
</tr>
<tr><td align="left">Mostly normal last 6 months</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">2.015</td>
<td align="left">1.525, 2.663</td>
</tr>
<tr><td align="left">Always find what looking for</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">2.637</td>
<td align="left">1.706, 4.076</td>
</tr>
<tr><td align="left"></td>
<td align="left"></td>
<td align="left">Search monthly or more often</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">2.290</td>
<td align="left">1.659, 3.160</td>
</tr>
<tr><td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left">Online information helps to cope</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">1.684</td>
<td align="left">1.276, 2.221</td>
</tr>
<tr><td align="left"></td>
<td align="left"></td>
<td align="left"></td>
<td align="left">Discuss findings with doctor</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">3.023</td>
<td align="left">2.024, 4.517</td>
</tr>
<tr><td align="left" rowspan="3">34</td>
<td align="left" rowspan="3">How concerned are you about privacy and confidentiality?</td>
<td align="left" rowspan="3">Moderately or very concerned</td>
<td align="left" rowspan="3">723</td>
<td align="left">Intercept</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">0.085</td>
<td align="left">0.049, 0.147</td>
</tr>
<tr><td align="left">Power Distance Index</td>
<td char="." align="char"><0.001</td>
<td char="." align="char">1.030</td>
<td align="left">1.020, 1.040</td>
</tr>
<tr><td align="left">Search online to learn anonymously</td>
<td char="." align="char">0.001</td>
<td char="." align="char">1.705</td>
<td align="left">1.260, 2.308</td>
</tr>
</tbody>
</table>
<table-wrap-foot><p><sup>a</sup>
See survey for details and exact wording</p>
<p><sup>b</sup>
Missing values not included</p>
</table-wrap-foot>
</table-wrap>
</p>
<p>To explain if patients always find what they are looking for, the estimated coefficients from the best fitting model suggested that consulting another medical professional (e.g., primary care, psychologist or counselor) in addition to a psychiatrist will decrease the odds by 41 %. There was no association with expertise or education.</p>
<p>To explain if patients search monthly or more frequently, the estimated coefficients from the best fitting model suggested that a one unit increase in education ratio will decrease the odds by 38 %, having a mostly normal mood for the last 6 months will decrease the odds by 60 %, having a mental health site as a favorite source will increase the odds by 29 %, looking for drug side effects will increase the odds by 47 %, being male will increase the odds by 53 %, bipolar disorder interfering with life will increase the odds by 95 %, participating in online support groups will increase the odds by 129 %, and feeling the Internet helps to cope will increase the odds by 170 %.</p>
<p>There was no association between the favorite sources of online information and coming from a country where the primary language is English. To explain having a mental health site as a favorite source, the estimated coefficients from the best fitting model suggested that a 1 year increase in age will increase the odds by 2 %, being male will decrease the odds by 27 %, searching monthly or more frequently will increase the odds by 38 %, consulting another medical professional will increase the odds by 52 %, needing help coping will increase the odds by 60 %, and attempting to verify the information found online will increase the odds by 167 %. To explain having Wikipedia as a favorite source, the estimated coefficients from the best fitting model suggested that being male will increase the odds by 57 %, and having self-rated expert search skills will increase the odds by 58 %.</p>
<p>To explain if the patients discuss online information with their doctor, the estimated coefficients from the best fitting model suggested that feeling very confident when to see the doctor will increase the odds by 94 %, feeling the Internet helps to cope will increase the odds by 162 %, and attempting to verify the information found online will increase the odds by 215 %.</p>
<p>To explain if patients feel the information learned online helps to cope, the estimated coefficients from the best fitting model suggested that needing help coping will increase the odds by 68 %, having a mostly normal mood for the last 6 months will increase the odds by 102 %, searching monthly or more frequently will increase the odds by 129 %, always find what looking for will increase the odds by 164 %, and discussing findings with the doctor will increase the odds by 202 %.</p>
