Quality of Life and Bipolar Disorder

The CREST.BD network has been researching, refining measurement of, and exchanging knowledge on quality of life in bipolar disorder for over a decade now. Overall, research into quality of life in people with bipolar disorder shows that the condition, especially episodes of depression, can have a serious impact on life quality. However, it also critical to know that excellent quality of life is possible for many people with bipolar disorder, and that life quality is relatively preserved in those who are newly diagnosed with bipolar disorder, pointing to the importance of early intervention.

Quality of life refers to “individuals  perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (World Health Organization, 1995). By measuring quality of life, we can help people who live with bipolar disorder to clarify which areas of their life they are flourishing in, and which might need some attention. Routine measurement of quality of life in clinical practice can help healthcare providers to define goals for treatment and evaluate the impact of different treatments on well-being.

A strong argument can be made for measuring both mood symptoms and quality of life over time in people with bipolar disorder. For example:

1. People may give higher priority to improvements in quality of life than in symptoms;
2. Symptoms and quality of life are not always as closely related as we might assume;
3. Treatments may impact symptoms and quality of life differently.

Development of the QoL.BD

CREST.BD conducted a four-year program of research to develop the paper-and-pencil version of the Quality of Life in Bipolar Disorder (QoL.BD) scale, the first quality of life questionnaire specifically designed for people with bipolar disorder. The full version of the scale assesses contains 56 questions and has 12 basic domains:

Physical, Sleep, Mood, Cognition, Leisure, Social, Spirituality, Finances, Household, Self-esteem, Independence and Identity) and two optional domains (Work and Education).

The QoL.BD Brief, designed for use in research settings, contains 12 questions (i.e. one item per core domain, minus the work and education domains).

The QoL.BD scale can now also be taken online – the QoL Tool.

Using the QoL.BD: Information for people with bipolar disorder

While it is feasible to use the paper-and-pencil version of the QoL.BD to track your quality of life over time, the online QoL Tool is preferable (for example, the QoL Tool provides automated scoring and tailored information on self-management strategies to access according to your personal quality of life profile).

Using the QoL.BD: Information for healthcare providers

We welcome use of the QoL.BD and QoL Tool in clinical settings; no permission is required, and no licencing fees imposed. There are advantages and disadvantages of the paper-and-pencil QoL.BD versus the online QoL Tool in clinical settings. One advantage of the QoL.BD is that it is now available in multiple languages, whereas the QoL Tool is currently only available in English. However, scoring is automated in the QoL Tool and it is a more powerful clinical tool (for example, attractive visual outputs, embedded letter for healthcare providers, tailored self-management information).

In clinical settings, we recommend using the full version of the scale and calculating all domain scores (12, 13 or 14 scores, depending on the individual’s work and study status).  In many clinical situations, it may turn out that one or two of the domains are of particular interest to the client and may provide targets for clinical attention. In these cases, directing the client to the relevant domain/s of the Bipolar Wellness Centre may be beneficial. In clinical settings, we suggest that response to treatment should be evaluated by examining change in the individual’s scores from their baseline assessment, or to use the scale to explore wellbeing at a domain level with an eye to treatment goal setting.

Further details about the rationale for assessing quality of life in clinical practice are provided in this book chapter.

Using the QoL.BD: Information for researchers

Both the full and the brief version of the QoL.BD may be used without licensing fees in research settings but we appreciate being informed of the research projects you are using it in. Please contact Dr. Michalak (erin.michalak@ubc.ca) for details of licensing fees as they pertain to clinical trials.

Please refer to this Frequently Asked Questions document for further information on scoring the QoL.BD and interpreting or reporting results.

QoL.BD Languages

Multiple translations of the QoL.BD are now available, and validation data is available for some translated versions.

The scale is currently available in: English (full), English (brief), Arabic (brief), French (full), French (brief), Mandarin (brief), Simplified Chinese (brief), Hungarian, Japanese (brief), Korean (brief), Malay (brief), Polish (brief), Portuguese (brief, for Portugal), Romanian (brief), Spanish (brief, for Chile), Spanish (brief, for Mexico), Tamil (brief), and Turkish (brief).

Please contact Dr. Erin Michalak if you wish to obtain permission to translate or validate the scale in other languages.