Subsyndromal Depressive Symptoms Are Associated With Functional Impairment in Patients With Bipolar Disorder: Results of a Large, Multisite Study
J Clin Psychiatry 2006;67(10):1551-1560
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Objective: Studies of patients with unipolar
depression have demonstrated a relationship
between subthreshold depressive symptoms and impairment
in role functioning. Research examining this
relationship in persons with bipolar disorder is rare. This
study sought to evaluate the association between
subsyndromal depressive symptoms and role functioning
in subjects with bipolar disorder.
Method: 759 adult outpatients with a
DSM-IV diagnosis of bipolar disorder were entered into
this study at 7 different sites in the Stanley
Foundation Bipolar Network (SFBN) beginning in March
1996 and ending in November 2002 and were followed
longitudinally for assessment of their course of
illness. Subsyndromal depression was operationalized
using cutoff scores on the Inventory for Depressive
Symptomatology-Clinician Rated (IDS-C), and
patients were divided into 3 groups: not depressed
(IDS-C score < 13), subsyndromally depressed (IDS-C
score 13 to 27), and syndromally depressed (IDS-C
score >= 28). Groups were compared using a series of
chi2 analyses on degree of role function impairment
across 4 role domains (work, home duties, family life,
and friendships) from the Life Functioning
Questionnaire. Logistic regression was used to estimate the
probability of any impairment in life functioning based
on severity of depressive symptoms.
Results: Subsyndromally depressed patients
were significantly more likely than those not depressed
to report impairment in their work and home
functioning roles, as well as impairment in relations with
family and friends (p < .001). Across all domains of
role function, the proportion of patients impaired in
the subsyndromally depressed group was more similar
to the syndromally depressed group than to the not
Conclusions: These findings clearly
demonstrate the public health significance of subsyndromal
depression in the bipolar population. The most
appropriate interventions for subsyndromal
depressive symptoms in patients with bipolar disorder remain
to be determined.