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. |