title: Poor quality of life and functioning in bipolar disorder.
abstract: BACKGROUND
  This study explores the association of demographic and clinical features with quality of life and functioning in individuals with bipolar disorder.
  
  
  METHODS
  Adult participants (N = 482) with bipolar I or II disorder were enrolled in a comparative effectiveness study across eleven study sites and completed baseline measures of medical and psychiatric history, current mood, quality of life, and functioning. Participants with at least mildly depressive or manic/hypomanic symptomatic severity were randomized to receive lithium or quetiapine in addition to adjunctive personalized treatment for 6 months.
  
  
  RESULTS
  Participants with more severe depressive and irritability symptoms had lower quality of life and higher functional impairment. All psychiatric comorbid conditions except substance use disorder were associated with worse quality of life. On average, females had lower quality of life than males. Patients who were married, living as married, divorced, or separated had worse functional impairment compared with patients who were single or never married. A composite score of social disadvantage was associated with worse functioning and marginally associated with worse quality of life. Symptom severity did not moderate the effect of social disadvantage on quality of life or functioning.
  
  
  CONCLUSIONS
  Our findings highlight that depression, irritability, and psychiatric comorbid conditions negatively impact quality of life and functioning in bipolar disorder. The study suggests that individuals with social disadvantage are at risk for functional impairment. Trial Registration This study is registered with ClinicalTrials.gov. Identification number: NCT01331304.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA, 02114, USA. lsylvia2@partners.org.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. lsylvia2@partners.org.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA, 02114, USA.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Montana
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA, 02114, USA.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
authors.affiliation: Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA.
authors.forename: Maurcio
authors.initials: M
authors.lastname: Tohen
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA, 02114, USA.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
authors.forename: Noreen
authors.initials: N
authors.lastname: Reilly-Harrington
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Melvin G
authors.initials: MG
authors.lastname: McInnis
authors.affiliation: Department of Psychiatry, Weill Cornell Medicine, New York City, NY, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Kocsis
authors.affiliation: Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Bowden
authors.affiliation: Bipolar Disorders Research Center, University Hospital's Case Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Calabrese
authors.affiliation: Bipolar Disorders Research Center, University Hospital's Case Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Keming
authors.initials: K
authors.lastname: Gao
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: Ketter
authors.affiliation: Department of Psychiatry, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Shelton
authors.affiliation: Lindner Center of HOPE, Mason, OH, USA.|Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Friedman
authors.affiliation: Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Rabideau
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA, 02114, USA.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
keywords: Bipolar disorder; Functioning; Quality of life; Social disadvantage