Outcome of group psychoeducation for stabilised bipolar disorders

The article by Colom et al ¹ further enhanced our understanding about the role of psychoeducation in the management of bipolar disorders. The study draws its strengths from the fact that it included an active control group and individuals with bipolar disorder and Axis II comorbidity, follow-up rates were excellent and the authors assessed the outcome in the form of the number and type of recurrences, time to recurrence, time spent ill and number of hospitalisations at 5 years. However, some of the issues require further clarification.

When one looks at the article reporting 2-year follow-up of the same cohort, ² the authors report that individuals with Axis I comorbidity were excluded, but at 5-year follow-up the authors report that only those with severe Axis I diagnosis were excluded. Further, the authors do not define ‘severe’. Individuals with bipolar disorder can have a high rate of comorbidity, hence clarification of this fact is very important from the perspective of generalisability of the study findings. In addition, Colom et al do not provide details of status and/or type of Axis I/II comorbidities and whether the drop-out rate and the number of completers made any difference with regard to clinical and demographic features.

Another important aspect is the way the authors defined recurrence based on rating scale scores. This type of definition in the true sense does not include the subsyndromal symptoms and can influence almost all the outcome measures such as time spent ill, time to recurrence and the number of recurrences, especially when the cohort is being followed up at a frequency of every 2 weeks. Similarly, although the study included the number and duration of hospitalisations as an outcome measure, the authors have not discussed the criteria for hospitalisation.

Another important aspect which needs clarification is the analysis of data. In many places Colom et al have used parametric tests to compare the numerical variables, although the standard deviation is more than the mean. Similarly, mean values are given for the number of recurrences without standard deviations, and comparison statistics are given as F-values. In Table 2, ¹ again the authors compare the mean values using Fisher F statistics and demonstrate that there was a significant difference in the number of days spent in each episode for all types of episodes. However, when one looks at the data, it is difficult to understand this contention. In the same table when one adds the mean number of days spent in each episode for the control group, the data regarding each episode and the total duration do tally, but the same is not the case for the psychoeducation group.