Simon Gregory E, Bauer Mark S, Ludman Evette J, Operskalski Belinda H, Unützer Jürgen
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA.
J Clin Psychiatry. 2007 Aug;68(8):1237-45. doi: 10.4088/jcp.v68n0811.
To examine the relationship between changes in mood symptoms and changes in functioning or disability in people treated for bipolar disorder.
This study was a secondary analysis of data from 441 patients enrolled in a randomized trial of a care management and psychoeducational intervention for bipolar disorder (diagnosed according to DSM-IV). Study participants were enrolled between August 1999 and October 2000, and follow-up data were collected until October 2001. Five in-person assessments spaced 3 months apart included structured assessment of current mood symptoms (using the Structured Clinical Interview for DSM-IV), the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) functional status questionnaire, and questions regarding days of disability during the past 3 months. Repeated-measures analyses examined the associations between each outcome measure and severity of mood symptoms. Additional analyses separated variability in mood symptoms into between-person variation (average symptom severity, or trait effects) and within-person variation (change from average symptom severity, or state effects).
Severity of depression symptoms showed a strong and consistent association with all 4 measures of impairment and disability (SF-36 Role-Emotional score, SF-36 Social Function score, days unable to perform household responsibilities, days disabled from other activities; p < .001 for all comparisons). These associations all remained highly significant (p < .001) after adjustment for co-occurring symptoms of mania. Severity of mania/ hypomania symptoms also showed significant association with all disability measures (p < .001 for all comparisons), but these associations were weaker after adjustment for co-occurring symptoms of depression (p < .001 for SF-36 Role-Emotional score, p = .004 for SF-36 Social Function score, p = .069 for days unable to perform household activities, p = .049 for days disabled from other activities). In analyses focused on within-person variation, change in depression was again strongly related to all measures of impairment and disability (p < .001 for all comparisons). After adjustment for co-occurring depression, change in mania/hypomania was not consistently associated with measures of impairment or disability (p = .02 for SF-36 Role-Emotional score; p > .40 for all other comparisons).
Among people treated for bipolar disorder, modest changes in severity of depression are associated with statistically and clinically significant changes in functional impairment and disability. In contrast, changes in severity of mania or hypomania are not consistently associated with differences in functioning. Conventional measures of functioning, however, may not be sensitive to the effects of mania symptoms.
研究双相情感障碍患者情绪症状变化与功能或残疾变化之间的关系。
本研究是对441名参与双相情感障碍护理管理和心理教育干预随机试验（根据《精神疾病诊断与统计手册第四版》[DSM-IV]诊断）患者的数据进行的二次分析。研究参与者于1999年8月至2000年10月入组，并收集随访数据直至2001年10月。每隔3个月进行5次面对面评估，包括对当前情绪症状的结构化评估（使用DSM-IV的结构化临床访谈）、医学结局研究36项简短健康调查（SF-36）功能状态问卷，以及关于过去3个月残疾天数的问题。重复测量分析检验了每个结局指标与情绪症状严重程度之间的关联。额外分析将情绪症状的变异性分为个体间变异（平均症状严重程度，或特质效应）和个体内变异（与平均症状严重程度的变化，或状态效应）。
抑郁症状严重程度与所有4项功能损害和残疾指标（SF-36角色-情感得分、SF-36社会功能得分、无法履行家庭责任的天数、因其他活动而残疾的天数；所有比较p <.001）均呈现强烈且一致的关联。在对同时出现的躁狂症状进行调整后，这些关联均保持高度显著（p <.001）。躁狂/轻躁狂症状严重程度与所有残疾指标也呈现显著关联（所有比较p <.001），但在对同时出现的抑郁症状进行调整后，这些关联较弱（SF-36角色-情感得分p <.001，SF-36社会功能得分p =.004，无法进行家务活动的天数p =.069，因其他活动而残疾的天数p =.049）。在关注个体内变异的分析中，抑郁变化再次与所有功能损害和残疾指标密切相关（所有比较p <.001）。在对同时出现的抑郁进行调整后，躁狂/轻躁狂的变化与功能损害或残疾指标并非始终相关（SF-36角色-情感得分p =.02；所有其他比较p >.40）。
在接受双相情感障碍治疗的患者中，抑郁严重程度适度变化与功能损害和残疾的统计学及临床显著变化相关。相比之下，躁狂或轻躁狂严重程度的变化与功能差异并非始终相关。然而，传统的功能指标可能对躁狂症状的影响不敏感。
