Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores

doi:10.1016/S0165-0327(98)00003-2

Journal of Affective Disorders

Volume 49, Issue 3, 1 June 1998, Pages 189-193

https://doi.org/10.1016/S0165-0327(98)00003-2 Get rights and content

Abstract

Background: The importance of gender on the course and outcome in bipolar disorder (BD) has been widely acknowledged. The limited data suggest that the prevalence is similar between sexes but that the course of illness may be different. This study investigated gender differences in a clinic sample of patients with BD including a measure of subjects' perception of well-being and functioning. Methods: Euthymic outpatients attending a mood disorders clinic were systematically assessed. Measurements obtained included SADS-LV, Hamilton Depression Ratings scores, Young Mania Rating scores, and Medical Outcome Survey Short Form 20 items and Global Assessment of Functioning. Results: Women with BD have a later onset of mania, are more likely to have a rapid cycling course, experience mixed episodes, experience more depressive episodes and report more overall impairment in all MOS subscale scores with significant impairment in physical health and pain. Conclusions: Further investigation and replication of these differences need to be addressed including non-euthymic patients and during a longer period of systematic follow-up.

Introduction

Studies of gender differences in major depressive disorder (MDD) indicate that women are more susceptible to depression, may experience different symptoms and have a more refractory course of illness (Goodwin and Jamison, 1990). Less attention has been directed at the empirical study of women with bipolar disorder (BD). The data would suggest that there is no gender difference in prevalence rates of bipolar disorder (Weissman et al., 1988) but that women may have a different course of illness. These differences would include (1) a rapid cycling course (Bauer et al., 1994, Coryell et al., 1992, Leibenluft, 1996); (2) more episodes of depression or dysphoric mania (Leibenluft, 1996, Dilsaver et al., 1994, McElroy et al., 1992); (3) a later age of onset of BD (Leibenluft, 1996); (4) more episodes of depression than mania (Angst et al., 1978); and (5) longer duration of individual episodes of depression (Kessler et al., 1993). Although these studies suggest substantial gender differences in BD, conclusions are limited by the small number of studies and their methodologic limitations; particularly, small sample sizes.

The aim of the present study was to investigate gender differences in a clinic sample of patients with BD. Furthermore, a measure of well-being and functioning was obtained from a subset of the larger group to provide a subjective appraisal of the participant's experience with the illness.

Section snippets

Methods

Subjects were outpatients attending the Mood Disorders Program at the Clarke Institute of Psychiatry, University of Toronto. All participants gave informed written consent to participate in an ongoing study of the course and outcome of BD. Each met Research Diagnostic Criteria (Endicott and Spitzer, 1978) for BD as determined by clinical assessment and by the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-LV) (Spitzer et al., 1978) administered by a nurse clinician.

Results

Sixty nine subjects completed the outcome measure and this group consisted of 27 men and 42 women, BP type I, n=54;type II n=15 and a mean age 36.0±1.2 years (eight patients 1M/7F were rapid cycling). Results are presented in Table 1. There were no significant differences between gender groups with respect to age or type of BD. Women appear to experience episodes of both depression (27.2 yrs±1.3 vs 22.4 yrs±1.2) and mania (25.9±1.0 vs 21.8±1.0) at a significantly later age than men. Women had

Discussion

Our findings suggest specific clinical differences experienced by women compared with men who have the diagnosis of BD. The present data further acknowledge that rapid cyclers are female (88%) and this finding is comparable to those of Bauer et al. (1994)and Coryell et al. (1992)who found 70% of the rapid cycling patients were women. In a similar fashion women tended to more commonly have mixed episodes (20% vs 3%) consistent with earlier studies (Dilsaver et al., 1994McElroy et al., 1992).

References (25)

R.G. Cooke et al.
Well-being and functioning in patients with bipolar disorder assessed using the MOS 20-item short form
J. Affect. Disord.
(1996)
R.C. Kessler et al.
Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity and recurrence
J. Affect. Disord.
(1993)
J. Angst
The course of affective disorders. II. Typology of bipolar manic-depressive illness
Arch. Psychiatr. Nervenkr
(1978)
J. Angst et al.
The course of affective disorders: I. Change of diagnosis of monopolar, unipolar and bipolar illness
Arch. Psychiatr. Nervenkr
(1978)
M.S. Bauer et al.
Multisite Data Reanalysis of the Validity of Rapid cycling as a Course Modifier for Bipolar Disorder in DSM-IV
Am. J. Psychiatry
(1994)
W. Coryell et al.
Rapidly cycling affective disorder: Demographics, diagnosis, family history and course
Arch. Gen. Psychiatry
(1992)
S.C. Dilsaver et al.
Suicidality in patients with pure and depressive mania
Am J. Psychiatry
(1994)
J. Endicott et al.
A diagnostic interview. The schedule for affective disorders and schizophrenia
Arch. Gen. Psychiatry
(1978)
Goodwin, F.K., Jamison, K.R., 1990. Manic Depressive Illness. Oxford University Press, New...
M. Hamilton
Development of a rating scale for primary depressive illness
Br. J. Soc. Psychol.
(1967)

C.L. Hammen et al.

