Predictors of functional impairment in bipolar disorder: Results from 13 cohorts from seven countries by the global bipolar cohort collaborative

Katherine E Burdick¹, Caitlin E Millett¹, Anastasia K Yocum², Cara M Altimus³, Ole A Andreassen^{4

5}, Valerie Aubin⁶, Raoul Belzeaux⁷, Michael Berk^{8

9}, Joanna M Biernacka^{10

11}, Hilary P Blumberg¹², Anthony J Cleare¹³, Claudia Diaz-Byrd², Caroline Dubertret¹⁴, Bruno Etain¹⁵, Lisa T Eyler^{16

17}, Brent P Forester^{18

19}, Janice M Fullerton^{20

21}, Mark A Frye¹⁰, Sébastien Gard²², Ophelia Godin^{23

24}, Emmanuel Haffen²⁵, Federica Klaus^{16

17}, Trine Vik Lagerberg⁴, Marion Leboyer^{23

24}, Anabel Martinez-Aran²⁶, Susan McElroy^{27

28}, Philip B Mitchell²⁹, Emilie Olie³⁰, Phebe Olorunfemi³¹, Christine Passerieux³², Amy T Peters³¹, Daniel L Pham³, Mircea Polosan³³, Julia R Potter¹, Martha Sajatovic³⁴, Ludovic Samalin³⁵, Raymund Schwan³⁶, Megan Shanahan¹, Brisa Solé²⁶, Rebecca Strawbridge¹³, Amanda L Stuart⁸, Ivan Torres³⁷, Torrill Ueland^{4

38}, Eduard Vieta²⁶, Lana J Williams^{8

39}, Anna L Wrobel^{8

9}, Lakshmi N Yatham³⁷, Allan H Young¹³, Andrew A Nierenberg³¹, Melvin G McInnis²

Affiliations

¹ Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² University of Michigan, Ann Arbor, Michigan, USA.
³ The Milken Institute, Washington, District of Columbia, USA.
⁴ NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway.
⁶ Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, Monaco.
⁷ Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France.
⁸ Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.
⁹ Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia.
¹⁰ Mayo Clinic Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Mayo Clinic Department of Quantitative Health Sciences, Mayo Clinic, Rocester, MN, USA.
¹² Yale School of Medicine, New Haven, Connecticut, USA.
¹³ Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹⁴ Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France.
¹⁵ Université de Paris, AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS, Paris, France.
¹⁶ University of California San Diego, La Jolla, CA, USA.
¹⁷ Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA.
¹⁸ Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA.
¹⁹ Harvard Medical School, Boston, Massachusetts, USA.
²⁰ Neuroscience Research Australia, Sydney, Australia.
²¹ School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia.
²² Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France.
²³ Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Créteil, France.
²⁴ APHP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France.
²⁵ Clinical Psychiatry Department, Treatment-Resistant Depression Fondamental Expert Center, EA 481 Neurosciences, Bourgogne Franche Comté University, Besançon, France.
²⁶ Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
²⁷ SLM Lindner Center of HOPE, Mason, Ohio, USA.
²⁸ University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²⁹ School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.
³⁰ Department of Emergency Psychiatry and Acute Care, CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.
³¹ Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³² Service Hospitalo-Universitaire de psychiatrie d'adulte et d'addictologie, Centre Hospitalier de Versailles, INSERM UMR1018, DisAP-DevPsy-CESP, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, Gif-sur-Yvette, France.
³³ Univ. Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U 1216, Grenoble, France.
³⁴ University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
³⁵ CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal (IP), Clermont-Ferrand, France.
³⁶ Université de Lorraine, Inserm U 1114, Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie CPN, Laxou, France.
³⁷ Department of Psychiatry, University of British Columbia, Vancouver, Canada.
³⁸ Department of Psychology, University of Oslo, Oslo, Norway.
³⁹ Barwon Health, Geelong, Victoria, Australia.

PMID: 35322518
PMCID: PMC9500115
DOI: 10.1111/bdi.13208

Predictors of functional impairment in bipolar disorder: Results from 13 cohorts from seven countries by the global bipolar cohort collaborative

Katherine E Burdick et al. Bipolar Disord. 2022 Nov.

