THE ENDURING PSYCHOSOCIAL CONSEQUENCES OF MANIA AND DEPRESSION

Objective: The authors sought to determine the scope, severity, and pe rsistence 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 treatme nt and again after a 5-year follow-up. Concurrently, parents, siblings , and adult children underwent similar assessments and were followed f or 6 years. To quantify the impact of affective disorder, probands wer e individually matched to relatives who bad no lifetime history of aff ective disorder. Sixty-nine relatives who were depressed at intake con stituted a separate, nonclinical study group and were also matched to relatives who were well. Results: Both unipolar and bipolar patients b egan 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 s ignificantly less likely to report improvements. Similarly, both bipol ar and unipolar patients showed significant deficits in nearly all oth er 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 th e final 2 years of follow-up also showed severe and widespread impairm ent. 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 ma jor depression extends to essentially all areas of functioning and per sists for years, even among individuals who experience sustained resol ution of clinical symptoms.