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Am J Psychiatry 1993; 150:720-727
Copyright © 1993 by American Psychiatric Association
The enduring psychosocial consequences of mania and depression
W Coryell, W Scheftner, M Keller, J Endicott, J Maser and GL Klerman
Department of Psychiatry, University of Iowa College of Medicine, Iowa City 52242.
OBJECTIVE: The authors sought to determine the scope, severity, and
persistence of psychosocial impairment arising from bipolar and unipolar
affective disorder. METHOD: Patients with bipolar (N = 148) or unipolar (N
= 240) major affective disorder were assessed as they sought treatment and
again after a 5-year follow-up. Concurrently, parents, siblings, and adult
children underwent similar assessments and were followed for 6 years. To
quantify the impact of affective disorder, probands were individually
matched to relatives who had no lifetime history of affective disorder.
Sixty-nine relatives who were depressed at intake constituted a separate,
nonclinical study group and were also matched to relatives who were well.
RESULTS: Both unipolar and bipolar patients began follow-up with deficits
in annual income. Relative to comparison subjects, affective disorder
groups were significantly more likely to report declines in job status and
income at the end of follow-up and significantly less likely to report
improvements. Similarly, both bipolar and unipolar patients showed
significant deficits in nearly all other areas of psychosocial functioning
measured at follow-up. Except for relationships with spouses, deficits did
not differ significantly by polarity. Surprisingly, probands with recovery
sustained throughout the final 2 years of follow-up also showed severe and
widespread impairment. Relatives with major depression exhibited
substantial deficits on follow-up, but job status and income were not
significantly affected. CONCLUSIONS: The psychosocial impairment associated
with mania and major depression extends to essentially all areas of
functioning and persists for years, even among individuals who experience
sustained resolution of clinical symptoms.
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