Bipolar disorder and quality of life: A patient-centered perspective
Erin E. Michalak
1
, Lakshmi N. Yatham
1
, Sharlene Kolesar
2
& Raymond W. Lam
1
1
Division of Mood Disorders, Department of Psychiatry, University of British Columbia, Vancouver, BC V6T
2A1Canada (E-mail: emichala@interchange.ubc.ca);
2
University of British Columbia, Vancouver, BC
Canada
Accepted in revised form 27 June 2005
Abstract
Objectives: Several quantitative studies have now examined the relationship between quality of life (QoL) and
bipolar disorder (BD) and have generally indicated that QoL is markedly impaired in patients with BD.
However, little qualitative research has been conducted to better describe patients’ own experiences of how
BD impacts upon life quality. We report here on a series of in-depth qualitative interviews we conducted as
part of the item generation phase for a disease-specific scale to assess QoL in BD. Methods: We conducted 52
interviews with people with BD (n=35), their caregivers (n=5) and healthcare professionals (n=12) iden-
tified by both convenience and purposive sampling. Clinical characteristics of the affected sample ranged
widely between individuals who had been clinically stable for several years through to inpatients who were
recovering from a severe episode of depression or mania. Interviews were tape recorded, transcribed verbatim
and analyzed thematically. Results: Although several interwoven themes emerged from the data, we chose to
focus on 6 for the purposes of this paper: routine, independence, stigma and disclosure, identity, social
support and spirituality. When asked to prioritize the areas they thought were most important in determining
QoL, the majority of participants ranked social support as most important, followed by mental health.
Conclusions: Findings indicate that there is a complex, multifaceted relationship between BD and QoL. Most
of the affected individuals we interviewed reported that BD had a profoundly negative effect upon their life
quality, particularly in the areas of education, vocation, financial functioning, and social and intimate
relationships. However, some people also reported that having BD opened up new doors of opportunity.
Key words: Bipolar disorder (BD), Quality of life (QoL), Qualitative
Introduction
Patient outcome in bipolar disorder (BD), for-
merly known as manic-depression, has tradition-
ally been determined by the assessment of
objectively measured clinical information, such as
rates of relapse, hospitalization, or degree of
symptom reduction. However, many treatment
studies are now including objective and subjective
measures of well-being, with one recent area of
research focusing upon patients’ perceptions of
their quality of life (QoL). Quality of life is a broad
and potentially complex concept, but essentially
refers to an individual’s well-being in a spectrum
of life domains, such as occupational, emotional,
social and physical functioning. Although a rela-
tively large body of research has addressed the
relationship between QoL and unipolar major
depressive disorder (MDD) (for example, [1–4]),
research into QoL in BD has been slow on the
uptake, despite expert opinion that improving
functioning and QoL is a key treatment goal in
this patient population [5, 6]. Three reviews of this
nacent body of literature have now been per-
formed [7–9], all which have concluded that QoL is
markedly impaired in patients with BD, even in
comparison to patients with chronic medical
conditions or other severe, enduring psychiatric
Quality of Life Research (2006) 15: 25–37
Ó
Springer 2006
DOI 10.1007/s11136-005-0376-7