Profiles of disability among adults with bipolar spectrum disorders

Abstract

Background: Heterogeneous groups of patients with a spectrum of service needs are commonplace in mental health settings. Although comprehensive assessments are available to measure variations in service needs, numerous challenges still exist when confronting this heterogeneity and many assessments used in clinic settings are lengthy and have not been demonstrated to be consistent over time. Objective: The purpose of this study was to identify subgroups of persons with bipolar spectrum disorders, who have similar disability profiles, and to the extent to which the subgrouping is stable over time. Methods: Participants were recruited from the Continuous Improvement for Veterans in Care-Mood Disorders. Eligible patients (N = 435) were those who received inpatient or outpatient treatment for bipolar disorder at a large urban VA mental health facility in Western Pennsylvania from July 2004 through July 2006. This was a naturalistic cohort study of patients with bipolar spectrum disorders. Baseline and 1-year follow-up data were collected using face-to-face interviews and recorded abstraction. The World Health Organization Disability Assessment Scale was the primary measure used to identify subgroups within this sample. Results: Using a classification strategy called latent profile analysis, this study identified three unique subgroups that showed significant differences in various clinical measures at baseline and follow-up. The largest and most consistent subgroup differences were observed in the current bipolar symptomatology. Conclusion: The classification of functional status in the present study can aid clinicians in the identification of bipolar patients, with specific impairment profiles, who may need additional intervention. Future research is needed to understand whether specific interventions targeted at these subgroups can improve the quality of care for this high-need and at-risk population. © 2009 Springer-Verlag.