title: Early clinical predictors and correlates of long-term morbidity in bipolar disorder.
abstract: Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD).
  
  
  
  We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling.
  
  
  
  Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P=0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P<0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis.
  
  
  
  Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity.
authors.affiliation: Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA; Lucio Bini Mood Disorder Center, Rome, Italy. Electronic address: giuliaserra@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Serra
authors.affiliation: International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Koukopoulos
authors.affiliation: NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: De Chiara
authors.affiliation: NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: A E
authors.initials: AE
authors.lastname: Koukopoulos
authors.affiliation: NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sani
authors.affiliation: Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA; Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Tondo
authors.affiliation: NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Girardi
authors.affiliation: International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA; Lucio Bini Mood Disorder Center, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Reginaldi
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D013694:Temperament
keywords: Bipolar disorder; D/M ratio; Long-term morbidity; Outcome; Prediction; Prodrome