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Table 1 Summary of studies assessing quality of life in patients with bipolar disorder

From: Quality of life in bipolar disorder: A review of the literature

Study Location Population(s) QoL instrument(s) Main findings and limitations
Arnold et al., (2002) US 44 BD patients (38 type I, 5 type II, I NOS)
30 back pain patients
2474 general population
SF-36 HRQOL impaired in BD patients compared to non-clinical sample. Chronic back pain patients more impaired in all SF-36 domains except role limitation (emotional) and mental health.
Limitation – disparate sample sizes.
Atkinson et al., (1997) Canada 37 BD patients
69 patients with schizophrenia
35 MDD patients
QoL index BD and MDD patients subjectively reported lower QoL than patients with schizophrenia, but schizophrenia group had poorer objectively measured QoL.
Limitation – relatively small BD and MDD sample sizes.
Bond et al., (2000) US 149 patients with SMI (21 with BD) QOLI Mean overall life satisfaction QOLI scores showed mid-range impairment.
Limitation – small sample of patients with BD.
Chand et al., (2004) India 50 BD patients in remission
20 patients with schizophrenia
20 control subjects
Q-LES-Q, WHO-QOL-BREF Patients with BD generally reported better QoL than patients with schizophrenia, and equivalent QoL to control group subjects.
Limitation – incomplete matching between groups; unusually low Q-LES-Q scores in control group
Cooke et al., (1996)* Canada 68 euthymic BD patients (55 type I, 13 type II) SF-20 SF-20 scores comparable to those reported for patients with MDD. BD type II patients reported poorer HRQOL that BD type I.
Limitation – shortcomings of SF-20 compared to SF-36.
Dogan et al., (2003) Turkey 26 outpatients with BD stabilized on lithium WHO-QOL-BREF Significant improvement in general health, physical functioning and social functioning 3 months after a psychoeducation intervention.
Limitation – small sample size.
Kusznir et al., (2000) Canada 61 euthymic BD patients (47 type I, 14 type II) OPQ One third of sample did not meet criteria for adequate community functioning.
Limitation – cross-sectional research design.
Leidy et al., (1998) US 62 BD patients, type I (34 euthymic, 28 depressed) SF-36, QLDS, MHI-17 and CFS Psychometric properties of instruments generally in acceptable ranges. Marked impairment in SF-36 scores apparent and QLDS scores lower than reported elsewhere for patients with unipolar MDD.
Limitation – test-retest reliability was measured over an unusually long period.
MacQueen et al., (1997) Canada 62 euthymic BD patients, type I SF-20 No significant differences in SF-20 scores between psychotic and non-psychotic patients.
Limitation – small sample of patients with psychotic symptoms.
MacQueen et al., (2000) Canada 64 euthymic BD patients, type I SF-20 Number of previous depressive episodes a stronger determinant of HRQOL than number of previous manic episodes.
Limitation – number of previous episodes determined retrospectively.
Namjoshi et al., (2002) US 139 BD patients, type I SF-36 Acute treatment with olanzapine resulted in improved SF-36 physical functioning scores; improvement in vitality, pain, general health and social functioning domains apparent in open-label phase.
Limitation – adjunctive use of lithium and fluoxetine during open-label phase.
Namjoshi et al., (2004) US 224 BD patients, type I QOLI Olanzapine cotherapy associated with better outcome in several QOLI domains compared to monotherapy with lithium or valproate.
Limitation – only acute QoL outcome data available.
Olusina et al., (2003) Nigeria 25 outpatients with BD type I or II WHO-QOL-BREF-TR Majority of sample report 'fair/average' QoL. Small sample of patients with BD, little clinical information for sample.
Ozer et al., (2002) Turkey 100 interepisode BD patients Q-LES-Q Depression scores on SADS interview significantly predicted lower Q-LES-Q scores.
Limitation – cross-sectional nature of research.
Patelis-Siotis et al., (2001) Canada 49 BD mildly depressed or euthymic patients SF-36 SF-36 vitality and role (emotional) scores significantly improved after CBT.
Limitation – Open study, and SF-36 scores only available for a sub-set of patients.
Perlis et al., (2004) US 983 patients with BD type I, II or NOS Q-LES-Q Younger age of onset of BD predicts Q-LES-Q scores.
Revicki et al., (1997) US 28 outpatients diagnosed with DSM-III-R BD SF-36 Onset of BD determined retrospectively.
