Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-12-04T19:49:48.088Z Has data issue: false hasContentIssue false
  • English
  • Français

Quality of life in bipolar disorder: towards a dynamic understanding

Published online by Cambridge University Press:  18 September 2017

E. Morton ,
G. Murray ,
E. E. Michalak ,
R. W. Lam ,
S. Beaulieu ,
V. Sharma ,
P. Cervantes ,
S. V. Parikh  and
L. N. Yatham
E. Morton
Affiliation:
Faculty of Health, Arts and Design Swinburne University, Melbourne, Australia
G. Murray*
Affiliation:
Faculty of Health, Arts and Design Swinburne University, Melbourne, Australia
E. E. Michalak
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
R. W. Lam
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
S. Beaulieu
Affiliation:
Bipolar Disorders Program, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
V. Sharma
Affiliation:
Regional Mental Health Care London, London, ON, Canada
P. Cervantes
Affiliation:
Mood Disorders Program, Department of Psychiatry, McGill University Health Center (MUHC), Montreal, Canada
S. V. Parikh
Affiliation:
Department of Psychiatry, Toronto Western Hospital, Toronto, ON, Canada
L. N. Yatham
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
*
Author for correspondence: G. Murray, Ph.D., E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although quality of life (QoL) is receiving increasing attention in bipolar disorder (BD) research and practice, little is known about its naturalistic trajectory. The dual aims of this study were to prospectively investigate: (a) the trajectory of QoL under guideline-driven treatment and (b) the dynamic relationship between mood symptoms and QoL.

Methods

In total, 362 patients with BD receiving guideline-driven treatment were prospectively followed at 3-month intervals for up to 5 years. Mental (Mental Component Score – MCS) and physical (Physical Component Score – PCS) QoL were measured using the self-report SF-36. Clinician-rated symptom data were recorded for mania and depression. Multilevel modelling was used to analyse MCS and PCS over time, QoL trajectories predicted by time-lagged symptoms, and symptom trajectories predicted by time-lagged QoL.

Results

MCS exhibited a positive trajectory, while PCS worsened over time. Investigation of temporal relationships between QoL and symptoms suggested bidirectional effects: earlier depressive symptoms were negatively associated with mental QoL, and earlier manic symptoms were negatively associated with physical QoL. Importantly, earlier MCS and PCS were both negatively associated with downstream symptoms of mania and depression.

Conclusions

The present investigation illustrates real-world outcomes for QoL under guideline-driven BD treatment: improvements in mental QoL and decrements in physical QoL were observed. The data permitted investigation of dynamic interactions between QoL and symptoms, generating novel evidence for bidirectional effects and encouraging further research into this important interplay. Investigation of relevant time-varying covariates (e.g. medications) was beyond scope. Future research should investigate possible determinants of QoL and the interplay between symptoms and wellbeing/satisfaction-centric measures of QoL.

