Symptomatic and functional outcome of bipolar disorder in Butajira, Ethiopia.
BACKGROUND
Limited information is available on the outcome of bipolar disorder in developing countries.


OBJECTIVE
To describe the symptomatic and functional outcome of bipolar disorder.


METHODS
The psychoses and affective disorder modules of the CIDI were used to screen 68,378 individuals by a door-to-door survey of a defined district in Ethiopia. In addition, key informants were used to identify individuals with probable major mental illnesses. SCAN interviews were completed at the second stage to confirm the diagnosis. A total of 315 cases of bipolar disorder were identified, of which 264 (69 recent-onset and 195 prevalent cases) were prospectively followed for a mean of 2.5 (range 1-4) years by baseline and annual clinical assessments using symptom rating scales. Functional dimensions of the SF-36 scale were used to describe functional outcome. Random coefficient analyses were used to evaluate potential correlates of outcome.


RESULTS
The magnitudes of mania and depression symptoms were elevated at baseline but improved with follow-up, although the improvement was less marked for depression. Sociodemographic or clinical variables were not associated with the improvements in symptomatic outcome. Between 35% and 47% of the recent-onset cases had functional role restrictions, while 42-52% of long-standing cases had such restrictions during the follow-up years. Similarly, social and physical functioning deficits were also present in 52-86% and 35-47% of recent-onset and long-standing cases, respectively. The magnitude of depression and mania symptoms was associated with poor functional outcome, while male sex, rural residence and being married were associated with better functional outcome.


CONCLUSIONS
Although there were improvements in function with follow-up, between one-third and one-half of cases continued to have functional deficits.
Kebede
Derege
D
deregekebede@yahoo.com
Alem
Atalay
A
Shibire
Teshome
T
Deyassa
Negussie
N
Negash
Alemayehu
A
Beyero
Teferra
T
Medhin
Ghirmay
G
Fekadu
Abebaw
A
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005002:Ethiopia; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D012737:Sex Factors; D012959:Socioeconomic Factors; D013223:Statistics as Topic
D014150:Antipsychotic Agents