Health-Related Quality of Life and Functioning of Middle-Aged and Elderly Adults With Bipolar Disorder

Colin A. Depp, Ph.D.; C. Ervin Davis, Ph.D.; Dinesh Mittal, M.D.; Thomas L. Patterson, Ph.D.; and Dilip V. Jeste, M.D.

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.

(J Clin Psychiatry 2006;67:215-221)

Received Jan. 10, 2005; accepted July 6, 2005. From the Department of Psychiatry, University of California, San Diego (Drs. Depp, Davis, Patterson, and Jeste); the VA Health Services Research and Development Center for Mental Healthcare and Outcomes Research and the South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System; and the Department of Psychiatry and Behavioral Sciences, University of Arkansas, Little Rock (Dr. Mittal); and the VA San Diego Healthcare System, San Diego, Calif. (Dr. Jeste).

This work was supported, in part, by the National Institute of Mental Health (Bethesda, Md.) grants MH66248 and MH59101 and by the Department of Veterans Affairs.

Drs. Depp, Davis, Mittal, Patterson, and Jeste report no other significant commercial relationships relevant to this study.

Corresponding author and reprints: Dilip V. Jeste, M.D., VA San Diego Healthcare System, 3350 La Jolla Village Dr. (116A-1), San Diego, CA 92161 (e-mail: djeste@ucsd.edu).