Keywords

Bipolar disorderdepressionfunctioningmaniaquality of life
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 7 , May 2018 , pp. 1111 - 1118
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Basu, D (2004) Quality-of-Life issues in mental health care: past, present, and future. German Journal of Psychiatry 7, 35–43.Google Scholar
Bauer, IE, Gálvez, JF, Hamilton, JE, Balanzá-Martínez, V, Zunta-Soares, GB, Soares, JC et al. (2016) Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: a systematic review. Journal of Psychiatric Research 74, 1–7.CrossRefGoogle ScholarPubMed
Bernstein, EE, Rabideau, DJ, Gigler, ME, Nierenberg, AA, Deckersbach, T and Sylvia, LG (2016) Patient perceptions of physical health and bipolar symptoms: the intersection of mental and physical health. Journal of Affective Disorders 189, 203–206.CrossRefGoogle ScholarPubMed
Brissos, S, Dias, VV, Carita, AI and Martinez-Arán, A (2008) Quality of life in bipolar type I disorder and schizophrenia in remission: clinical and neurocognitive correlates. Psychiatry Research 160, 55–62.CrossRefGoogle ScholarPubMed
Canadian Network for Mood and Anxiety Treatments (CANMAT) (1997) The treatment of bipolar disorder: review of the literature, guidelines, and options. Canadian Journal of Psychiatry 42, 67–100.Google Scholar
Deckersbach, T, Nierenberg, AA, McInnis, MG, Salcedo, S, Bernstein, EE, Kemp, DE et al. (2016) Baseline disability and poor functioning in bipolar disorder predict worse outcomes: results from the bipolar CHOICE study. Journal of Clinical Psychiatry 77, 100–108.CrossRefGoogle ScholarPubMed
de Hert, M, Correll, CU, Bobes, J, Cetkovich-Bakmas, M, Cohen, D, Asai, I et al. (2011) Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10, 52–77.CrossRefGoogle ScholarPubMed
Endicott, J, Paulsson, B, Gustafsson, U, Schiöler, H and Hassan, M (2008) Quetiapine monotherapy in the treatment of depressive episodes of bipolar I and II disorder: improvements in quality of life and quality of sleep. Journal of Affective Disorders 111, 306–319.CrossRefGoogle ScholarPubMed
Endicott, J, Rajagopalan, K, Minkwitz, M and Macfadden, W (2007) A randomized, double-blind, placebo-controlled study of quetiapine in the treatment of bipolar I and II depression: improvements in quality of life. International Clinical Psychopharmacology 22, 29–37.Google Scholar
Ferrari, AJ, Stockings, E, Khoo, JP, Erskine, HE, Degenhardt, L, Vos, T et al. (2016) The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013. Bipolar Disorders 18, 440–450.CrossRefGoogle ScholarPubMed
Frank, E, Swartz, HA and Kupfer, DJ (2000) Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biological Psychiatry 48, 593–604.CrossRefGoogle ScholarPubMed
Gazalle, FK, Andreazza, AC, Hallal, PC, Kauer-Sant'Anna, M, Ceresér, KM, Soares, JC et al. (2006) Bipolar depression: the importance of being on remission. Revista Brasileira de Psiquiatria 28, 93–96.Google Scholar
Gazalle, FK, Frey, BN, Hallal, PC, Andreazza, AC, Cunha, ÂBM, Santin, A et al. (2007 a). Mismatch between self-reported quality of life and functional assessment in acute mania: a matter of unawareness of illness? Journal of Affective Disorders 103, 247–252.CrossRefGoogle Scholar
Gazalle, FK, Hallal, PC, Andreazza, AC, Frey, BN, Kauer-Sant'Anna, M, Weyne, F et al. (2007 b). Manic symptoms and quality of life in bipolar disorder. Psychiatry Research 153, 33–38.CrossRefGoogle ScholarPubMed
Gutiérrez-Rojas, L, Gurpegui, M, Ayuso-Mateos, JL, Gutiérrez-Ariza, JA, Ruiz-Veguilla, M and Jurado, D (2008) Quality of life in bipolar disorder patients: a comparison with a general population sample. Bipolar Disorders 10, 625–634.CrossRefGoogle ScholarPubMed
Hayhurst, H, Palmer, S, Abbott, R, Johnson, T and Scott, J (2006) Measuring health-related quality of life in bipolar disorder: relationship of the EuroQol (EQ-5D) to condition-specific measures. Quality of Life Research 15, 1271–1280.Google Scholar
