This study examined how self-reported cognitive functioning relates to quality of life in bipolar disorder. The researchers found that: (1) higher levels of depression were associated with lower quality of life, (2) self-reported cognitive failures independently predicted quality of life after accounting for mood and objective cognitive performance, and (3) how individuals perceive their daily cognitive functioning may impact their overall quality of life beyond their actual cognitive abilities or mood symptoms.

1. Metacognition and QOL in BD:
Preliminary findings
Ivan Torres
Erin Michalak
Lakshmi Yatham
Sylvia Mackala
UBC Department of Psychiatry
BC Mental Health and Addictions Services

2. Predicting QOL
• If we understand the determinants of
QOL in BD, perhaps we can modify
these variables and improve QOL.

3. Predictors of QOL
• Mood (in particular depression)
• Cognition: Mental processing and
knowledge of the external world
– Memory, Attention, Executive Function, etc
• Metacognition: Knowledge of internal
world, one’s own cognitive functioning
or performance

4. Metacognition: different levels
• Metacognitive Knowledge: General
knowledge about one’s cognitive ability
• Metacognitive Experience: Task specific
knowledge
• Metacognition of daily functioning:
Knowledge in the context of daily life

5. Research Questions
• How do individuals diagnosed with BD self-rate
their everyday cognitive functioning?
• Do these self-ratings predict QOL?

6. Depression Cognition
Metacognition
QOL

7. Measures
• Depression: HAMD
• Cognition:
– Learning/Memory: RAVLT trials 1-3
– Executive: Trailmaking Test B
• Self-reported cognitive failures
– Cognitive Failures Questionnaire (CFQ; Broadbent
et al., 1982)
• QOL: QoL.BD (Michalak et al., 2010)

8. Very
often
Quite
often
Cognitive Failures Questionnaire
Occasion-ally
Very
rarely
Never
4 3 2 1 0
Do you find you forget appointments?
Do you forget where you put something like a newspaper or a book?
Do you daydream when you ought to be listening to something?
Do you find you forget people’s names?
Do you start doing one thing at home and get distracted into doing something else (unintentionally)?
Do you find you can’t quite remember something although it’s “on the tip of your tongue”?
Do you read something and find you haven’t been thinking about it and must read it again?
Do you find you forget why you went from one part of the house to the other?
Do you find you confuse right and left when giving directions?
Do you find you forget whether you’ve turned off a light or a fire or locked the door?
Do you fail to hear people speaking to you when you are doing something else?
Do you leave important letters unanswered for days?
Do you find you forget which way to turn on a road you know well but rarely use?
Do you fail to see what you want in a supermarket (although it’s there)?

9. Table 1: Demographics and Characteristics of the Sample
Patients (n=63)a Controls (n=40)b
Continuous Variable c M SD M SD
Age 39.0 10.3 35.3 10.4
Education (years) 15.2 2.2 15.5 2.2
Premorbid IQ 109.1 8.4 108.3 7.5
HAMD 5.7 4.5 - -
YMRS 1.5 2.7 - -
QoL*** 161.2 29.6 191.6 23.9
CFQ*** 42.6 17.9 25.5 10.2
RVLT .6 1.1 .6 .9
TMT-B 48.3 11.3 46.8 10.5
Note. Premorbid IQ= North American Adult Reading Test FSIQ. HAMD= Hamilton Depression Rating
Scale (17). YMRS- Young Mania Rating Scale. QoL= Quality of Life- Bipolar Disorder Questionnaire.
CFQ= Cognitive Failures Questionnaire. RVLT= Rey’s Verbal Learning Test mean trials 1-3. TMT-B=
Trail Making Test trial B.
a Female n= 40 (63.5%). b Female n= 22 (55.0%). c No significant difference on any variables except
for QoL and CFQ. *** p<.001

10. Table 2: Correlations between Quality of Life and depression, cognitive function, and CFQ
Patients (n=63) Controls (n=40)
Pearson Correlation QoL p QoL p
HAMD -.74 .00 - -
CFQ -.53 .00 -.43 .01
RVLT .33 .00 -.06 .70
TMT-B -.25 .03 -.12 .48
Note. QoL= Quality of Life- Bipolar Disorder Questionnaire. CFQ= Cognitive Failures Questionnaire.
RVLT= Rey’s Verbal Learning Test mean trials 1-3. TMT-B= Trail Making Test trial B.

11. Table 3: Hierarchical Regression: Predictors of QoL in patients with BD
Patients (n=63)
Entry ΔR² p
Step 1: HAMD 0.47 <.001
Step 2: Cognition 0.06 <.05
Step 3: CFQ 0.04 <.05
Note. QoL= Quality of Life- Bipolar Disorder Questionnaire. HAMD= Hamilton
Depression Rating Scale. CFQ= Cognitive Failures Questionnaire. Cognition = Rey’s
Verbal Learning Test mean trials 1-3, Trail Making Test trial B.

12. Correlation between cognitive failures and QOL

13. Summary Slide
• Main research finding: In addition to, and independent of mood
symptoms and cognitive functioning, perception of daily
cognitive functioning may be a predictor of overall quality of life
in BD.
• Knowledge Exchange for CREST.BD network members: If self-perceptions
of daily cognitive functioning indeed associate with
QOL in BD, then these perceptions may serve as targets for
change via treatment/intervention.