title: Patient perceptions of physical health and bipolar symptoms: The intersection of mental and physical health.
abstract: BACKGROUND
  Affective symptoms and medical comorbidities have a negative impact on the course of bipolar disorder. The aim of this analysis was to examine how the perceptions of physical health and functioning in individuals with bipolar disorder relate to their mood symptoms.
  
  
  METHODS
  We analyzed longitudinal data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) on the physical subscales of the Short Form Health Survey (SF-36) (physical functioning, role limitations due to physical problems, bodily pain, and general health).
  
  
  RESULTS
  Participants' perception of their overall physical health predicted severity of mania/hypomania, depression, and life satisfaction at concurrent and future visits. Perceptions of role limitations due to physical health problems predicted depressive symptoms and poor life satisfaction. Worse bodily pain predicted symptoms of mania/hypomania. Reports of specific or concrete physical limitations in daily life showed no associations with psychiatric symptoms at concurrent assessments, but did predict worse course of illness one year later. SF-36 scores showed significant, but small associations with the presence of medical comorbidities.
  
  
  CONCLUSIONS
  Perceptions of physical health and quality of life were self-report, potentially lending themselves to transient negative biases, particularly among depressed participants. Additionally, the SF-36 was selected as a generic, widely used measure; as a result, it was not specific to the illness burden of bipolar disorder.
  
  
  CONCLUSIONS
  Overall, broad perceptions of poor physical health were associated with worse course of illness over the 24 months of the study. Though further research is warranted, changes in subjective physical health related quality of life, even independent of objective health changes, may offer important insight into global wellbeing and be targets of psychotherapy treatment.
authors.affiliation: Department of Psychology, Harvard University, 1244 William James Hall, 33 Kirkland Street, Cambridge, MA 02138, USA. Electronic address: ebernstein@fas.harvard.edu.
authors.forename: Emily E
authors.initials: EE
authors.lastname: Bernstein
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, USA.
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Rabideau
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Gigler
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001714:Bipolar Disorder / Q000523:psychology*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D011788:Quality of Life / Q000523:psychology; D055815:Young Adult
keywords: Bipolar disorder; Functioning; Mood; Physical health; Quality of life