Calidad de vida, distrés y autoestigma en pacientes con trastorno bipolar en eutimia

Resumen

Introduction and objectives: Scientific literature has shown that bipolar disorder patients scored lower in quality of life than healthy controls, even when euthymic. However, previous findings and assessment instruments are heterogeneous. Furthermore, constructs such as distress or perceived discomfort have received little attention in bipolar disorder literature, despite of its association with variables such as quality of life or functioning. Moreover, although variables such as distress or stigma that have been found to be highly associated with social withdrawal, no previous studies have analysed their predictive role. Due to the aforementioned, the aims of the study are: 1) To conduct a systematic review and metanalysis addressing studies who have analysed variables associated with quality of life in euthymic bipolar patients; 2) To design an assessment scale aimed to identify distress or perceived discomfort in euthymic bipolar patients; 3) To identify social withdrawal predictors in euthymic bipolar patients. Methods: PRISMA guidelines were used to perform the systematic review and metanalysis. Bibliographic searches were conducted in August 2018. After selecting cross-sectional matched case-control studies, data collection, quality assessment and subsequently statistical analysis were done. On the other hand, in the assessment scale validation, 101 euthymic patients took part in the final study, whereas sub-samples were taken for the rest of the studies, as preliminary results. Reliability and validity analyses were conducted to test psychometric properties. Moreover, regression analyses were also conducted to identify potential predictors of social withdrawal. Results: In the first study, findings showed that euthymic bipolar patients scored lower in quality of life than healthy controls (d=-0.922; SE=0.316; 95% CI=-1.541 to -0.303; p=.004). More time euthymic helped to explain 15.62% of the variance. Four different quality of life instruments were used. The tendency was towards using general quality of life instruments, instead of specific ones for bipolar disorder. In terms of the psychometric properties of DISBIP-S scale to assess distress, analyses showed a high internal consistency (Cronbach’s alpha=0.90) as well as content and construct validity, among others. In the third study, analyses showed that stereotype endorsement, discrimination experience and perceived control over illness, taken together, helped to explain 80.4% of the variance in social withdrawal. Conclusions: Quality of life is lower in euthymic bipolar patients, although longer time in euthymia is associated with better outcomes. DISBIP-S scale showed its adequacy to assess distress or perceived discomfort in bipolar patients. It would be highly encouraged to use this scale for an early detection and intervention. Moreover, an early assessment of self-stigma and perceived control over illness might help bipolar patients to improve their social situation, by reducing social withdrawal.