No significant differences in SF-36 domain scores according to mode of administration (in-person vs. telephone).
Limitation – small sample size.
Revicki et al., (2003) US 120 BD type I patients hospitalized for acute mania Q-LES-Q No differential effects of treatment with divalproex sodium vs. olanzapine on QoL
Limitation – only 43% of randomized patients completed Q-LES-Q
Ritsner et al., (2002) Israel 17 BD patients (9 manic, 4 depressed, 4 mixed) Q-LES-Q and LQOLP Q-LES-Q scores poorest in depressed patients, highest in manic.
Limitation – small sample of patients diagnosed with BD.
Robb et al., (1997)* Canada 68 euthymic BD patients (55 type I, 13 type II) IIRS Greater illness intrusiveness associated with higher Ham-D scores, recent depression and BD type II.
Limitation – IIRS not validated for use in BD populations.
Robb et al., (1998)* Canada 69 euthymic BD patients (54 type I, 15 type II) SF-20 Women possessed significantly lower SF-20 scores in the domains of pain and physical health.
Limitation – shortcomings of SF-20 as a HRQOL measure.
Russo et al., (1997) US 241 BD inpatients (138 depressed, 103 manic) QOLI Manic BD patients reported better QoL than BD depressed patients.
Limitation – lower response rate in acutely manic group.
Ruggeri et al., (2002) Italy 22 BD patients LQOLP LQOLP mean scores similar to those observed in larger mixed sample of psychiatric patients.
Limitation – small sample of bipolar patients.
Salyers et al., (2000) US 164 BD patients SF-12 Mental health scores significantly lower in patients with unipolar depression.
Limitation – brief nature of SF-12.
Shi et al., (2002) Europe US, South America South Africa 453 BD patients, type I SF-36 Olanzapine superior to haloperidol in improving HRQOL during acute and continuation treatment in most SF-36 domains.
Limitation – relatively high drop-out rates during acute treatment phase.
Shi et al., (2004) 7 countries 573 BD in/outpatients, type I, most recent episode depressed SF-36, QLDS Olanzapine-fluoxetine combination associated with grater improvement in HRQOL.
Limitation – high drop-out rate for an 8-week trial (55%).
ten Have et al., (2002) Netherlands 136 BD patients (93 type I, 43 NOS) SF-36 BD sample generally showed greater impairment in SF-36 scores than patients with other psychiatric diagnoses.
Limitation – accuracy of CIDI diagnosis of BD NOS in question.
Tsevat et al., (2000) US 53 BD patients SF-36, TTO and SG TTO (0.61) and SG (0.70) scores for mental health comparable to those reported for other psychiatric conditions.
Limitation – cognitive complexity of TTO and SG tasks.
Vojta et al., (2001) US 86 BD patients (16 manic/hypomanic, 26 MDD, 14 mixed, 30 euthymic) SF-12 and EuroQoL SF-12 mental health scores significantly lower in manic group than in euthymic group. MDD/mixed group SF-12 scores significantly poorer than in manic/euthymic groups.
Limitation – small sub-samples, brief nature of the SF-12.
Wells et al., (1999) US 331 BD patients 944 double depression 3479 MDD 151 dysthymia 987 depressive symptoms SF-12, TTO and SG BD group had lower health utility than MDD, dysthymia and depressive symptoms groups.
Limitation – cognitive complexity of TTO and SG tasks.
Yatham et al., (2004) 15 countries 920 BD type I patients (currently depressed/experienced episode of depression in previous 60 days) SF-36 SF-36 scores markedly impaired compared to general population norms and consistently lower than sub-scale scores for patients with unipolar MDD.
Limitation – depression severity not controlled for.
  1. * counted as one study for purposes of review
  2. EuroQoL visual analog scale
  3. Illness Intrusiveness Rating Scale
  4. Lancashire Quality of Life Profile
  5. Lehman Quality of Life Interview
  6. Longitudinal Interval Follow-up Evaluation
  7. Mental Health Index 17
  8. MOS Cognitive Function Scale
  9. MOS Short Form 12
  10. MOS Short Form 20
  11. MOS Short Form 36
  12. Occupational Performance Questionnaire
  13. Quality of Life Enjoyment and Satisfaction Questionnaire
  14. Quality of Life in Depression Scale
  15. Quality of Life Index
  16. Quality of Life Interview
  17. Severe Mental Illness
  18. Standard gamble
  19. Time tradeoff
  20. World Health Organization Quality of Life Assessment