Differential responses to male and female depressive relations

J. Abnorm. Psychol.

(1977)

M.B. Keller et al.

Differential outcome of pure mania, mixed/cycling, and pure depressive episodes in patients with bipolar illness

J. Am. Med. Assoc.

(1986)

Cited by (126)

Sex-specific associations between lifetime diagnosis of bipolar disorder and cardiovascular disease: A cross-sectional analysis of 257,673 participants from the UK Biobank
2022, Journal of Affective Disorders
Sex is seldom considered as a potential moderator of the impact of bipolar disorder (BD) on cardiovascular disease (CVD) risk. We aimed to characterize the sex-specific association of CVD and BD using data from the UK Biobank.
In a cross-sectional analysis, we compared the odds ratio between women and men with BD for seven CVD diagnoses (coronary artery disease, myocardial infarction, angina, atrial fibrillation, heart failure, stroke, and essential hypertension) and four cardiovascular biomarkers (arterial stiffness index, low-density lipoprotein, C-reactive protein, and HbA1c) in 293 participants with BD and 257,380 psychiatrically healthy controls in the UK Biobank.
After adjusting for age, we found a two- to three-fold stronger association among women than among men between BD and rates of coronary artery disease, heart failure, and essential hypertension, with a significant sex-by-diagnosis interactions. The association remained significant after controlling for self-reported race, education, income, and smoking status. After controlling for potential confounders, there was no significant association between sex and any cardiovascular biomarkers.
These analyses could not disentangle effects of BD from its treatment.
Our results underscore the importance of incorporating sex and mental illness in risk estimation tools for CVD, and improving screening for, and timely treatment of, CVD in those with BD. Future research is needed to better understand the contributors and mechanisms of sex differences related to CVD risk in BD.
Gender differences of amplitude of low-frequency fluctuations in bipolar disorder: A resting state fMRI study
2021, Journal of Affective Disorders
Citation Excerpt :
Gender differences in epidemiological and clinical features have been observed in bipolar disorder (BD). Evidence showed that women with BD were more likely to have depressive episodes, hypomania, rapid cycling, and mixed episodes than men with BD (Altshuler et al., 2010), who are at greater risk for manic episodes than their female counterpart (Robb et al., 1998). Women with BD usually experience depressive episodes in winter, manic episodes in autumn and summer, and mixed episodes in summer, while men with BD experience manic episodes in summer (Fellinger et al., 2019).
: The clinical and epidemiological features of bipolar disorder (BD) between females and males have many differences. The association between brain function and gender in BD is unknown. This research aimed to investigate the association between brain function and gender in BD by using amplitude of low-frequency fluctuations (ALFFs).
: Ninety-eight patients (49 females and 49 males) with BD and 171 matched healthy controls (HCs, 89 females and 82 males) were recruited for resting-state functional magnetic resonance imaging. ALFF was used to estimate brain function.
: A main effect of diagnosis in ALFF was observed in the dorsal lateral prefrontal cortex (DLPFC), ventral prefrontal cortex (VPFC), caudate and occipital lobe. A main effect of gender in ALFF was found in the right VPFC, DLPFC, thalamus, and occipital lobe. A main effect of diagnosis gender interaction in ALFF was observed in the left DLPFC. Analyses of two-sample t-test indicated that male patients with BD had increased ALFF in the right hippocampus, right amygdala, left caudate, and left DLPFC, and decreased ALFF in the occipital lobe compared with male HC. Female patients with BD demonstrated increased ALFF in the right VPFC and right DLPFC compared with female HC. Male patients with BD exhibited increased ALFF in the right VPFC and left DLPFC and decreased ALFF in the occipital lobe compared with female patients with BD.
: This study did not consider the effect of medications and emotional states on brain activity.
: Results suggested gender differences in the dysfunctions of the cortico-limbic neural system in BD.
A Randomized Controlled Trial of Transcultural Validation of Group-Based Psychosocial Intervention for Patients with Bipolar Disorder
2020, Psychiatry Research
Adjunctive psychosocial interventions are part of the preferred method to treat bipolar disorder (BD). This study aimed to conduct a randomized control and protocol-guided trial, in order to evaluate the feasibility and effectiveness of adjunctive group-based treatments for Chinese outpatients with BD. A single-blind trial in which 68 outpatients with BD were randomly assigned to either treatment as usual (TAU) or to an experimental group with 12 additional weekly sessions and 3 monthly booster sessions. Participants were assessed at baseline for mood condition, suicidal ideation, medication adherence, and quality of life (QoL), with follow-up assessments every 3 months over a 1-year period. The overall retention rate of this study was 89.7%. The results showed significant differences between groups for the variables evaluated, which included achieving euthymia, decrease of depression symptoms, and improvement of QoL. No improvements in medication adherence, reduction in manic symptoms, or suicidal ideation was observed. The results of this study support the transcultural validity and efficacy of group-based psychosocial intervention as anadjunct to TAU among Chinese outpatients with BD to promote improvements during the course of the illness including achieving euthymia, reducing depressive symptoms, and improving QoL.
Perinatal Mixed Affective State: Wherefore Art Thou?
2020, Psychiatric Clinics of North America
Quality of life in euthymic bipolar patients: A systematic review and meta-analysis
2019, Journal of Affective Disorders
Patients with bipolar disorder, even euthymic, could suffer an impairment in their quality of life compared to healthy controls. Since no previous systematic review and meta-analysis has been conducted, the aim of the current study is to conduct a systematic review and meta-analysis of cross-sectional case-controlled studies on quality of life in adult euthymic Bipolar Disorder patients.
A systematic review and meta-analysis that followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) was conducted. Major electronic databases were searched on August 2018 to assess the variables associated with quality of life in euthymic bipolar disorder patients. After selecting case-control studies, data collection, quality assessment and subsequently statistical analysis were done.
66 studies were finally selected for systematic review and meta-analysis. Four different quality of life instruments were used among the different studies. Effect size analysis showed that there were significant differences in quality of life outcomes between euthymic bipolar disorder patients and healthy controls (d=−0.922; SE=0.316; 95%CI=−1.541–−0.303; p=.004), with lower quality of life in the euthymic patients. Furthermore, time since euthymia explained 15.62% of variability, and age of control group explained 29.6% of variability. No other moderators were statiscally significant.
The instruments used were heterogeneous. Moreover, the role of other clinical moderators could not be included due to the lack of this information in most of the articles.
Quality of life is lower in euthymic bipolar patients than in healthy controls. However, longer time in euthymia is associated with better outcomes.
Are affective temperaments determinants of quality of life in euthymic patients with bipolar disorder?
2018, Journal of Affective Disorders
Bipolar disorder (BD) is a disabling illness that is associated with low quality of life (QoL). This low QoL goes further than mood episodes, which suggests that stable traits, such as affective temperaments, can cause functional impairment.
Our study analyses the impact of affective temperaments on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of QoL in euthymic BD patients.
A multicentre study was conducted in 180 euthymic BD patients and 95 healthy controls. Firstly, statistical analyses were performed to compare QoL and affective temperaments between the two groups. Secondly, Adaptive Lasso Analysis was carried out to identify the potential confounding variables and select the affective temperaments as potential predictors on the PCS and MCS of QoL in BD patients, as well as the control group.
QoL scores in terms of PCS and MCS in BD patients were significantly lower than in healthy individuals. Whereas anxious temperament, anxiety disorder comorbidity, and age were the best predictors of PCS impairment in BD patients, anxious temperament, subclinical depressive symptoms, and age were the best predictors of MCS impairment.
Further longitudinal studies with unaffected high-risk relatives are needed to examine the potential interaction between affective temperament and psychopathology.
Anxious temperament has an impact on QoL in BD in terms of both the physical component and the mental component. Systematic screening of temperament in BD would give clinicians better knowledge of QoL predictors. Further research should allow more individualized treatment of BD patients based on temperamental factors.

View all citing articles on Scopus

View full text

Research reportGender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores

Abstract

Introduction

Section snippets

Methods

Results

Discussion

J. Affect. Disord.

J. Affect. Disord.

The course of affective disorders. II. Typology of bipolar manic-depressive illness

Arch. Psychiatr. Nervenkr

The course of affective disorders: I. Change of diagnosis of monopolar, unipolar and bipolar illness

Arch. Psychiatr. Nervenkr

Multisite Data Reanalysis of the Validity of Rapid cycling as a Course Modifier for Bipolar Disorder in DSM-IV

Am. J. Psychiatry

Rapidly cycling affective disorder: Demographics, diagnosis, family history and course

Arch. Gen. Psychiatry

Suicidality in patients with pure and depressive mania

Am J. Psychiatry

A diagnostic interview. The schedule for affective disorders and schizophrenia

Arch. Gen. Psychiatry

Development of a rating scale for primary depressive illness

Br. J. Soc. Psychol.

Differential responses to male and female depressive relations

J. Abnorm. Psychol.

Differential outcome of pure mania, mixed/cycling, and pure depressive episodes in patients with bipolar illness

J. Am. Med. Assoc.

Research report
Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores