Patient-Important Outcomes in the Long-Term Treatment of Bipolar Disorder: A Mixed-Methods Approach Investigating Relative Preferences and a Proposed Taxonomy

  • Øystein Eiring
  • Magne Nylenna
  • Kari NytrøenEmail author
Original Research Article



In patient-centered healthcare, the assessment and selection of treatment should be based on outcomes important to patients and the relative importance patients place on these outcomes. The evidence base on long-term treatment outcomes important to patients with bipolar disorder is inconclusive.


The aim of this study was to investigate the relative importance of patient-important outcomes in bipolar disorder, and to construct a holistic and logically sound shortlist of treatment outcomes relevant in the evaluation and selection of pharmacological treatment in bipolar disorder.


Overall, 22 outpatients from southern and eastern Norway participated in four focus groups, and suggested outcomes important in treatment decisions. Quantitative, relative importance weights for treatment outcomes identified in literature reviews were elicited from each participant, employing a self-explicated approach (SEA). The method combined a ranking- and rating-stated preference exercise and resulted in a 0–100 SEA-score for each outcome.


Outcomes from the literature accommodated the outcomes suggested in the focus groups. Mean age in the sample was 42 years and 64 % were women. All patients completed the exercises with consistent results. The most important outcomes were severe depression (median SEA 95 [interquartile range 26]), severe mania (76 [40]), quality of life (65 [53]), work/school functioning (58 [48]), and social functioning (54 [50]). Avoiding severe mania was significantly more important to patients with bipolar disorder type I compared with patients with type II. Outcome scores correlated strongly (p < 0.01) across the ranking and rating exercises. Based on the results, a simplified and consistent set of outcomes was constructed.


Patients’ preferences for outcomes in the long-term treatment of bipolar disorder vary considerably. To advance patient-centered healthcare, we propose that researchers, clinical guideline producers, and patient–clinician dyads integrate a taxonomy of patient-important outcomes, such as constructed in this study, when assessing treatment options.


Focus Group Bipolar Disorder Aripiprazole Acute Episode Importance Weight 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to thank Brynjar Landmark (Psychiatrist, Ph.D.) and Endre Aas (Librarian) for their valuable help in identifying medication-associated outcomes relevant to bipolar disorder from clinical practice guidelines and textbooks.


Financial support for this study was partly provided by a grant from the Norwegian Research Council. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report.

Conflict of interest

Øystein Eiring, Magne Nylenna, and Kari Nytrøen declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.


Øystein Eiring and Kari Nytrøen were involved in the study design, literature search, focus-group planning and conduction, data analyses and interpretation, and writing and revising the paper. Magne Nylenna was involved in the study design, data synthesis, data interpretation, and revision of the manuscript. All authors had full access to the data, approved the final draft, and take responsibility for the accuracy of the analysis and the integrity of the data. Øystein Eiring and Kari Nytrøen are guarantors for the article.

Supplementary material

40271_2015_128_MOESM1_ESM.docx (83 kb)
Supplementary material 1 (DOCX 82 kb)
40271_2015_128_MOESM2_ESM.docx (81 kb)
Supplementary material 2 (DOCX 81 kb)
40271_2015_128_MOESM3_ESM.docx (77 kb)
Supplementary material 3 (DOCX 77 kb)


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of OsloOsloNorway
  2. 2.Norwegian Knowledge Centre for the Health ServicesOsloNorway
  3. 3.Department of Quality and Patient SafetyInnlandet Hospital TrustBrumunddalNorway
  4. 4.Oslo University Hospital, RikshospitaletOsloNorway

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