Bipolar disorder (BD) is a mental illness marked by extreme shifts in mood ranging from manic to depressive states [1, 2]. Bipolar disorder is the 6th leading cause of disability [3] among the non-communicable diseases and various studies estimate the prevalence to be between 1-2% [4, 5]. BD affects over 54 million people worldwide [6] and is associated with high levels of morbidity and mortality [7]. BD has an estimated 4.4 – 10.3 (7%) disability-adjusted life years (DALYs), making it the 7th leading cause of years of life lost (YLL) and years lived with disability (YLD)[8]. In Africa, the lifetime prevalence of bipolar spectrum disorders based on surveys done in Egypt and Nigeria was found to be between 0.1% and 0.6% [9]. Bipolar disorder has a chronic course characterized by frequent and recurrent episodes and this chronicity causes significant impairment in functioning [10-13] and a considerable amount of disability even after remission of symptoms [14-16]. Estimates show that 25-50 % of patients with bipolar disorder attempt suicide in their lifetime while about 15-19% commit suicide [17].
Previous studies show that the quality of life ( QoL) of patients with BD is poorer compared to the general population [18, 19]. According to the World Health Organization (WHO), quality of life is a constellation of different factors in relation to an individual and their environment including how they perceive their position in society in the context of their culture, their goals, expectations and concerns [20]. Health related quality of life comprises of different aspects of life including psychological, social and physical functioning and improved health related QoL is a good indicator of improved functioning for people with bipolar disorder and other chronic conditions [21, 22]. Presence of depressive symptoms and illicit drug use among people with bipolar disorder are associated with worsened quality of life [23, 24]. Additionally presence of psychotic symptoms during a manic episode is associated with slow recovery and high relapse rates which affect functionality [25, 26]. People with bipolar disorder experience compromised quality of life with profound impact on different domains including education, work productivity and intimate relationships [21, 27]. Impaired quality of life has been reported to persist even when patients are in remission [28-30]. At individual level, there is a significant alteration of one's cognition, sleeping patterns, impairment in occupational functioning and disturbance in interactions with family and friends [31, 32].
BD negatively impacts health-seeking behaviors and the treatment outcomes which in turn affects the individuals' ability to function properly in society [33, 34]. Moreover, when bipolar disorder starts early in life it causes poorer global functioning, higher rates of academic failure, poor interpersonal relationships and a high risk of suicide attempts [35, 36]. There is a high rate of marital dysfunction in patients with BD, including hyper and hypo-sexuality, promiscuity, lack of self-control and misuse of family assets, and as a result, the rate of divorce is high among couples where a spouse has bipolar disorder [37]. Divorce and separation are more common among people with bipolar disorder than in the general population [38-40]. Furthermore, BD is highly comorbid with other medical conditions like cardiovascular diseases, HIV and other psychiatric disorders like anxiety disorders, alcohol and drug abuse [41, 42], which further affect the QoL of the affected individuals.
Several factors have been shown to contribute to the decline in functioning among people with bipolar disorder including lack of social support and poor health-seeking behaviour [29, 43]. In sub-Sahara Africa, the quality of life of patients with bipolar disorder may be worse given the numerous challenges encountered in the management and support of individuals with mental illness [44, 45]. For example, in Uganda, with a population of approximately 40 million people [46], there are less than 30 psychiatrists, meaning that for every 1.3 million people, there is one psychiatrist. The country’s economic situation and social support system, which leaves many people unemployed with minimal education, causes a further decrement in the quality of life of people with bipolar disorder [47]. Despite the negative impact that BD has on the social and psychological functioning of the affected individuals and their QoL, the health-related quality of life of patients with bipolar disorder in Uganda is not well established. The aim of this study was to determine the health-related quality of life and the factors associated among patients with Bipolar disorder in rural southwestern Uganda.