The impact of sex in the effectiveness of functional remediation in bipolar disorder
Maria Serra-Navarro
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorDerek Clougher
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Alava University Hospital, BIOARABA, University of the Basque Country, Vitoria, Spain
Search for more papers by this authorBrisa Solé
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorJose Sánchez-Moreno
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorAna González-Pinto
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Alava University Hospital, BIOARABA, University of the Basque Country, Vitoria, Spain
Search for more papers by this authorEsther Jiménez
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Alava University Hospital, BIOARABA, University of the Basque Country, Vitoria, Spain
Search for more papers by this authorBenedikt L. Amann
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Institute of Mental Health, Hospital del Mar Medical Research Institute, Barcelona, Spain
Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
Search for more papers by this authorVicent Balanzá-Martínez
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, INCLIVA, Valencia, Spain
Search for more papers by this authorRafael Tabarés-Seisdedos
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, INCLIVA, Valencia, Spain
Search for more papers by this authorCelso Arango
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Child and Adolescent Psychiatry Department, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Madrid, Spain
Search for more papers by this authorVivian Accardo
Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
Search for more papers by this authorMaría Paz García-Portilla
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Department of Psychiatry, School of Medicine, Instituto de Neurociencias del Principado de Asturias, INEUROPA, Servicio de Salud del Principado de Asturias (SESPA), University of Oviedo, Oviedo, Spain
Search for more papers by this authorÁngela Ibáñez
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Department of Psychiatry, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
Search for more papers by this authorJosé Manuel Crespo
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Department of Psychiatry, Bellvitge Biomedical Research Institute (IDIBELL), University Hospital of Bellvitge, Barcelona, Spain
Search for more papers by this authorJosé Luis Ayuso-Mateos
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Department of Psychiatry, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
Search for more papers by this authorCorresponding Author
Silvia Amoretti
Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
Correspondence
Silvia Amoretti, Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
Email: [email protected]
Carla Torrent, Department of Psychiatry and Psychology. Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Spain.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Carla Torrent
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Correspondence
Silvia Amoretti, Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
Email: [email protected]
Carla Torrent, Department of Psychiatry and Psychology. Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Spain.
Email: [email protected]
Search for more papers by this authorAnabel Martínez-Aran
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorEduard Vieta
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorCIBERSAM Functional Remediation Group
Search for more papers by this authorMaria Serra-Navarro
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorDerek Clougher
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Alava University Hospital, BIOARABA, University of the Basque Country, Vitoria, Spain
Search for more papers by this authorBrisa Solé
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorJose Sánchez-Moreno
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorAna González-Pinto
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Alava University Hospital, BIOARABA, University of the Basque Country, Vitoria, Spain
Search for more papers by this authorEsther Jiménez
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Alava University Hospital, BIOARABA, University of the Basque Country, Vitoria, Spain
Search for more papers by this authorBenedikt L. Amann
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Institute of Mental Health, Hospital del Mar Medical Research Institute, Barcelona, Spain
Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
Search for more papers by this authorVicent Balanzá-Martínez
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, INCLIVA, Valencia, Spain
Search for more papers by this authorRafael Tabarés-Seisdedos
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, INCLIVA, Valencia, Spain
Search for more papers by this authorCelso Arango
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Child and Adolescent Psychiatry Department, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Madrid, Spain
Search for more papers by this authorVivian Accardo
Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
Search for more papers by this authorMaría Paz García-Portilla
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Department of Psychiatry, School of Medicine, Instituto de Neurociencias del Principado de Asturias, INEUROPA, Servicio de Salud del Principado de Asturias (SESPA), University of Oviedo, Oviedo, Spain
Search for more papers by this authorÁngela Ibáñez
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Department of Psychiatry, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
Search for more papers by this authorJosé Manuel Crespo
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Department of Psychiatry, Bellvitge Biomedical Research Institute (IDIBELL), University Hospital of Bellvitge, Barcelona, Spain
Search for more papers by this authorJosé Luis Ayuso-Mateos
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Department of Psychiatry, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
Search for more papers by this authorCorresponding Author
Silvia Amoretti
Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
Correspondence
Silvia Amoretti, Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
Email: [email protected]
Carla Torrent, Department of Psychiatry and Psychology. Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Spain.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Carla Torrent
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Correspondence
Silvia Amoretti, Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
Email: [email protected]
Carla Torrent, Department of Psychiatry and Psychology. Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Spain.
Email: [email protected]
Search for more papers by this authorAnabel Martínez-Aran
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorEduard Vieta
Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
Fundació Clínic per la Recerca Biomèdica-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Barcelona, Spain
Department de Medicina, Facultat de Medicina i Ciències de la Salut, Institute of Neurosciences (UBNeuro), Universitat de Barcelona, Barcelona, Spain
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Madrid, Spain
Search for more papers by this authorCIBERSAM Functional Remediation Group
Search for more papers by this authorAnabel Martínez-Aran and Eduard Vieta should be considered joint last author.
Abstract
Background
Functional recovery remains a core clinical objective for patients with bipolar disorder (BD). Sociodemographic, clinical, and neurocognitive variables are associated with long-term functional impairment, yet the impact of sex differences is unclear. Functional remediation (FR) is a validated intervention aimed at achieving functional recovery in BD. The present study assessed the effect of sex differences of FR on psychosocial functioning at post-treatment (6-months) and 12-month follow-up (FUP). To the best of our knowledge, this is the first study to explore the role of sex as a factor in the efficacy of FR.
Methods
157 participants with BD were randomly assigned to either FR (N = 77) or treatment as usual group (80). Clinical, sociodemographic, neuropsychological, and functional data were obtained using a comprehensive assessment battery. Sex differences were explored via a general linear model (GLM) for repeated measures to compare the effect of sex on the intervention over time (6 months and FUP).
Results
Results demonstrated that FR benefits both sexes, males (p = 0.001; d’ = 0.88) and females (p = 0.04; d’ = 0.57), at 6 months suggesting a generalized functional improvement. Conversely, at 12-month FUP sex differences were observed only in males (p = 0.005; d’ = 0.68).
Conclusions
FR is a beneficial intervention for males and females after treatment, suggesting that there are no relevant distinct needs. Females may benefit from ongoing psychosocial functioning booster sessions after the intervention to maintain original improvements. Future research exploring sex differences could help to identify strategies to offer personalized FR intervention approaches in individuals with BD.
CONFLICT OF INTEREST STATEMENT
EV has received grants and served as a consultant, advisor, or CME speaker for the following entities: AB-Biotics, AbbVie, Angelini, Biogen, Biohaven, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Idorsia, Janssen, Lundbeck, Novartis, Orion Corporation, Organon, Otsuka, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris, outside the submitted work. AI has received research support from or served as speaker or advisor for Janssen Cilag, Lundbeck, Otsuka Pharmaceutical SA, Alter and Rovi, outside the submitted work. CA has been a consultant to or has received honoraria or grants from Abbot, Acadia, Angelini, Biogen, Boehringer, Gedeon Richter, Janssen Cilag, Lundbeck, Medscape, Menarini, Minerva, Otsuka, Pfizer, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion, Takeda and Teva. VBM has received honoraria from Angelini during the last 3 years, unrelated to the present work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Supporting Information
| Filename | Description |
|---|---|
| acps13748-sup-0001-supinfo.docxWord 2007 document , 67.5 KB | Data S1: Supporting Information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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