Enhancing quality of life among adolescents with bipolar disorder: A randomized trial of two psychosocial interventions

Abstract

Background Adolescents with bipolar disorder (BD) report lower quality of life (QoL) than adolescents with other psychiatric disorders. 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. Methods Participants were 141 adolescents (mean age: 15.6 ± 1.4yr) 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 KINDLR Questionnaire (Ravens-Sieberer and Bullinger, 1998) during active treatment (baseline to 9 months) and during a post-treatment follow-up (9–24 months). 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. Limitations We were unable to standardize medication use or adherence over time. Quality of life was based on self-report rather than on observable functioning. Conclusions A short course of family psychoeducation and skills training may enhance relational functioning and health in adolescents with BD. The effects of different psychosocial interventions on peer relationships deserves further study.

The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up

“…Consistent with prior research [7], it is not surprising that a higher level of emotional problems at baseline was associated with lower initial QoL. Although there have been few longitudinal studies assessing QoL change in adolescent psychiatric patients during and following treatment [49][50][51], they all have reported an increase in QoL over time. In these studies, a single specific structured therapeutic intervention was evaluated.…”

Comorbid disorders as moderators of response to family interventions among adolescents with bipolar disorder

“…In an adolescent sample conducted in three sites, we reported that (1) FFT and a brief family educational treatment (enhanced care, or EC) did not differ on time to recovery from index study episodes or time until recurrence; (2) patients in FFT-A had greater improvements in manic but not depressive symptoms compared to those in EC in the post-treatment year; and (3) patients with comorbid anxiety disorders and ADHD had earlier mood recurrences, regardless of treatment condition (Miklowitz et al, 2014). A separate report from this study found that FFT-A was associated with greater improvements in self-reported quality of life compared to the EC treatment (O'Donnell et al, 2017). However, these studies did not investigate the role that comorbid disorders may play in moderating the effects of family interventions.…”

Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder

“…Involving the family, O’Donnell and colleagues (2017) tested the effect of 2 psychological interventions on QoL scores in a sample of adolescents with BD. They compared the efficacy of a FFTplus pharmacotherapy vs brief psychoeducation plus pharmacotherapy on self-related QoL over 2 years.…”