Enhancing Quality of Life Among Adolescents with Bipolar Disorder: A Randomized Trial of Two Psychosocial Interventions

Background and Purpose: Adolescents with bipolar disorder (BD) report lower quality of life (QoL) in the areas of psychosocial, physical, and emotional well-being compared to children with major depression, anxiety disorders, disruptive behavior disorders, or no psychiatric history.  High levels of depression, which are persistent throughout the course of BD, are strongly associated with low self-reported QoL in youth with BD. However, adolescent patients who are in continuous remission from depressive symptoms report lower QoL than their unaffected siblings or age-matched healthy controls. There are currently no treatment studies examining the impact of psychosocial treatments on QoL in childhood-onset BD.  This study compared the efficacy of family-focused therapy for adolescents (FFT-A) plus pharmacotherapy to brief psychoeducation (enhanced care, or EC) plus pharmacotherapy on self-rated QoL in adolescents with BD over 2 years. We hypothesized that 1) adolescents in FFT-A would report better QoL over time than those in EC in the areas of family relationships and emotional well-being (both of which are targets of the FFT model); and 2) these group differences would be independent of baseline differences among adolescents in depressive or manic symptoms.  

Methods: Participants were 141 adolescents (mean age: 15.6 yrs ± 1.4) with BD I or II who had a mood episode in the previous 3 months. Adolescents and parents were randomly assigned to (1) FFT-A, given in 21 sessions in 9 months of psychoeducation, communication enhancement training, and problem-solving skills training, or (2) EC, given in 3 family psychoeducation sessions. Study psychiatrists provided patient participants with protocol-based pharmacotherapy for the duration of the study. QoL was assessed with The KINDL^R Questionnaire (Ravens-Sieberer & Bullinger, 1998) during active treatment (baseline to 9 months) and during a post-treatment follow-up (9 to 24 months). We examined treatment group differences in the trajectory of KINDL scores over time using mixed-effect regression models (SAS PROC MIXED).

Results: The two treatment groups did not differ in overall QoL scores over 24 months. However, adolescents in FFT-A had greater improvements in quality of family relationships and physical well-being than participants in EC. For quality of friendships, the trajectory during active treatment favored EC, whereas the trajectory during post-treatment favored FFT-A.

Conclusions/Implications: A short course of family psychoeducation and skills training as adjuncts to pharmacotherapy in the early stages of bipolar disorder may enhance relational functioning, help adolescent patients to live more satisfying lives and reduce the burden of care on family members during a critical period of their lives. The effects of different psychosocial interventions on peer relationships deserves further study.