Heck, RH, Thomas, SL and Tabata, LN (2014) Multilevel and Longitudinal Modeling with IBM SPSS. New York: Routledge.Google Scholar
Hopman, WM, Towheed, T, Anastassiades, T, Tenenhouse, A, Poliquin, S, Berger, C et al. (2000) Canadian normative data for the SF-36 health survey. CMAJ: Canadian Medical Association Journal 163, 265–271.Google Scholar
Hox, JJ (2010) Multilevel Analysis: Techniques and Applications, 2nd edn. New York: Routledge.Google Scholar
IsHak, WW, Greenberg, JM, Balayan, K, Kapitanski, N, Jeffrey, J, Fathy, H et al. (2011) Quality of life: the ultimate outcome measure of interventions in major depressive disorder. Harvard Review of Psychiatry 19, 229–239.CrossRefGoogle ScholarPubMed
Keyes, CL (2005) Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology 73, 539–548.CrossRefGoogle ScholarPubMed
Kilbourne, AM, Cornelius, JR, Han, X, Pincus, HA, Shad, M, Salloum, I et al. (2004) Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disorders 6, 368–373.CrossRefGoogle ScholarPubMed
Krishnan, KR (2005) Psychiatric and medical comorbidities of bipolar disorder. Psychosomatic Medicine 67, 1–8.Google Scholar
Lam, DH, Jones, SH and Hayward, P (2010) Cognitive Therapy for Bipolar Disorder: A Therapist's Guide to Concepts, Methods and Practice. Chichester, West Sussex: John Wiley & Sons.Google Scholar
Leitan, ND, Michalak, EE, Berk, L, Berk, M and Murray, G (2015) Optimizing delivery of recovery-oriented online self-management strategies for bipolar disorder: a review. Bipolar Disorders 17, 115–127.Google Scholar
Maczka, G, Siwek, M, Skalski, M and Dudek, D (2009) Patients’ and doctors’ attitudes towards bipolar disorder – do we share our beliefs? Psychiatria Polsk 43, 301–312.Google ScholarPubMed
Malhi, G, Bassett, D, Boyce, P, Bryant, R, Fitzgerald, P, Fritz, K et al. (2015) Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry 49, 1087–1206.Google Scholar
Michalak, EE, Guiraud-Diawara, A and Sapin, C (2014) Asenapine treatment and health-related quality of life in patients experiencing bipolar i disorder with mixed episodes: post-hoc analyses of pivotal trials. Current Medical Research and Opinion 30, 711–718.Google Scholar
Montgomery, SA and Asberg, M (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
Morton, E, Michalak, EE and Murray, G (2017) What does quality of life refer to in bipolar disorders research? A systematic review of the construct's definition, usage and measurement. Journal of Affective Disorders 212, 128–137.CrossRefGoogle ScholarPubMed
Murray, G, Leitan, ND, Thomas, N, Michalak, EE, Johnson, SL, Jones, S et al. (2017) Towards recovery-oriented psychosocial interventions for bipolar disorder: quality of life outcomes, stage-sensitive treatments, and mindfulness mechanisms. Clinical Psychology Review 52, 148–163.Google Scholar
Murray, G and Michalak, EE (2012) The quality of life construct in bipolar disorder research and practice: past, present, and possible futures. Bipolar Disorders 14, 793–796.Google Scholar
Namjoshi, MA, Rajamannar, G, Jacobs, T, Sanger, TM, Risser, R, Tohen, MF et al. (2002) Economic, clinical, and quality-of-life outcomes associated with olanzapine treatment in mania: results from a randomized controlled trial. Journal of Affective Disorders 69, 109–118.CrossRefGoogle ScholarPubMed
Namjoshi, MA, Risser, R, Shi, L, Tohen, M and Breier, A (2004) Quality of life assessment in patients with bipolar disorder treated with olanzapine added to lithium or valproic acid. Journal of Affective Disorders 81, 223–229.Google Scholar
Nusslock, R, Abramson, LY, Harmon-Jones, E, Alloy, LB and Hogan, ME (2007) A goal-striving life event and the onset of hypomanic and depressive episodes and symptoms: perspective from the behavioral approach system (BAS) dysregulation theory. Journal of Abnormal Psychology 116, 105–115.CrossRefGoogle ScholarPubMed
