Quality of Life and Bipolar Disorder
If you have the illness, you know that you suffer emotionally, mentally, socially, and physically.
Medically, the diagnosis is associated with impaired functioning.
For instance, if a woman develops bipolar disorder at the age of 25, she could lose up to 9 years of her life because of cardiovascular and other medical problems.
She may also lose up to 14 years of productivity, and 12 years of good health.
A study by Greg Murray, PhD and Erin E. Michalak, PhD (2007), examined quality of life in patients with bipolar disorder. I take a look at this study in this article, also gleaning information from experience and facts I have received along the way.
The lifetime suicide rates of patients with bipolar disorder (treated or not) is as high as 15%.
Increasingly, studies are trying to access more details about quality of life impairment experienced by people with bipolar disorder.
Quality of life in populations with bipolar disorder appears to fall far below that observed in general population samples.
The medical outcome survey, or SF-36, is the most widely used quality of life measure in the bipolar population to date. Most quality of life studies have been done on populations such as those with unipolar depression.
The SF-36 contains 8 subscales. They assess physical functioning, social functioning, physical role limitations, emotional role limitations, pain, mental health, general health, and vitality.
Results indicate that quality of life in patients with bipolar disorder tends to be significantly compromised in all areas except for physical, compared with the general population.
As noted in the 2007 article, a study from the Netherlands compared SF-36 scores in people with bipolar disorder with scores found in people with a variety of other psychiatric disorders (anxiety disorders, substance abuse issues, depression, and no psychiatric disorder).
The participants with bipolar disorder were significantly more impaired in most SF-36 domains compared to the other participants.
Scores in general health, social functioning, physical roles, and emotional roles were consistently lower in the group with bipolar disorder than the group with unipolar depression; however, those with unipolar disorder showed more impairment in the bodily pain domain.
However, much of the morbidity and mortality in bipolar disorder appears to be in the depressive phase, rather than the defining manic or hypomanic phases.
Among a sample of 129 patients, those who experienced an acute depressive episode or mixed episode were at significantly higher risk for suicide, panic disorder, and psychosis than patients experiencing purely manic episodes.
And, odds of experiencing significant impairment of role functioning with patients with depressive symptoms were 3 to 6 times greater than for those who were not depressed.
Growing evidence for the marked association between depressive episodes and lowered quality of life in patients with bipolar disorder is clinically significant.
This is especially important in that depressive symptoms predominate over manic symptoms in patients with bipolar disorder I and particularly bipolar disorder II .
A large portion of the quality of life challenge therefore evidently stems from the depressive side of bipolar disorder.
One criticism that experts have is that certain elements of bipolar disorder such as financial indiscretion and hypersexuality when hypomanic demand specific instruments not already accounted for.
For this reason, clinicians are now trying to develop disorder-specific scales for bipolar disorder.
These two PhDs who wrote the article developed a scale that measured a variety of factors, including adverse affects of medications, occupation, level of education, environment, and sexuality.
Even though many of the patients were functioning very well despite their diagnosis, they all mentioned several years of hardship and adjustment before getting “back on track”.
The emerging body of research suggests that the factor of quality of life in patients with bipolar disorder should be carefully evaluated and brought into the holistic picture of treatment.
Experts encourage therapists and psychiatrists to continuously evaluate quality of life in patients with bipolar disorder to enrich understanding of patient progress.
With this as a tool, clinicians can tailor treatment regimens, considering the important aspects of a person’s life.
People with bipolar disorder deserve to know more about how to make all facets of their lives better, along with what medicines to take and how to change their thought patterns.
We need guidance on why we aren’t doing well and how to stay well. This would go a long way in prolonging and enriching the lives of those with bipolar disorder.
What is the biggest obstacle you struggle with in the 8 subscales of the SF-36? What do you think your clinicians can do to help you increase your quality of life? What can you do for yourself?
Murray, G., & Michalak, E. E. (2007). Quality of life in patients with bipolar disorder: Defining and measuring goals. Psychiatric Times, Retrieved from http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/54001?pageNumber=1
Dawkins, K. (2013). Quality of Life and Bipolar Disorder. Psych Central. Retrieved on July 7, 2015, from http://blogs.psychcentral.com/bipolar-life/2013/05/quality-of-life-and-bipolar-disorder/