title: Co-occurring conditions and health-related quality of life in patients with bipolar disorder.
abstract: OBJECTIVE
  To assess changes in health-related quality of life (HRQOL) and to determine whether co-occurring substance use and medical comorbidities were associated with worse HRQOL over a 1-year period in a naturalistic sample of patients with bipolar disorder.
  
  
  METHODS
  Patients enrolled in the Continuous Improvement for Veterans in Care: Mood Disorders (CIVIC-MD), a large prospective study from July 2004 to July 2006, completed baseline and follow-up assessments related to bipolar symptoms, comorbidity, and Short Form 12 HRQOL assessment at baseline and at 1 year later. Predictors of changes in HRQOL mental and physical health component scores were determined, using multivariable linear regression models and path analyses.
  
  
  RESULTS
  Of 334 participants, the mean age was 49 years (standard deviation [SD] = 10.1 years; range = 21-78 years), 15.9% women, and 10.8% African American. At baseline, 19.8% reported hazardous drinking, 25.5% reported illicit drug use, and the mean number of co-occurring medical conditions was 2.70 (SD = 2.02). Illicit drug use was associated with worse mental HRQOL (beta = -2.01; p < .05), and increased number of medical comorbidities was significantly associated with worse physical HRQOL over time (beta = -0.71; p < .01). Depressive symptoms exhibited a strong and consistent influence on mental health scores over time, but path analyses revealed that they did not seem to mediate effects of comorbidities on lower HRQOL.
  
  
  CONCLUSIONS
  Illicit drug use and medical comorbidity negatively affected mental HRQOL over time, independent of bipolar symptoms, suggesting the need for interventions that address physical health and drug treatment needs for patients with bipolar disorder.
authors: VA Ann Arbor Health Services Research & Development and National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA. amykilbo@umich.edu
authors: Amy M
authors: AM
authors: Kilbourne
authors: Brian E
authors: BE
authors: Perron
authors: Briana
authors: B
authors: Mezuk
authors: Deborah
authors: D
authors: Welsh
authors: Mark
authors: M
authors: Ilgen
authors: Mark S
authors: MS
authors: Bauer
mesh_terms: D000328:Adult; D000367:Age Factors; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology