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 KINDLRQuestionnaire (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.

Trial registration: ClinicalTrials.gov NCT00332098.

Keywords: Childhood-onset bipolar disorder; Family intervention; Functional outcomes; Mood disorders; Psychosocial functioning.

Copyright © 2017. Published by Elsevier B.V.

Figures

Fig. 1

CONSORT Diagram: 2-year randomized trial of pharmacotherapy with either family-focused treatment (21 sessions) or enhanced care (3 sessions) in adolescents with bipolar I or II disorder.

Fig. 2

KINDL quality of family life scores (parent and child averages) for 2 Years in family-focused treatment for adolescents (FFT-A) versus enhanced care (EC): covarying for baseline depression and mania scores and treatment site. Numbers plotted are adjusted means. 9-month marker indicates the end of the active treatment period (baseline – 9 months) and the start of the post-treatment period (9–24 months).

Fig. 3

KINDL quality of physical well-being scores (parent and child averages) for 2 Years in family-focused treatment for adolescents (FFT-A) versus enhanced care (EC): covarying for baseline depression and mania scores and treatment site. Numbers plotted are adjusted means. 9-month marker indicates the end of the active treatment period (baseline – 9 months) and the start of the post-treatment period (9–24 months).

Fig. 4

KINDL quality of friendship scores (parent and child averages) for 2 Years in family-focused treatment for adolescents (FFT-A) versus enhanced care (EC): covarying for baseline depression and mania scores and treatment site. Numbers plotted are adjusted means. 9-month marker indicates the end of the active treatment period (baseline – 9 months) and the start of the post-treatment period (9–24 months).