<p>To explain if patients are concerned about privacy, the estimated coefficients from the best fitting model suggested that a one unit increase in the country PDI will increase the odds by 3 %, and going online to learn anonymously will increase the odds by 71 %.</p>
</sec>
</sec>
<sec id="Sec9"><title>Discussion</title>
<sec id="Sec10"><title>Three reasons for online information seeking</title>
<p>There were three primary reasons why patients looked online for information about bipolar disorder: prescription drugs, perceived anonymity, and help coping. About half the patients looked online because of side effects from prescription drugs, in agreement with prior reports that patients with bipolar disorder want to know more about their drugs and especially side effects (Hallett et al. <xref ref-type="bibr" rid="CR39">2013</xref>
; Bowskill et al. <xref ref-type="bibr" rid="CR10">2007</xref>
). Many patients looked online to learn about bipolar disorder without revealing their identity. Although incorrect, the belief that one is anonymous online is a commonly perceived benefit of the Internet by those with a stigmatized illness (Berger et al. <xref ref-type="bibr" rid="CR8">2005</xref>
; Pohjanoksa-Mäntylä et al. <xref ref-type="bibr" rid="CR90">2009</xref>
; Chan et al. <xref ref-type="bibr" rid="CR13">2016</xref>
). Patients also sought information online because they were having difficulty coping with the illness, confirming the need for online sources to help deal with the consequences of bipolar disorder.</p>
</sec>
<sec id="Sec11"><title>Using a general search engine on a computer</title>
<p>The vast majority of patients started looking for information on bipolar disorder from a general search engine (79 %) on a laptop/desktop computer (89 %). This is consistent with prior findings that 80 % of the general public started looking for health information with a general search engine (Fox and Duggan <xref ref-type="bibr" rid="CR28">2013</xref>
), and that general search engines are used much less frequently from a smartphone than from a computer (Arthur <xref ref-type="bibr" rid="CR1">2015</xref>
; MacMillan <xref ref-type="bibr" rid="CR67">2015</xref>
; Friedman <xref ref-type="bibr" rid="CR29">2015</xref>
). Providers involved in developing online projects for bipolar disorder should consider how the targeted consumer device may impact use. About 43 % of total handsets in the world were smartphones in 2015, with an expected increase to 50 % by 2020 (Cisco <xref ref-type="bibr" rid="CR16">2016</xref>
). In some countries such as the US, those with mental illness may have a much lower smartphone ownership than the general public (Klee et al. <xref ref-type="bibr" rid="CR54">2016</xref>
; Miller et al. <xref ref-type="bibr" rid="CR73">2016</xref>
).</p>
</sec>
<sec id="Sec12"><title>General search engine background</title>
<p>Most patients start looking for information from a general search engine. Google dominates with a market share of ≥90 % in all but 3 of the 17 countries in this study, the exceptions being 87 % in Canada, 73 % in Hong Kong and 73 % in the US (Return on Now <xref ref-type="bibr" rid="CR94">2016</xref>
). Search terms entered are brief and guided by auto-completion suggestions, with 57 % in Google US being 1–2 words, and 88 % being 4 words or less (Statistica <xref ref-type="bibr" rid="CR104">2016</xref>
). Over 90 % of people select a website from the first page of search engine results, with 61 % of people selecting a web site from the top 3 results (Sharp <xref ref-type="bibr" rid="CR100">2014</xref>
).</p>
</sec>
<sec id="Sec13"><title>1/3 rated search skills as expert</title>
<p>In this study, about 2/3 of the patients rated their search skills as basic or intermediate, and 1/3 as expert. There was no association between education and self-rating as an expert. The factors that increased the odds of self-rating as an expert included being male, having confidence when to see the doctor about bipolar disorder, having Wikipedia as a favorite source, and attempting to verify the information. In prior research, self-reported computer skill ratings were found to be unreliable (Merritt et al. <xref ref-type="bibr" rid="CR72">2005</xref>
), with university students tending to overestimate their abilities (Ivanitskaya et al. <xref ref-type="bibr" rid="CR50">2006</xref>
), and females perceiving lower abilities than males at the same skill level (Bunz et al. <xref ref-type="bibr" rid="CR12">2007</xref>
