A Systematic Review Evaluating Health-Related Quality of Life, Work Impairment, and Healthcare Costs and Utilization in Bipolar Disorder
Bipolar disorder greatly impacts health-related quality of life (HRQoL), physical and social functioning, employment, and work productivity, and greatly increases health-care utilization and costs. Our objective was to characterize how bipolar disorder impacts HRQoL, work impairment, and health-care utilization and costs.
A systematic literature review was conducted to identify bipolar disorder studies of HRQoL, functioning, work impairment, and health-care utilization and costs. We searched Medline, ClinPSYC, and HealthSTAR for English-language articles published between January 1985 and November 2002 using MeSH headings and keywords. Additional articles were identified from references of relevant articles.
We identified 65 HRQoL articles, 14 work-impairment articles, and 28 utilization-and-care-cost articles. For all HRQoL instruments used, bipolar disorder patients' HRQoL was rated similarly to that of unipolar depression patients, and equal to or lower compared with patients with other chronic nonmental illnesses. Current treatments have been shown to improve HRQoL and physical and social functioning; some data indicate that management may improve selfreported work impairment and absenteeism. Bipolar disorder patients have been found to utilize health-care services more than do patients with depression or chronic medical conditions. Inpatient costs are the largest cost contributor; treatment to prevent recurrence has been shown to be the most effective way to reduce costs.
Bipolar disorder imposes a tremendous burden on patients and the health-care system, resulting in decreased HRQoL and increased medical and work impairment costs. Limited data suggest that appropriate management can improve HRQoL and functioning while reducing utilization and cost.
Available from: Mukesh Swami
- "The difference in work domain was not significant between the two groups. Contrary to our findings, Dean and colleagues reported that rates of employment are low in people with BAD in comparison to those observed in patients with other affective disorders . "
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ABSTRACT: Introduction. Major depressive disorder (MDD) and bipolar affective disorder (BAD) are among the leading causes of disability. These are often associated with widespread impairments in all domains of functioning including relational, occupational, and social. The main aim of the study was to examine and compare nature and extent of psychosocial impairment of patients with MDD and BAD during depressive phase. Methodology. 96 patients (48 in MDD group and 48 in BAD group) were included in the study. Patients were recruited in depressive phase (moderate to severe depression). Patients having age outside 18-45 years, psychotic symptoms, mental retardation, and current comorbid medical or axis-1 psychiatric disorder were excluded. Psychosocial functioning was assessed using Range of Impaired Functioning Tool (LIFE-RIFT). Results. Domains of work, interpersonal relationship, life satisfaction, and recreation were all affected in both groups, but the groups showed significant difference in global psychosocial functioning score only (P = 0.031) with BAD group showing more severe impairment. Conclusion. Bipolar depression causes higher global psychosocial impairment than unipolar depression.
Available from: Maria Francesca Moro
- "Europe, too (Fajutrao et al., 2009). A number of issues impact on the burden of the disease, such as comorbidity, suicide, early death, unemployment or underemployment, which is why Bipolar disorder greatly impacts on health-related quality of life (Dean et al., 2004). The Epidemiologic Catchment Area (ECA) study evaluated that approximately 55% of the persons affected by this disease received some treatment in a year, and that approximately 33% underwent about 14 medical/psychiatric examinations, on average , over the same period of time (Simon and Unützer , 1999). "
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ABSTRACT: INTRODUCTION: The objective was to estimate the rate of subjects who tested positive at a screening for bipolar disorders among the people insured by a French Health Company, and subsequently to measure treatment patterns. METHODS: Cross-sectional postal survey on the "Mutuelle Générale de l'Education Nationale" (MGEN) policyholders. A self-rated questionnaire was sent by mail to 20,099 individuals randomly selected among MGEN policyholders. Tools: questionnaire on socio-demographic variables and health-care use; Mood Disorder Questionnaire (MDQ); Composite International Diagnostic Interview Short Form Self-Administered (CIDI-SA). RESULTS: Responders were 10,288 (53%). The prevalence of MDQ positivity (MDQ(+)) was 3.6%. The respondents older than 65 showed the lowest frequencies. High frequencies were recorded by the people who had left work because of long term sickness and by people with invalidity. Subjects having a diagnosis of ICD-10 major depression were found to be at risk. Positive subjects had no more contacts with general practitioners than negative subjects; on the contrary they had more contacts with psychiatrists, alternative medicine professionals, psychologists, psychoanalysts, spiritual guides or welfare workers. MDQ+ subjects had a higher risk to use all kinds of psychodrugs, including antidepressants (27.7%, OR=2.7, CI95% 1.9-3.9). DISCUSSION: The prevalence of MDQ(+) was similar to the surveys in the USA and Italy. The use of ADs in people with MDQ(+) and MDD diagnosis needs to be taken into account when managing the public health-care system. A large rate of positive subjects reported to have used ineffective treatments for bipolar disorders. LIMITS: Relative low response rate and observational design.
Available from: Jorge Maurino
- "The estimated lifetime prevalence of bipolar disorder in Europe is approximately 1%.1 In the population aged 15–44 years, bipolar disorder is among the leading causes of disability in the developed world, which partially explains the significant economic burden of the disease.2 In addition, bipolar patients use health care services more than patients with other mental disorders.2,3 "
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ABSTRACT: The primary aim of this study was to assess drug treatment adherence in patients with bipolar disorder and to identify factors associated with adherence. The secondary aim was to analyze the impact of suboptimal adherence on clinical and functional outcomes.
A cross-sectional study was conducted in a sample of outpatients receiving an oral antipsychotic drug. Medication adherence was assessed combining the 10-item Drug Attitude Inventory, the Morisky Green Adherence Questionnaire, and the Compliance Rating Scale. Logistic regression was used to determine significant variables associated with suboptimal adherence to medication.
Three hundred and three patients were enrolled into the study. The mean age was 45.9 ± 12.8 years, and 59.7% were females. Sixty-nine percent of patients showed suboptimal adherence. Disease severity and functioning were significantly worse in the suboptimal group than in the adherent group. Multivariate analysis showed depressive polarity of the last acute episode, presence of subsyndromal symptoms, and substance abuse/dependence to be significantly associated with suboptimal treatment adherence (odds ratios 3.41, 2.13, and 1.95, respectively).
A high prevalence of nonadherence was found in an outpatient sample with bipolar disorder. Identification of factors related to treatment adherence would give clinicians the opportunity to select more adequately patients who are eligible for potential adherence-focused interventions.
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