Health-Related Quality of Life and Functioning of Middle-Aged and Elderly Adults With Bipolar Disorder
J Clin Psychiatry 2006;67(2):215-221
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Objective: Data characterizing bipolar
disorder in older people are scarce, particularly
on functional status. We evaluated health-related quality of life and functioning (HRQoLF)
among older outpatients with bipolar disorder as well
as the relationship of HRQoLF to bipolar illness characteristics.
Method: We compared
community-dwelling middle-aged and older adults (age range, 45 to
85 years) with bipolar disorder (N = 54; mean age = 57.6 years), schizophrenia (N = 55;
mean age = 58.5 years), or no psychiatric illnesses (N = 38; mean age = 64.7 years) on indicators
of objective functioning (e.g., education, occupational attainment, medical comorbidity)
and health status (e.g., Quality of Well-Being
scale [QWB] and the Medical Outcomes Study-Short Form Health Survey [SF-36]). Within the
group with bipolar disorder, we examined the
relationship between HRQoLF and clinical variables (e.g., phase and duration of illness,
psychotic symptoms, cognitive functioning).
Results: Patients with bipolar disorder
were similar in educational and occupational
attainment to the normal comparison group, but
they obtained lower scores on the QWB and SF-36 (with large effect sizes). Compared with
schizophrenia, bipolar disorder was associated with
better educational and work histories but similar QWB and SF-36 scores and more medical
comorbidity. Patients in remission from bipolar
disorder had QWB scores that were worse than those
of normal comparison subjects. Greater severity of psychotic and depressive symptoms and
cognitive impairment were associated with lower HRQoLF.
Conclusions: Bipolar disorder was
associated with substantial disability in this sample of
older adults, similar in severity to schizophrenia.
Remission of bipolar disorder was associated with significant but incomplete improvement in
functioning, whereas psychotic and depressive symptoms and cognitive impairment seemed to
contribute to lower HRQoLF.