Health-Related Quality of Life in Euthymic Bipolar Disorder Patients: Differences Between Bipolar I and II Subtypes

Giuseppe Maina, M.D.; Umberto Albert, M.D., Ph.D.; Laura Bellodi, M.D.; Cristina Colombo, M.D.; Carlo Faravelli, M.D.; Palmiero Monteleone, M.D.; Filippo Bogetto, M.D.; Giovanni B. Cassano, M.D., F.R.C.Psych.; and Mario Maj, M.D., Ph.D.

Objective: The aim of the present study was to compare health-related quality of life (HRQoL) measures in euthymic patients with bipolar I and II disorder. We included as comparison samples a group of subjects with recurrent major depression (RMD) and a group of non-psychiatrically ill individuals.

Method: HRQoL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) in 253 subjects recruited in 5 Italian centers: 90 patients with bipolar I disorder, 52 patients with bipolar II disorder, 61 subjects with RMD, and 50 healthy comparison individuals. All subjects were evaluated with the Structured Clinical Interview for DSM-IV; psychiatric patients had to be in a euthymic state for at least 2 months prior to the inclusion in the study, as confirmed by a Hamilton Rating Scale for Depression total score < 8 and a Young Mania Rating Scale total score < 6. Data were drawn from a study that was performed from May 2003 to December 2004.

Results: When we compared the bipolar and RMD groups with the control group of non-psychiatrically ill individuals and controlled for differences in mean actual age, both bipolar subgroups and subjects with RMD had lower SF-36 mean scores on several subscales; differences in mean SF-36 scores were also detected between bipolar subtypes: bipolar II patients showed HRQoL that was poorer than that of bipolar I patients, even after controlling for age, age at onset, and length of illness, and equal to that of RMD subjects.

Conclusion: Our study provides evidence that bipolar type II is associated with poorer HRQoL compared to type I even during sustained periods of euthymia and excluding residual symptoms. Interventions targeting rehabilitation and/or functional enhancement may be helpful to improve HRQoL, especially among patients with bipolar II disorder. 

(J Clin Psychiatry 2007;68:207-212)

Received June 29, 2006; accepted Aug. 18, 2006. From the Department of Neurosciences, Mood and Anxiety Disorders Unit, University of Turin, Turin (Drs. Maina, Albert, and Bogetto); the Department of Neuropsychiatric Sciences, Scientific Institute and University Vita-Salute San Raffaele, Milan (Drs. Bellodi and Colombo); the Department of Neurology and Psychiatry, University of Florence, Florence (Dr. Faravelli); the Department of Psychiatry, University of Naples SUN, Naples (Drs. Monteleone and Maj); and the Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Pisa (Dr. Cassano), Italy.

Supported by the Italian Ministry of Instruction, University and Research (MIUR), COFIN 2002, prot. 2002063425_006.

In the spirit of full disclosure and in compliance with all ACCME Essential Areas and Policies, the faculty for this CME article were asked to complete a statement regarding all relevant financial relationships between themselves or their spouse/partner and any commercial interest (i.e., any proprietary entity producing health care goods or services consumed by, or used on, patients) occurring within at least 12 months prior to joining this activity. The CME Institute has resolved any conflicts of interest that were identified. The disclosures are as follows: Drs. Maina, Albert, Bellodi, Colombo, Faravelli, Monteleone, Bogetto, Cassano, and Maj have no personal affiliations or financial relationships with any proprietary entity producing health care goods or services consumed by, or used on, patients to disclose relative to the article.

Corresponding author and reprints: Giuseppe Maina, M.D., Department of Neurosciences, Mood and Anxiety Disorders Unit, University of Turin, Via Cherasco 11-10126 Torino, Italy (e-mail: giuseppemaina@hotmail.com).