Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA.
Health Qual Life Outcomes. 2011 Oct 13;9:90. doi: 10.1186/1477-7525-9-90.
Existing literature on mood disorders suggests that the demographic distribution of bipolar disorder may differ from that of unipolar depression, and also that bipolar disorder may be especially disruptive to personal functioning. Yet, few studies have directly compared the populations with unipolar depressive and bipolar disorders, whether in terms of demographic characteristics or personal limitations. Furthermore, studies have generally examined work-related costs, without fully investigating the extensive personal limitations associated with diagnoses of specific mood disorders. The purpose of the present study is to compare, at a national level, the demographic characteristics, work productivity, and personal limitations among individuals diagnosed with bipolar disorder versus those diagnosed with unipolar depressive disorders and no mood disorder.
The Medical Expenditure Panel Survey 2004-2006, a nationally representative survey of the civilian, non-institutionalized U.S. population, was used to identify individuals diagnosed with bipolar disorder and unipolar depressive disorders based on ICD-9 classifications. Outcomes of interest were indirect costs, including work productivity and personal limitations.
Compared to those with depression and no mood disorder, higher proportions of the population with bipolar disorder were poor, living alone, and not married. Also, the bipolar disorder population had higher rates of unemployment and social, cognitive, work, and household limitations than the depressed population. In multivariate models, patients with bipolar disorder or depression were more likely to be unemployed, miss work, and have social, cognitive, physical, and household limitations than those with no mood disorder. Notably, findings indicated particularly high costs for bipolar disorder, even beyond depression, with especially large differences in odds ratios for non-employment (4.6 for bipolar disorder versus 1.9 for depression, with differences varying by gender), social limitations (5.17 versus 2.85), cognitive limitations (10.78 versus 3.97), and work limitations (6.71 versus 3.19).
The bipolar disorder population is distinctly more vulnerable than the population with depressive disorder, with evidence of fewer personal resources, lower work productivity, and greater personal limitations. More systematic analysis of the availability and quality of care for patients with bipolar disorder is encouraged to identify effectively tailored treatment interventions and maximize cost containment.
现有关于心境障碍的文献表明，双相情感障碍的人口分布可能与单相抑郁不同，而且双相情感障碍可能对个人功能造成特别大的破坏。然而，很少有研究直接比较单相抑郁和双相情感障碍患者人群，无论是在人口统计学特征还是个人局限性方面。此外，研究通常检查与工作相关的成本，而没有充分调查与特定心境障碍诊断相关的广泛个人局限性。本研究的目的是在全国范围内比较诊断为双相情感障碍与单相抑郁和无心境障碍的个体的人口统计学特征、工作生产力和个人局限性。
使用 2004-2006 年全国代表性的美国非住院平民医疗支出面板调查，根据 ICD-9 分类确定诊断为双相情感障碍和单相抑郁障碍的个体。感兴趣的结果是间接成本，包括工作生产力和个人局限性。
与抑郁和无心境障碍的个体相比，更多的双相情感障碍患者群体生活贫困、独居且未婚。此外，双相情感障碍患者群体的失业和社会、认知、工作和家庭限制率高于抑郁患者群体。在多变量模型中，与无心境障碍的个体相比，患有双相情感障碍或抑郁症的患者更有可能失业、旷工，并且存在社会、认知、身体和家庭限制。值得注意的是，即使与抑郁症相比，双相情感障碍的发现表明其成本更高，尤其是在非就业（双相情感障碍为 4.6，抑郁症为 1.9，性别差异不同）、社会限制（5.17 对 2.85）、认知限制（10.78 对 3.97）和工作限制（6.71 对 3.19）方面的比值差异更大。
双相情感障碍患者群体明显比抑郁症患者群体更脆弱，证据表明他们的个人资源更少、工作生产力更低、个人局限性更大。鼓励更系统地分析双相情感障碍患者的护理资源和质量，以确定有效定制的治疗干预措施并最大限度地控制成本。