). There are several concerns about the accuracy of the self-rating of search expertise in this study.</p>
<p>A minority of patients (16 %) always found what they were looking for, but this was not associated with expertise, education or attempting to verify the information. However, always finding the answer was associated with not consulting more than one medical professional. There is concern that some patients may be satisfied with any answer, or use the Internet as a second opinion.</p>
<p>Although 1/3 of the patients rated their search skills as expert, it is quite difficult to search for medical information. In a recent study, no answer was found in the top three search results returned for 32 of 54 simple consumer mental health questions using the National Institute of Mental Health (NIMH) website (Crangle and Kart <xref ref-type="bibr" rid="CR20">2015</xref>
). Patient questions are not answered due to a high degree of specificity, false presuppositions, and layman use of medical terminology (Crangle and Kart <xref ref-type="bibr" rid="CR20">2015</xref>
; MacCray et al. <xref ref-type="bibr" rid="CR68">1999</xref>
). In an analysis of consumer messages to MedlinePlus, the majority concerned specific medical questions rather than general information (Miller <xref ref-type="bibr" rid="CR74">2007</xref>
). For perspective, physicians also report barriers to successful online searching including the need for specific information, too much information, selecting reliable sources, and time requirements (Clarke et al. <xref ref-type="bibr" rid="CR17">2013</xref>
; Bennett et al. <xref ref-type="bibr" rid="CR7">2004</xref>
; McKibbon and Fridsma <xref ref-type="bibr" rid="CR69">2006</xref>
).</p>
<p>There was no association between concern about privacy and expertise. In this study, 43 % of patients believed they are anonymous online, a result similar to the 37 % found in a survey of the US general public (Rainie et al. <xref ref-type="bibr" rid="CR91">2013</xref>
). Although the legal framework for online privacy varies internationally (Bowman <xref ref-type="bibr" rid="CR9">2016</xref>
), this finding emphasizes an important need to educate patients at all levels of expertise about privacy on the Internet. Commercial firms that provide services at no charge, including search engines, social media, and many medical sites, generally make money by tracking all activities to sell targeted behavioral advertising, or by selling the tracked activities to third parties (Greengard <xref ref-type="bibr" rid="CR37">2012</xref>
; Stark and Fins <xref ref-type="bibr" rid="CR103">2013</xref>
; Glenn and Monteith <xref ref-type="bibr" rid="CR35">2014</xref>
; FTC <xref ref-type="bibr" rid="CR30">2014</xref>
; Eavis <xref ref-type="bibr" rid="CR23">2016</xref>
; Rosenberg <xref ref-type="bibr" rid="CR96">2015</xref>
). The data collected includes details about all Internet and smartphone activities including search terms, websites visited, email and social media content and metadata (data about data that provides context) (Libert <xref ref-type="bibr" rid="CR63">2015</xref>
; NISO <xref ref-type="bibr" rid="CR84">2004</xref>
). In a recent study of over 80,000 health-related websites in the US, over 90 % sent data to third parties, with 70 % including specific symptoms, treatments and diseases (Libert <xref ref-type="bibr" rid="CR63">2015</xref>
). Those who use social media and online support groups owned by commercial organizations may not realize that privacy policies often give consent to the sale of patient created data (Li <xref ref-type="bibr" rid="CR62">2013</xref>
; Lupton <xref ref-type="bibr" rid="CR65">2014</xref>
; Glenn and Monteith <xref ref-type="bibr" rid="CR35">2014</xref>
). Online medical data may be combined with other data for health risk predictions (Dixon and Gellman <xref ref-type="bibr" rid="CR22">2014</xref>
), combined with genetic data for commercial research (Seife <xref ref-type="bibr" rid="CR99">2013</xref>
), and de-identified data may be re-identified using very large, high-dimensional databases (Narayanan et al. <xref ref-type="bibr" rid="CR81">2016</xref>
). Even though the legal framework is changing, such as with the general data protection regulation (GDPR) to be implemented by 2018 for the EU (European Parliament News <xref ref-type="bibr" rid="CR24">2016</xref>
), patients of all search skill levels need to understand the data policies of websites they visit regularly for information on mental health.</p>
</sec>
<sec id="Sec14"><title>Favorite sources are mental health sites and Wikipedia</title>
