Health-related quality of life and functioning in remitted bipolar I outpatients Armando Piccinni 4 , Mario Catena, Alessandro Del Debbio, Donatella Marazziti, Cristina Monje, Elisa Schiavi, Alessandra Mariotti, Carolina Bianchi, Agnese Palla, Isabella Roncaglia, Marina Carlini, Stefano Pini, Liliana Dell’Osso Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, 56127 Pisa, Italy Abstract The aim of this study was to characterize the health-related quality of life (HR-QOL) and functioning in 90 bipolar I remitted outpatients. According to Diagnostic and Statistical Manual of Mental Disorders IV remission specifiers, patients were categorized into 4 groups: group 1, fully remitted; group 2, less than 2 months remitted; group 3, with persisting manic symptoms; group 4, with persisting depressive symptoms. The severity of psychopathology was evaluated by using the Bech-Rafaelsen Mania-Melancholia Scale. The HR-QOL, functioning, and insight were assessed via the medical outcomes study 36-item short form, the global assessment of functioning scale, and the scale to assess unawareness of mental disorder, respectively. Fully remitted patients reported the highest scores in almost all domains of medical outcomes study 36-item short form, and had significantly higher scores on physical functioning, general health, social functioning, and mental health compared to patients with persisting depressive symptoms. Furthermore, patients with persisting manic symptoms reported significantly higher scores on general health, vitality and mental health than the group with persisting depressive symptoms. In contrast, the global assessment of functioning scale score differed among the 4 groups, with fully remitted patients reporting higher, although not statistically significant, scores than the other groups. Our data suggest that the persistence of depressive or manic symptoms seem to affect self-report measures of HR-QOL. An affectively biased cognition may explain the gap between patient’s perception of functioning and estimated functional adjustment, as assessed by clinicians. D 2007 Elsevier Inc. All rights reserved. 1. Introduction Bipolar disorder is a recurrent, lifelong, and common psychiatric disorder leading to severe disruptions in familial, social, and occupational adjustment [1-5]. A growing body of evidence indicates that patients with bipolar disorder also experience reduced functioning and well-being during interepisode intervals and after recovery from an acute episode of illness [4,6-11]. In particular, the persistence of affective symptoms seems to negatively impact on the functional recovery that is often delayed with respect to the syndromal one [12]. It has been reported that patients with residual depressive symptoms after the first major depressive episode may present a more severe and chronic course of the illness [13], and that the more severe the residual symptoms, the more impaired the psychosocial functioning [14]. In recent years, health-related quality of life (HR-QOL) has been recognized as a major outcome measure in patient’s care and clinical research [15-17]. The assessment of HR-QOL aims to provide a comprehensive evaluation of the individual’s well-being, including physical, social, and role functioning, perception of general and mental health, community integration, and personal adjustment [18]. A reduced HR-QOL in patients with bipolar disorder has been widely reported [8,9,12,19-21], and mainly derived from comparison with the general population and with patients affected by other chronic illnesses [9,22]; however, little is known about the factors influencing HR-QOL within the group of patients with bipolar disorder who are quite heterogeneous. As already noted, residual depressive symptoms even at subthreshold level [23,24] seem to result in a reduced HR-QOL [25-30], whereas only a few data are available on the self-perceived HR-QOL in patients with manic or hypomanic symptoms. Manic/hypomanic patients were shown to present a reduced quality of life, as compared 0010-440X/$ – see front matter D 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.comppsych.2006.12.007 4 Corresponding author. Tel.: +39 050 835435; fax: +39 050 992925. E-mail address: a.piccinni@med.unipi.it (A. Piccinni). Comprehensive Psychiatry 48 (2007) 323 – 328 www.elsevier.com/locate/comppsych