King's College London

Background: Long-term follow up studies of functioning in people with bipolar (type I) and major depressive disorders (BD and MDD) have not been reported from Africa. Objectives: To describe the long-term functional outcome of BD and MDD, and factors that influence such outcome. Methods: Door-to-door survey of 83,282 adults (ages 15–49 years) in a rural district of Ethiopia to identify potential cases whose diagnosis was later confirmed by standardized clinician interviews were followed by for an average of 11 years. The Short-Form- SF-36 scale was used to describe the functional outcome. Mixed linear models were used to evaluate potential factors associated with outcome. A total of 311 people with BD and 187 people with MDD that were identified at baseline and with complete data on functional outcome were included in the analyses. Results: Mean social functioning levels at baseline were 55–65% for people with BD and 55% for MDD but improved with follow-up. About 33% incident and 37% prevalent cases of people with BD had reduced social functioning for three years or more. Baseline functioning was significantly associated with longitudinal functioning. When baseline functioning is adjusted in the model, longitudinal functioning was not associated with socio-demographic or illness characteristics. Conclusions: The level of functions of people with BP and MDD were significantly lower than that of the general population both at baseline and during the follow-up period. Although there were improvements in function with follow-up, a significant proportion had functional deficits during the follow-up period.