Background: Suicide prevention strategies recognise the need to address suicide in high-risk groups, such as people with psychiatric illness. People with bipolar disorder are known to be at particularly high risk of suicide and self-harm, with around half of people diagnosed with bipolar disorder making at least one suicide attempt during their lifetime. It is important that clinicians can identify who is most at risk among people with bipolar disorder so that interventions that meet the needs of this high risk group can be implemented. Method: A multiple-methods approach was used to explore suicidal behaviour in bipolar disorder. Descriptive analysis, case-control methods, and survival analysis were used on data held by The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI), and the Manchester Self-Harm (MaSH) Project, to identify characteristics and risk factors associated with suicide in bipolar disorder. Semi-structure interviews were carried out with people who had a range of experiences of suicidal behaviour in bipolar disorder, and these data were analysed using Thematic Analysis to add context and depth to the quantitative results. Results: Suicidal behaviours were common in people with bipolar disorder, accounting for around 10% of all psychiatric suicide deaths in England; this rate was fairly stable over time. Characteristics associated with suicidal behaviour in bipolar disorder included; being aged 45 to 64 years old, experiencing negative life events, comorbid alcohol use, multiple inpatient admissions; there was a particularly strong association with a history of self-harm. It is clinically important that people with bipolar disorder were often seen by services in the 24 hours before they died. This both emphasises the weaknesses in current risk assessment, and highlights the potential for successful intervention if risk can be determined more accurately. Key issues identified in the interview study included being able to access care rapidly during time periods when risk was elevated, the importance of obtaining a correct diagnosis of bipolar disorder, and the potential benefits of including family in the care of people with bipolar disorder. Conclusion: Suicidal behaviours are common in people with bipolar disorder. People with bipolar disorder who die by suicide tend to have several markers that may indicate a more severe (e.g. multiple inpatient admission, history of self-harm) and complex course of illness (e.g. comorbid alcohol use, personality disorder). Diagnosis-specific risk assessment is needed to better identify risk of suicide in an illness that is often characterised by fluctuating mood states. Family involvement in care may aid detection of increased suicide risk.

The core essence of a marketing transaction is the exchange of value between two parties. Quite often, the exchange of value describes a customer purchasing a product from a company. When purchasing products, the exchange of value can often fail due to product defects or customer dissatisfaction. When the marketing exchange fails, customers often desire an avenue for recourse to right the exchange imbalance. Accepting and quickly processing product returns represents a strategic tool companies can leverage to maintain healthy relationships with customers, despite an exchange failure. Effectively managing product returns also benefits companies financially, by reducing inventory levels, costs, and the risk of product obsolescence. Despite providing both relationship management and financial benefits, numerous companies struggle to manage product returns effectively. In a time when companies are facing a growing number of product returns due to omni-channel retailing and online shopping, implementing an effective system to manage product returns has become a vital strategic tool necessary to maintain competitiveness. First, the current research answers the question of why do companies struggle with product returns? by identifying the important components of an effective product returns system. Informed by complex adaptive systems theory and based on a qualitative, grounded theory analysis, the current research finds that the hidden complex nature of managing product returns prevents numerous companies from implementing an effective system to mange returns. Managing product returns requires five important components (firm capabilities, employees, the returns management information system, organizational climate, and the customer service boundary), which interact with each other multiple times to process a product return. After identifying the important components and interactions within a product returns system, Essay I integrates the information together to form a substantive theory of the complexity of product returns management. The substantive theory implies that companies looking to improve their management of product returns need to understand and invest in multiple components within the product returns system. Second, the current research answers the question of how do the employees, returns management information system, and climate for creativity components of a product returns system relate to a firm’s flexibility, adaptability, and performance? To answer this research question, this dissertation empirically evaluates the role these three components play in shaping a firm’s flexibility, adaptability, subjective performance and relationship quality by analyzing data collected through an online survey with 102 US managers with experience in product returns. The empirical analysis indicates that employee decision-making resources show a statistically significant negative relationship with firm adaptability, while the firm’s climate for creativity and flexibility show a statistically significant positive relationship with firm adaptability. Firm adaptability shows statistically significant positive relationships with subjective performance and relationship quality. Firm adaptability acts as a partial or full mediator in all of these relationships. The combined findings of Essay I and Essay II point to the importance of product returns as a strategic relationship management tool. Firms that can effectively manage product returns give employees more flexibility to respond to problems, are better able to make structural changes, have higher subjective performance ratings, and better quality relationships with customers.