title: Posttraumatic stress disorder, depression, and health-related quality of life in patients with bipolar disorder: review and new data from a multi-site community clinic sample.
abstract: BACKGROUND
  Evidence suggests that patients with bipolar disorder have an elevated risk for comorbid posttraumatic stress disorder (PTSD) compared to those without a bipolar diagnosis. Although bipolar disorder is associated with decreased health-related quality of life (HRQOL), it is unclear whether comorbid PTSD interacts to affect HRQOL.
  
  
  METHODS
  Baseline data from a multi-site study of patients with bipolar disorder were analyzed. Patient surveys ascertained clinical and demographic information, including physical and mental HRQOL based on the SF-12, mood symptoms (PHQ-9, Internal State Scale), and self-reported co-occurring conditions including PTSD.
  
  
  RESULTS
  Overall (N=384), 44.9% of patients self-reported co-occurring PTSD. Patients with PTSD had lower physical and mental HRQOL scores compared to those without PTSD (mean (SD) for those with and without PTSD, respectively): Mental Component Scale score 30.51 (8.22) and 32.86 (8.35); Physical Component Scale score 35.56 (7.77) and 37.21 (7.20). After adjusting for demographic and clinical factors including mood symptoms, multiple linear regression analyses revealed that PTSD was no longer significantly associated with physical or mental HRQOL; however, depressive symptoms were independently associated with mental HRQOL (Beta -0.63, p<0.01).
  
  
  CONCLUSIONS
  Depressive symptoms may explain the association between PTSD and mental HRQOL. Clinicians working with these patients will want to emphasize treatment of depression as important towards improving HRQOL for this group.
authors.affiliation: Center for Organization, Leadership, & Management Research, VA Boston Healthcare System, 150S. Huntington Ave 152M, Jamaica Plain, Boston, MA, United States. laura_bajor@hms.harvard.edu
authors.forename: Laura A
authors.initials: LA
authors.lastname: Bajor
authors.forename: Zongshan
authors.initials: Z
authors.lastname: Lai
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Miller
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.forename: Hyungjin
authors.initials: H
authors.lastname: Myra Kim
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*