<p>For 59 % of the patients in this study, a mental health site was a favorite information source on bipolar disorder, while Wikipedia was a favorite source for 33 %. The factors that increased the odds for a mental health site included being female, needing help coping, consulting more than one medical professional, and attempting to verify the information. Being male or having expert search skills increased the odds that Wikipedia was a favorite source.</p>
</sec>
<sec id="Sec15"><title>Types of mental health sites</title>
<p>Websites on mental health are owned by a variety of entities, including governments, professional organizations, and commercial businesses. The overall content of most Internet information related to affective disorders is generally rated as good (Grohol et al. <xref ref-type="bibr" rid="CR38">2014</xref>
; Morel et al. <xref ref-type="bibr" rid="CR78">2008</xref>
) although the quality may vary considerably (Reavley and Jorm <xref ref-type="bibr" rid="CR93">2011</xref>
; Hasty et al. <xref ref-type="bibr" rid="CR40">2014</xref>
; Barnes et al. <xref ref-type="bibr" rid="CR3">2009</xref>
; Monteith et al. <xref ref-type="bibr" rid="CR76">2013</xref>
). The content of government websites, such as from the US MedlinePlus and UK NHS are evaluated for accuracy and currency (MedlinePlus <xref ref-type="bibr" rid="CR70">2016</xref>
; NHS <xref ref-type="bibr" rid="CR83">2016</xref>
). Hospitals and health systems own many websites and understand the importance of accuracy, but also view these websites as marketing opportunities (Ford and Walls <xref ref-type="bibr" rid="CR26">2012</xref>
). Website content from providers that offer specific treatments, such as substance abuse treatment centers, may be incomplete or imbalanced (Schenker and London <xref ref-type="bibr" rid="CR98">2015</xref>
; Link et al. <xref ref-type="bibr" rid="CR64">2016</xref>
).</p>
<p>Articles from Wikipedia, the open encyclopedia that invites user contributions, frequently appear in first page of results for medical searches (Laurent and Vickers <xref ref-type="bibr" rid="CR59">2009</xref>
). The Wikipedia entry for bipolar disorder was viewed over 13 million times in 55 languages in 2013 (Heilman and West <xref ref-type="bibr" rid="CR42">2015</xref>
). In 2013, there were less than 300 editors for the medical articles on Wikipedia, of which 82 % were male and 50 % were healthcare providers (Heilman and West <xref ref-type="bibr" rid="CR42">2015</xref>
). About 85 % of the medical editors had a college degree, with editors of the non-English versions having a similar education level. As in this study, more males (56 %) than females (44 %) are readers of Wikipedia about all topics (Pande <xref ref-type="bibr" rid="CR88">2011</xref>
).</p>
<p>As of 2015, the Google search engine returns pre-vetted facts at the top of the first page for many medical searches (Google <xref ref-type="bibr" rid="CR36">2015</xref>
). Beyond this, results may be tailored to the user based on behavioral advertising algorithms (Monteith et al. <xref ref-type="bibr" rid="CR76">2013</xref>
; Vaidhyanathan <xref ref-type="bibr" rid="CR108">2012</xref>
). The results of medical searches from all major search engines overlap considerably (Wang et al. <xref ref-type="bibr" rid="CR111">2012</xref>
).</p>
</sec>
<sec id="Sec16"><title>Website language</title>
<p>There was no association between a native language other than English and the favorite information source in this study. Based on the top 10 million websites on the Internet, 53.6 % of all content is in English (W3 Techs <xref ref-type="bibr" rid="CR110">2016</xref>
). The percent of content in German, Japanese, Spanish and French ranged between 4 and 6 % each, with a smaller percent in the other languages in this study. One consequence of the Internet is a global increase in teaching English as a second language. In 2014, 77 % of primary school students in the EU learned English as a foreign language, up from 35 % in 2000 (Eurostat <xref ref-type="bibr" rid="CR25">2016</xref>
; Parker <xref ref-type="bibr" rid="CR89">2015</xref>
).</p>
</sec>
<sec id="Sec17"><title>Searching a couple times a year</title>
<p>Most of the patients in this study (62 %) looked online for information a couple of times a year, while 38 % looked monthly or more often. The odds of looking online more frequently were increased if bipolar disorder interfered with life, the patient was looking for drug side effects, felt the internet helps to cope, read or contributed to an online support group, or if male. The odds of looking online more frequently were decreased if patients were mostly euthymic, or if they were very educated. Both experiencing symptoms and participation in online support groups were previously noted to increase the frequency of information seeking (Rice <xref ref-type="bibr" rid="CR95">2006</xref>
; Weaver et al. <xref ref-type="bibr" rid="CR112">2010</xref>
). The very educated may prefer to consult with their doctor for individualized treatment (Bauer et al. <xref ref-type="bibr" rid="CR5">2016</xref>
).</p>
</sec>
<sec id="Sec18"><title>Seeking information on medical topics</title>
<p>The patients in this study most often sought information about medical topics, including symptoms (83 %), prescription drug information (73 %), general course of illness (58 %), coping strategies (52 %), and less frequently about nonmedical topics including clinic location, hours and directions (52 %), and physician credentials (31 %).</p>
<p>The strong patient interest in prescription drug information is important since both physical and mental side effects are associated with nonadherence (Bates et al. <xref ref-type="bibr" rid="CR4">2010</xref>
; Johnson et al. <xref ref-type="bibr" rid="CR51">2007</xref>
; Baldessarini et al. <xref ref-type="bibr" rid="CR2">2008</xref>
; Szmulewicz et al. <xref ref-type="bibr" rid="CR105">2016</xref>
). The accuracy of drug information on websites for consumers is of concern. Research has focused on Wikipedia, and compared the content for a variety of drugs to official product labels or professionally edited compendia. The drug information content on Wikipedia was mostly accurate but lacked details, was often incomplete (Kupferberg and Protus <xref ref-type="bibr" rid="CR57">2011</xref>
; Clauson et al. <xref ref-type="bibr" rid="CR18">2008</xref>
; Lavsa et al. <xref ref-type="bibr" rid="CR60">2011</xref>
), and drug safety information may not be current (Koppen et al. <xref ref-type="bibr" rid="CR55">2015</xref>
; Hwang et al. <xref ref-type="bibr" rid="CR48">2014</xref>
). Some drug articles on Wikipedia were missing references (Lavsa et al. <xref ref-type="bibr" rid="CR60">2011</xref>
) and unlike professional compendia, cited news stories as references (Koppen et al. <xref ref-type="bibr" rid="CR55">2015</xref>
). Similarly, studies of accuracy of drug information on other consumer websites found generally good content quality but incomplete topic coverage (Sidhu et al. <xref ref-type="bibr" rid="CR101">2006</xref>
; Ghoshal and Walji <xref ref-type="bibr" rid="CR32">2006</xref>
).</p>
<p>Drug review websites based on patient ratings of drugs are also available online. Unlike standard compendia, patient review sites emphasize side effects and personal ratings of efficacy. These sites may over-represent the experiences of patients with acute exacerbations of illness, severe side effects or dissatisfaction with results (Chew and Khoo <xref ref-type="bibr" rid="CR14">2016</xref>
; Hughes and Cohen <xref ref-type="bibr" rid="CR47">2011</xref>
). Comparisons of drug efficacy ratings found that results varied among the patient review sites (Gidwani and Zulman <xref ref-type="bibr" rid="CR34">2015</xref>
; Chew and Khoo <xref ref-type="bibr" rid="CR14">2016</xref>
).</p>
<p>Patient education should emphasize that online drug information may be inaccurate or incomplete, even in compendia (Randhawa et al. <xref ref-type="bibr" rid="CR92">2016</xref>
), and that patients should seek multiple sources. The emphasis on personal experience in drug review sites may be useful to some patients (Hughes and Cohen <xref ref-type="bibr" rid="CR47">2011</xref>
; Chew and Khoo <xref ref-type="bibr" rid="CR14">2016</xref>
), but patient education should also explain that these sites are not authoritative. Some patients may not realize that high quality drug information is available for free from government sources such as the US National Library of Medicine Drug Information Portal (NLM <xref ref-type="bibr" rid="CR85">2016</xref>
).</p>
</sec>
<sec id="Sec19"><title>Information seeking helps with coping</title>
<p>Online information seeking sometimes or frequently helped 67 % of the patients in this study to cope. In this study, the factors that increased the odds that information seeking helped to cope included being mostly euthymic, always finding what looking for, searching monthly or more frequently, needing help coping, and discussing findings with the doctor. In a prior study of high functioning patients with bipolar disorder, education about the disease was a key strategy for staying well (Murray et al. <xref ref-type="bibr" rid="CR79">2011</xref>