. 2022 Nov;24(7):709-719.

doi: 10.1111/bdi.13208. Epub 2022 Apr 15.

Authors

Affiliations

¹ Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² University of Michigan, Ann Arbor, Michigan, USA.
³ The Milken Institute, Washington, District of Columbia, USA.
⁴ NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway.
⁶ Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, Monaco.
⁷ Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France.
⁸ Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.
⁹ Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia.
¹⁰ Mayo Clinic Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Mayo Clinic Department of Quantitative Health Sciences, Mayo Clinic, Rocester, MN, USA.
¹² Yale School of Medicine, New Haven, Connecticut, USA.
¹³ Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹⁴ Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France.
¹⁵ Université de Paris, AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS, Paris, France.
¹⁶ University of California San Diego, La Jolla, CA, USA.
¹⁷ Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA.
¹⁸ Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA.
¹⁹ Harvard Medical School, Boston, Massachusetts, USA.
²⁰ Neuroscience Research Australia, Sydney, Australia.
²¹ School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia.
²² Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France.
²³ Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Créteil, France.
²⁴ APHP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France.
²⁵ Clinical Psychiatry Department, Treatment-Resistant Depression Fondamental Expert Center, EA 481 Neurosciences, Bourgogne Franche Comté University, Besançon, France.
²⁶ Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
²⁷ SLM Lindner Center of HOPE, Mason, Ohio, USA.
²⁸ University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²⁹ School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.
³⁰ Department of Emergency Psychiatry and Acute Care, CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.
³¹ Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³² Service Hospitalo-Universitaire de psychiatrie d'adulte et d'addictologie, Centre Hospitalier de Versailles, INSERM UMR1018, DisAP-DevPsy-CESP, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, Gif-sur-Yvette, France.
³³ Univ. Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U 1216, Grenoble, France.
³⁴ University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
³⁵ CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal (IP), Clermont-Ferrand, France.
³⁶ Université de Lorraine, Inserm U 1114, Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie CPN, Laxou, France.
³⁷ Department of Psychiatry, University of British Columbia, Vancouver, Canada.
³⁸ Department of Psychology, University of Oslo, Oslo, Norway.
³⁹ Barwon Health, Geelong, Victoria, Australia.

PMID: 35322518
PMCID: PMC9500115
DOI: 10.1111/bdi.13208

Abstract

Objectives: Persistent functional impairment is common in bipolar disorder (BD) and is influenced by a number of demographic, clinical, and cognitive features. The goal of this project was to estimate and compare the influence of key factors on community function in multiple cohorts of well-characterized samples of individuals with BD.

Methods: Thirteen cohorts from 7 countries included n = 5882 individuals with BD across multiple sites. The statistical approach consisted of a systematic uniform application of analyses across sites. Each site performed a logistic regression analysis with empirically derived "higher versus lower function" as the dependent variable and selected clinical and demographic variables as predictors.

Results: We found high rates of functional impairment, ranging from 41 to 75%. Lower community functioning was associated with depressive symptoms in 10 of 12 of the cohorts that included this variable in the analysis. Lower levels of education, a greater number of prior mood episodes, the presence of a comorbid substance use disorder, and a greater total number of psychotropic medications were also associated with low functioning.

Conclusions: The bipolar clinical research community is poised to work together to characterize the multi-dimensional contributors to impairment and address the barriers that impede patients' complete recovery. We must also identify the core features which enable many to thrive and live successfully with BD. A large-scale, worldwide, prospective longitudinal study focused squarely on BD and its heterogeneous presentations will serve as a platform for discovery and promote major advances toward optimizing outcomes for every individual with this illness.

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Figures

**Figure 1.**
The rate of low functioning at each site.

See this image and copyright information in PMC

References

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Predictors of functional impairment in bipolar disorder: Results from 13 cohorts from seven countries by the global bipolar cohort collaborative

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Predictors of functional impairment in bipolar disorder: Results from 13 cohorts from seven countries by the global bipolar cohort collaborative

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