Academic journal article Indian Journal of Psychiatry

A Cross-Sectional Comparison of Disability and Quality of Life in Euthymic Patients with Bipolar Affective or Recurrent Depressive Disorder with and without Comorbid Chronic Medical Illness

Academic journal article Indian Journal of Psychiatry

A Cross-Sectional Comparison of Disability and Quality of Life in Euthymic Patients with Bipolar Affective or Recurrent Depressive Disorder with and without Comorbid Chronic Medical Illness

Article excerpt

Byline: Hema. Tharoor, Ashutosh. Chauhan, Podila. Sharma

Background: There are major health care implications of quality of life (QOL) and disability in long-standing disorders such as bipolar affective disorder (BAD) and recurrent depressive disorder (RDD). Objectives: To compare the inter-episode QOL and disability in patients with the diagnosis of BAD or RDD in remission with and without comorbid chronic medical illness. Materials and Methods: Cross-sectional assessments of the four groups were carried out. Euthymic bipolar or RDD subjects with chronic comorbid medical illnesses were included in the study. QOL assessment was carried out using the World Health Organization (WHO)-QOL - Bref Kannada version. Disability was assessed using the Schedule for Assessment of Psychiatric Disability (SAPD), which is an Indian modification of the WHO Disability Assessment Schedule-II. Results: Eighty patients were enrolled into the study (20 patients in each group). The mean disability scores in the BAD group was significantly more in 'social role' (P = 0.038), and in the RDD group it was more in 'home atmosphere' (P = 0.001) in the two groups (n = 40) with chronic comorbid medical illness. In the other group without comorbid chronic medical illness (n = 40), the BAD group had significantly more disability in 'overall behavior' (P = 0.002) and 'social role' (P = 0.001), and the RDD group had significantly more disability in 'assets and/or liabilities' (P = 0.004) and 'home atmosphere' (P = 0.001). The QOL measures did not differ significantly between the two disorders. Conclusions: The presence of chronic comorbid medical illness did not cause a difference in the QOL between the two groups in periods of euthymia. However, disability measures differed significantly between the groups.

The concepts of 'disability' and 'quality of life (QOL)' offer a broad perspective for assessing the needs and outcomes of chronic mental patients. The assessments of disability in mood disorders in euthymia with chronic comorbid medical illnesses have been the focus of clinical research in general medicine and mental health specialty practices.[sup] [1] QOL research in bipolar disorders has evolved over the years and is fast gaining popularity as an important morbidity index along with disability.[sup] [2],[3] Recent developments in medical outcome research have made it possible to compare the impact of widely disparate medical and psychiatric conditions on overall patient functioning and well-being. This facilitates health care resource allocation to areas of greatest needs and potential benefits.[sup] [4] Therefore, cross-sectional and longitudinal studies using 'disability' and 'QOL' measures are needed to project the extent of dysfunction in mood disorders with and without chronic medical comorbidity.

Materials and Methods

Subjects

The sample comprised 40 subjects, aged 18 years and above, equally composed of two main disorders - bipolar affective disorder group (BAD) and recurrent depressive disorder group (RDD) in remission with and without comorbid chronic medical illness. A purposive sampling method was employed to ensure equal distribution of twenty subjects across four different subgroups. The four subgroups were as follows: BAD in remission, RDD in remission, BAD in remission with comorbid chronic medical illness, and RDD in remission with comorbid chronic medical illness. The period of remission required to enter the study was taken as 2 months. The patient groups were recruited from the outpatient department of psychiatry at Kasturba Hospital, Manipal, India. The target population consisted of patients fulfilling ICD-10 Diagnostic Criteria for Research (DCR)[sup] [5] guidelines of BAD or RDD in remission. The consultant psychiatrists in the department using the ICD-10 DCR delineated the diagnosis and duration of remission of 2 months. Patients with and without comorbid chronic medical illnesses were recruited in the study. …

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