The influence of stage of illness on functional outcomes after psychological treatment in bipolar disorder: A systematic review

Abstract

Objectives The aim of this study was to advance understanding of stage of illness in bipolar disorder (BD), by interrogating the literature for evidence of an influence of stage of illness on functional (ie non‐symptom) outcomes following psychosocial intervention. Methods A systematic literature search following PRISMA guidelines was conducted to identify empirical studies of psychosocial interventions for established BD. To investigate stage as a predictor of three functional outcomes (general/social functioning, cognitive functioning and quality of life [QoL]), study samples were dichotomised into earlier and later stage using proxy measures identified in existing staging models. Findings were integrated using data‐based convergent synthesis. Results A total of 88 analyses from 62 studies were identified. Synthesis across studies suggested that psychosocial intervention was more likely to be effective for general functioning outcomes earlier in the course of established BD. No stage‐related differences were found for cognitive or QoL outcomes. Exploratory investigations found some evidence of an interaction between specific intervention type and stage of illness in predicting outcomes. Conclusions A novel systematic review provided preliminary evidence that benefits general/social functioning may be more pronounced in earlier versus later stages of established BD. The review also generated hypotheses about a potential three‐way interaction, whereby specific psychosocial interventions may be best placed to target functional outcomes in earlier versus later stage BD. The strength of conclusions is limited by the overall low‐quality and significant heterogeneity of studies. Further research is urgently required to understand the impact of illness stage on the effectiveness of psychosocial interventions.

Mindfulness-based online intervention to improve quality of life in late-stage bipolar disorder: A randomized clinical trial.

“…On the other hand, a nonsignificant trend for greater acceptability of ORBIT 2.0 versus Psychoeducation suggests that personal recovery is also valued in this population. Much remains unknown about staging in BD (Tremain et al, 2020), and the present findings suggest that the assumption of discrete stages with distinct needs may be an oversimplification. Equally, the data here—including remarkably similar impact of interventions with nonoverlapping content (see Figure 3)—do not support a dichotomy between recovery-focused and clinically focused treatments.…”

Babies, bathwater, and bipolar disorder: Is it time to call curtains on staging?

“…Variation in the conceptualization and measurement of staging and related phenomena has contributed to the lack of parity and ultimately slowed progress within the BD staging literature. For example, a recent examination of the role of staging (via proxies) in psychosocial interventions for BD identified considerable inconsistency in the definitions and measurement of both functioning and number of episodes, obstructing meaningful synthesis of these data 4 . As these constructs reflect the most common proxies used to operationalize staging models in BD, these inconsistencies present a significant roadblock to advancing our understanding of stage of illness.…”