).</p>
<p>Only 20 % of the patients read or participated in online support groups or forums, a rate similar to that for the general public (Fox <xref ref-type="bibr" rid="CR27">2011</xref>
). In this study, participation in online support groups was not associated with information seeking helping patients to cope. This finding suggests that the information learned online is what helps most patients to cope, rather than emotional support or coping skills learned in online support groups. Prior research on online communities reported that information seeking was the most important activity, (Nambisan <xref ref-type="bibr" rid="CR80">2011</xref>
; Meier et al. <xref ref-type="bibr" rid="CR71">2007</xref>
; van Uden-Kraan <xref ref-type="bibr" rid="CR109">2009</xref>
), although emotional support was also important in bipolar disorder (Bauer et al. <xref ref-type="bibr" rid="CR6">2013</xref>
). The time length of most online psychological interventions is considerably shorter than for face-to-face programs and may not offer sufficient professional access for patients to learn coping skills (Hidalgo-Mazzei et al. <xref ref-type="bibr" rid="CR44">2015</xref>
).</p>
<p>In this study, 67 % of the patients rarely or never discussed what they learned online with their doctor. About 60–80 % of general medical patients also do not discuss Internet health information with their doctor for reasons including time constraints, fear of insulting the doctor or being dismissed, information was self-explanatory, and a desire for self-management (Chung <xref ref-type="bibr" rid="CR15">2013</xref>
; Russ et al. <xref ref-type="bibr" rid="CR97">2011</xref>
; Hay et al. <xref ref-type="bibr" rid="CR41">2008</xref>
; Kim and Kim <xref ref-type="bibr" rid="CR53">2009</xref>
; Diaz et al. <xref ref-type="bibr" rid="CR21">2002</xref>
; Imes et al. <xref ref-type="bibr" rid="CR49">2008</xref>
). In this study, the factors that increased the odds of patients discussing online information with their doctor include feeling very confident about when to see the doctor, feeling the Internet helped to cope, and attempting to verify the information. Similarly, in prior research, patients who talked with their doctors felt the information from the Internet was of high quality (Diaz et al. <xref ref-type="bibr" rid="CR21">2002</xref>
; Chung <xref ref-type="bibr" rid="CR15">2013</xref>
).</p>
<p>The patients in this study had a mean of 17 years of illness, so it is likely that many searches were for specific questions rather than general information about bipolar disorder. Since most patients do not discuss the information learned online with their doctor, patient education about online health information seeking is important, and should be integrated into psychoeducation programs. There is a need to help patients to access high quality information, such as by providing a short list of recommended websites (Monteith et al. <xref ref-type="bibr" rid="CR76">2013</xref>
). Website recommendations from physicians are favorably received by general medicine patients, and may increase communication about online information seeking (Coberly et al. <xref ref-type="bibr" rid="CR19">2010</xref>
; Siegel et al. <xref ref-type="bibr" rid="CR102">2006</xref>
). Patients should also understand that even a clear and accurate website will probably not provide answers to specific questions about their personal situation (Miller <xref ref-type="bibr" rid="CR74">2007</xref>
).</p>
</sec>
</sec>
<sec id="Sec20"><title>Limitations</title>
<p>Since this survey was collected as a convenience sample, the survey participants do not reflect the demographic compositions of the countries which may bias the results. There was no follow-up discussion of the survey responses, and patient actual use of the Internet could not be verified. The patients not included in this study are those with bipolar disorder who do not seek professional help, who may be less educated or have a less stable living situation. Valid response rates varied among the questions analyzed. However, all results were consistent with prior research. These survey results are associations and do not establish causality between variables. This survey was administered by the treating psychiatrist so questions on patient satisfaction were omitted, although dissatisfaction is associated with increased online searching for health information (Tustin <xref ref-type="bibr" rid="CR106">2010</xref>
