Health-related quality of life in bipolar disorder.

Objectives: Health-related quality of life (HRQOL) refers to an individual's overall sense of wellbeing, and subjective physical, psychological, and social functioning. HRQOL is significantly affected in patients with bipolar disorder (BD), a chronic affective disorder characterized by mood fluctuations, sleep and cognitive impairment, and impact on inter-personal relationships, all of which contribute to HRQOL impairment. This article reviews the relevant literature on the potential causes and magnitude of HRQOL impairment in BD and role of treatment interventions in restoring HRQOL in this patient population.

Methods: A systematic database search was conducted using Medline, Cochrane Database of Systematic Reviews, and PsycINFO from 1959 to 2010 with the key words: bipolar disorder, mania, quality of life, and wellbeing health-related quality of life. A total of 52 studies were initially identified, leading to the selection of 30 studies that focused on measurement of quality of life in adult population.

Results: While there is no one standard assessment of HRQOL, most measures incorporate a broad range of questions regarding the patient's own valuation of their physical, psychological, and social wellbeing. Three main findings are highlighted: (i) BD results in impairment of HRQOL compared to healthy individuals and variable negative impact as compared to other chronic psychiatric and medical conditions; (ii) comorbidities of BD have a further multi-factorial negative impact on HRQOL; and (iii) various pharmacological and non-pharmacological treatment modalities have a positive or equivocal effect on HRQOL in BD.

Conclusions: HRQOL is significantly adversely affected in BD patients. Additionally, the presence of comorbid conditions highly prevalent in BD further decreases HRQOL for these patients. In spite of these factors, this review offers renewed hope as several treatment regimens correlate with higher post-intervention HRQOL scores.