Oldis, M, Murray, G, Macneil, CA, Hasty, MK, Daglas, R, Berk, M et al. (2016) Trajectory and predictors of quality of life in first episode psychotic mania. Journal of Affective Disorders 195, 148–155.Google Scholar
Peugh, JL (2010) A practical guide to multilevel modeling. Journal of School Psychology 48, 85–112.Google Scholar
Post, RM (2009) Myth of evidence-based medicine for bipolar disorder. Expert Reviews of Neurotherapeutics 9, 1271–1273.Google Scholar
Roberts, JK and Monaco, JP (2006) Effect size measures for the two-level linear multilevel model. Paper Presented at the Annual Conference of the American Educational Research Association [AERA], San Francisco, CA.Google Scholar
Rosa, AR, Reinares, M, Michalak, EE, Bonnin, CM, Sole, B, Franco, C et al. (2010) Functional impairment and disability across mood states in bipolar disorder. Value in Health 13, 984–988.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E et al. (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 22–33.Google Scholar
Shi, L, Namjoshi, MA, Swindle, R, Yu, X, Risser, R, Baker, RW et al. (2004) Effects of olanzapine alone and olanzapine/fluoxetine combination on health-related quality of life in patients with bipolar depression: secondary analyses of a double-blind, placebo-controlled, randomized clinical trial. Clinical Therapeutics 26, 125–134.CrossRefGoogle ScholarPubMed
Shi, L, Namjoshi, MA, Zhang, F, Gandhi, G, Edgell, ET, Tohen, M et al. (2002) Olanzapine versus haloperidol in the treatment of acute mania: clinical outcomes, health-related quality of life and work status. International Clinical Psychopharmacology 17, 227–237.Google Scholar
Simon, GE, Bauer, MS, Ludman, EJ, Operskalski, BH and Unutzer, J (2007) Mood symptoms, functional impairment, and disability in people with bipolar disorder: specific effects of mania and depression. Journal of Clinical Psychiatry 68, 1237–1245.Google Scholar
Slade, M (2010) Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Services Research 10, 26.CrossRefGoogle ScholarPubMed
Vojta, C, Kinosian, B, Glick, H, Altshuler, L and Bauer, MS (2001) Self-reported quality of life across mood states in bipolar disorder. Comprehensive Psychiatry 42, 190–195.Google Scholar
Ware, JE, Kosinski, M and Keller, SD (1994) SF-36 Physical and Mental Health Summary Scales: A User's Manual. Boston, MA: The Health Institute, New England Medical Centre.Google Scholar
Ware, JE, Snow, KK, Kosinski, M and Gandek, B (1993) SF-36 Health Survey: Manual and Interpretation Guide. Boston, MA: The Health Institute, New England Medical Centre.Google Scholar
Yatham, LN, Kennedy, SH, Parikh, SV, Schaffer, A, Beaulieu, S, Alda, M et al. (2013) Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disorders 15, 1–44.CrossRefGoogle Scholar
Yatham, LN, Lecrubier, Y, Fieve, RR, Davis, KH, Harris, SD and Krishnan, AA (2004) Quality of life in patients with bipolar I depression: data from 920 patients. Bipolar Disorders 6, 379–385.Google Scholar
Yen, CF, Cheng, CP, Huang, CF, Yen, JY, Ko, CH and Chen, CS (2008) Quality of life and its association with insight, adverse effects of medication and use of atypical antipsychotics in patients with bipolar disorder and schizophrenia in remission. Bipolar Disorders 10, 617–624.CrossRefGoogle ScholarPubMed
Young, RC, Biggs, JT, Ziegler, VE and Meyer, DA (1978) A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429–435.CrossRefGoogle ScholarPubMed
Zhang, H, Wisniewski, SR, Bauer, MS, Sachs, GS and Thase, ME (2006) Comparisons of perceived quality of life across clinical states in bipolar disorder: data from the first 2000 Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) participants. Comprehensive Psychiatry 47, 161–168.CrossRefGoogle ScholarPubMed
Supplementary material: File

Morton et al. supplementary material

Tables S1-S3

Download Morton et al. supplementary material(File)
File 17.5 KB