). The survey did not address if patients visited sites in a language other than their native language or which specific websites were visited. The survey also did not address the use of problematic websites that encourage unwanted behaviors such as self-harm (Mitchell et al. <xref ref-type="bibr" rid="CR75">2014</xref>
), issues related to online purchase of prescription or illegal drugs (Monteith et al. <xref ref-type="bibr" rid="CR77">2016</xref>
; Orizio et al. <xref ref-type="bibr" rid="CR86">2011</xref>
), or the impacts of direct to consumer pharmaceutical advertising where applicable (Mackey et al. <xref ref-type="bibr" rid="CR66">2015</xref>
).</p>
</sec>
<sec id="Sec21"><title>Conclusions</title>
<p>Online information seeking helped two thirds of the patients to cope with bipolar disorder. When considering all 1222 patients who completed the survey, about 41 % of all patients found help coping using the Internet, so other information sources remain important. Most patients do not discuss information learned online with their doctor. There is concern about the quality of website content especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand online privacy issues. More patient education about online information seeking is needed, and physicians should recommend a few high quality websites about bipolar disorder to their patients.</p>
</sec>
</body>
<back><app-group><app id="App1"><sec id="Sec22"><title>Additional file</title>
<p><media position="anchor" xlink:href="40345_2016_58_MOESM1_ESM.doc" id="MOESM1"><caption><p><bold>Additional file 1.</bold>
 Questionnaire: Information seeking in bipolar disorder.</p>
</caption>
</media>
</p>
</sec>
</app>
</app-group>
<fn-group><fn><p>An erratum to this article is available at <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1186/s40345-017-0082-8">http://dx.doi.org/10.1186/s40345-017-0082-8</ext-link>
.</p>
</fn>
</fn-group>
<ack><title>Authors’ contributions</title>
<p>All authors contributed to and approved the final manuscript. Authors JC, RB, TG and MBa designed the study. Authors MA, RA, RB, MBe, YB, AB, LB, AMPC, EYWC, CC, SC, JC, RD, SD, AD, BE, AF, JGa, JGe, JGi, AGP, GMG, PG, HH, SH, CH, DHM, VK, GK, BL, CL, ERL, UL, RWL, AHL, BM, SM, RM, TN, REN, COD, YOk, YOs, PP, AR, PR, JKR, KSa, BS, ES, ÂMS, CS, AHS, KSu, AS, PT, YT, LT, EV, MV, BV, JV, and MZ were involved with data collection. Author TG provided data analysis. Authors RB, JC, TG, PCW and MBa were involved in the draft manuscript and initial review. All authors read and approved the final manuscript.</p>
<sec id="FPar1"><title>Acknowledgements</title>
<p>We thank Kerstin Heyde, Christiane Otto and Katharina Schultheiss for data entry support, and Daniela Jany for assisting with manuscript submission.</p>
</sec>
<sec id="FPar2"><title>Competing interests</title>
<p>Michael Berk is supported by an NHMRC Senior Principal Research Fellowship (1059660), Eduard Vieta received a Grant from Telefonica.</p>
<p>Jörn Conell, Rita Bauer, Tasha Glenn, Martin Alda, Raffaella Ardau, Bernhard T Baune, Yuly Bersudsky, Amy Bilderbeck, Alberto Bocchetta, Letizia Bossini, Angela Marianne Paredes Castro, Eric Yat Wo Cheung, Caterina Chillotti, Sabine Choppin, Maria Del Zompo, Rodrigo Dias, Seetal Dodd, Anne Duffy, Bruno Etain, Andrea Fagiolini, Julie Garnham, John Geddes, Jonas Gildebro, Ana Gonzalez-Pinto, Guy M Goodwin, Paul Grof, Hirohiko Harima, Stefanie Hassel, Chantal Henry, Diego Hidalgo-Mazzei, Vaisnvy Kapur, Girish Kunigiri, Beny Lafer, Chun Lam, Erik Roj Larsen, Ute Lewitzka, Rasmus Licht, Anne Hvenegaard Lund, Blazej Misiak, Patryk Piotrowski, Scott Monteith, Rodrigo Munoz, Takako Nakanotani, René E Nielsen, Claire O’Donovan, Yasushi Okamura, Yamima Osher, Andreas Reif, Philipp Ritter, Janusz K Rybakowski, Kemal Sagduyu, Brett Sawchuk, Elon Schwartz, Ângela Miranda Scippa, Claire Slaney, Ahmad Hatim Sulaiman, Kirsi Suominen, Aleksandra Suwalska, Peter Tam, Yoshitaka Tatebayashi, Leonardo Tondo, Maj Vinberg, Biju Viswanath, Julia Volkert, Mark Zetin, Peter C Whybrow and Michael Bauer have no conflict of interest to declare.</p>
</sec>
<sec id="FPar3"><title>Availability of data</title>
<p>The survey questionnaire is available in the Additional file <xref rid="MOESM1" ref-type="media">1</xref>
. Online posting of complete datasets was not approved by ethics boards or the participants.</p>
</sec>
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Online information seeking by patients with bipolar disorder: results from an international multisite survey

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