The association between post-traumatic stress disorder (PTSD) and mental health-related quality of life (HRQOL) among individuals with bipolar disorder may be mediated by depressive symptoms, the results of a US study indicate.
"These findings underscore the importance of proper screening and treatment for these two debilitating conditions because impairments in HRQOL are closely related to individuals being able to achieve important recovery outcomes," say Laura Bajor, from Harvard Medical School in Boston, Massachusetts, and colleagues.
They continue: "Given the inherent difficulties and potential lack of effectiveness presented by psychopharmacological intervention, clinicians working with these patients may choose to emphasize psychosocial treatments as important towards improving HRQOL for this group, especially those that emphasize increased social support."
For the study, the team examined baseline data from the multi-site Recovery-Oriented Collaborative Care study of bipolar disorder patients, collating data on responses to, among others, the Mental and Physical Component Subscales of the SF-12, and self-report co-occurring conditions.
The researchers report in the Journal of Affective Disorders that 44.9% of participants had a previous diagnosis of PTSD. Individuals with PTSD were significantly more likely to be women, at 80.24% versus 56.22% of men.
A diagnosis of PTSD was also associated with significantly lower Mental Component scores, at 30.51 versus 32.86 for those without PTSD. Furthermore, PTSD was linked to significantly higher scores for depressive symptoms on the Patient Health Questionnaire-9 (PHQ-9), at 14.75 versus 11.65, and greater scores on the activation scale of the Internal State Scale, at 22.91 versus 18.30.
In addition, the results showed that patients with PTSD were less likely to be euthymic, at 20.81% versus 36.22%.
On multiple regression analysis, PTSD was significantly associated with lower mental HRQOL. However, the association lost significance on inclusion of PHQ-9 scores in the analysis, indicating that depressive symptoms, and not the presence of PTSD, were significantly linked to reduced mental HRQOL scores.
"It seems reasonable to speculate that depression has the most direct effect on mental HRQOL, and that the odds of a patient in this population becoming depressed are increased by both bipolar disorder and PTSD," say Bajor et al.
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