Enhancing Family Functioning and Quality of Life in Adolescents with Bipolar Disorder: A Randomized Trial

• In Event: 1-158 - Randomized Controlled Trials for the Treatment and Prevention of Depressive Disorders: Effects on the Family

Integrative Statement

Introduction: Adolescents with bipolar disorder (BD) report greater difficulties with family functioning (e.g., high conflict, low cohesion, and low adaptability) and lower quality of life (QoL). This study compared the efficacy of family-focused therapy for adolescents (FFT-A) plus pharmacotherapy to brief psychoeducation [enhanced care (EC)] plus pharmacotherapy on family functioning outcomes and QoL in adolescents with BD over 2 years. We hypothesized that: (a) adolescents in FFT-A would report better QoL over time than those in EC in the areas of family relationships and emotional well-being, both of which are targets of the FFT model; (b) adolescents in FFT-A would report better family functioning over time than those in EC in the areas of cohesion, adaptability and conflict; and (c) these group differences would be independent of baseline differences among adolescents with depressive or manic symptoms.
Methods: Participants were 144 adolescents (mean age: 15.6±1.4yr) with bipolar disorder I or II who had a mood episode in the previous 3 months. Adolescents and parents were randomly assigned to either FFT-A or EC. FFT-A was developed based on findings from expressed emotion (EE) research. Patients with BD with families high in EE (criticism, hostility, emotional over-involvement) have more severe mood symptoms and higher rates of relapse. FFT-A is family therapy comprised of 21 sessions in 9 months focusing on psychoeducation, problem-solving skills training, and communication enhancement training. Enhanced Care (EC) involved three sessions of family psychoeducation. Study psychiatrists provided patient participants with protocol-based pharmacotherapy for the duration of the study. Family functioning was assessed using the Family Adaptability and Cohesion Evaluation Scales (FACES-II; Olsen et al., 1982) and the Conflict Behavior Questionnaire (CBQ; Prinz et al., 1979; Robin & Foster, 1989), and QoL was assessed with the KINDL-R Questionnaire (Ravens-Sieberer & Bullinger, 1998) during active treatment (baseline to 9 months) and during a post-treatment follow-up (9–24 months).
Results: Adolescents in FFT-A had greater improvements in quality of family relationships and KINDL-R physical well-being than youth in EC. For FACES-II cohesion outcomes, both treatment groups improved similarly during the treatment phase (baseline to 9 months), whereas the FFT group showed greater improvements in cohesion than the EC group during the post-treatment phase (specifically 12 and 18-months for child-reports). For FACES-II adaptability and CBQ outcomes, both treatment groups improved similarly over the 24 months. For quality of friendships, the trajectory during active treatment favored EC, whereas the trajectory during post-treatment favored FFT-A.
Conclusions: A short course of psychoeducation and family skills training may enhance relational functioning and health in adolescents with bipolar disorder as well as improve feelings of closeness and warmth in the family (i.e., cohesion). Additionally, the effects of different psychosocial interventions on peer relationships deserves further study.

Author

• Lisa O'Donnell, Wayne State University
  Presenting Author