Mood Instability Linked to Stress, Decreased Quality of Life in Bipolar Disorder

Teenage girl feeling depressed after breaking up with her boyfriend through messages
Even during full or partial remission, mood instability in bipolar disorder is associated with decreased quality of life and increased stress, according to self-report.

Mood instability was associated with greater perceived stress and decreased quality of life (QoL) in patients with bipolar disorder, according to study results published in Bipolar Disorders.

Investigators recruited participants from the ongoing Danish MONARCA II study, a randomized controlled trial of smartphone-based monitoring in bipolar disorder. As part of the MONARCA II intervention arm, patients with bipolar disorder used a smartphone-based self-monitoring system on a daily basis for 9 months. The smartphone-based system captured daily mood via a 6-point self-evaluation scale. Mood instability was derived from the number of reported mood changes over the study period. Patients also underwent in-person study visits at baseline; after 4 weeks; and at 3, 6, and 9 months. During these visits, patients were clinically assessed for depressive and manic symptoms, perceived stress, and QoL. A group of 37 healthy individuals were also clinically assessed at these time points to provide control data.

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A total of 84 adults provided self-monitoring data during the study with a mean (standard deviation [SD]) age of 43; 61.2% were women. The majority (87.1%) presented in full or partial remission at baseline. Participants and adhered to self-monitoring for 72.6% of days during the 9-month study period. The control group had similar demographic characteristics, although patients with bipolar disorder presented with significantly higher perceived stress levels (P <.0001), lower QoL (P <.0001), and lower functioning (P <.0003). Mood instability was significantly associated with increased perceived stress, decreased QoL, and lower functioning (all P <.0001). No significant differences in mood instability were observed between psychopharmacologic treatment modalities, including antipsychotic, anticonvulsant, antidepressant, and lithium therapies.

Investigators did not control for additional confounders, including familial support or financial resources.

These data suggest that even in remission, mood instability in bipolar disorder is a significant predictor of perceived stress, QoL, and functioning. “These findings emphasize the need to monitor and identify subsyndromal inter-episodic symptoms,” investigators concluded.

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Faurholt-Jepsen M, Frost M, Busk J, et al. Is smartphone-based mood instability associated with stress, quality of life, and functioning in bipolar disorder? [published online May 13, 2019]. Bipolar Disord. doi:10.1111/bdi.12796