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Quality of life in bipolar disorder: towards a dynamic understanding

Published online by Cambridge University Press:  18 September 2017

E. Morton
Faculty of Health, Arts and Design Swinburne University, Melbourne, Australia
G. Murray
Faculty of Health, Arts and Design Swinburne University, Melbourne, Australia
E. E. Michalak
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
R. W. Lam
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
S. Beaulieu
Bipolar Disorders Program, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
V. Sharma
Regional Mental Health Care London, London, ON, Canada
P. Cervantes
Mood Disorders Program, Department of Psychiatry, McGill University Health Center (MUHC), Montreal, Canada
S. V. Parikh
Department of Psychiatry, Toronto Western Hospital, Toronto, ON, Canada
L. N. Yatham
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
E-mail address:



Although quality of life (QoL) is receiving increasing attention in bipolar disorder (BD) research and practice, little is known about its naturalistic trajectory. The dual aims of this study were to prospectively investigate: (a) the trajectory of QoL under guideline-driven treatment and (b) the dynamic relationship between mood symptoms and QoL.


In total, 362 patients with BD receiving guideline-driven treatment were prospectively followed at 3-month intervals for up to 5 years. Mental (Mental Component Score – MCS) and physical (Physical Component Score – PCS) QoL were measured using the self-report SF-36. Clinician-rated symptom data were recorded for mania and depression. Multilevel modelling was used to analyse MCS and PCS over time, QoL trajectories predicted by time-lagged symptoms, and symptom trajectories predicted by time-lagged QoL.


MCS exhibited a positive trajectory, while PCS worsened over time. Investigation of temporal relationships between QoL and symptoms suggested bidirectional effects: earlier depressive symptoms were negatively associated with mental QoL, and earlier manic symptoms were negatively associated with physical QoL. Importantly, earlier MCS and PCS were both negatively associated with downstream symptoms of mania and depression.


The present investigation illustrates real-world outcomes for QoL under guideline-driven BD treatment: improvements in mental QoL and decrements in physical QoL were observed. The data permitted investigation of dynamic interactions between QoL and symptoms, generating novel evidence for bidirectional effects and encouraging further research into this important interplay. Investigation of relevant time-varying covariates (e.g. medications) was beyond scope. Future research should investigate possible determinants of QoL and the interplay between symptoms and wellbeing/satisfaction-centric measures of QoL.

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Copyright © Cambridge University Press 2017 

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