Psychosocial disability and work role function compared across the long-term course of bipolar I, bipolar II and unipolar major depressive disorders.
OBJECTIVE
The research literature on psychosocial disability and work in mood disorders has either focused on relatively short-term course, or did not consider direct comparisons of these domains across all three of the affective subtypes of bipolar I (BP-I), bipolar II (BP-II), and unipolar major depressive disorders (UP-MDD).


METHODS
Mean composite measures of psychosocial impairment and months at specific levels of overall and work impairment were compared for 158 BP-I, 133 BP-II, and 358 UP-MDD patients based on semi-structured interviews conducted during 15 years of follow-up in the NIMH Collaborative Depression Study (CDS). These are contrasted with a single month of psychosocial impairment ratings for a sample of 1787 subjects with no current psychiatric disorder.


RESULTS
Patients with mood disorders experienced some degree of disability during the majority of long-term follow-up (54 to 59% of months), including 19 to 23% of months with moderate and 7 to 9% of months with severe overall impairment. Severe disability occurred a substantial percentage of time only in the specific area of work role function. BP-I patients were completely unable to carry out work role functions during 30% of assessed months, which was significantly more than for UP-MDD and BP-II patients (21% and 20%, respectively).


CONCLUSIONS
These findings have public health, economic, and clinical importance, and underscore the need to reduce the chronicity and impairment associated with these three prevalent affective disorder subtypes. Interventional research is just beginning to address these challenges.
Judd
Lewis L
LL
Department of Psychiatry, University of California at San Diego, La Jolla, CA 92093-0603, USA. ljudd@ucsd.edu
Schettler
Pamela J
PJ
Solomon
David A
DA
Maser
Jack D
JD
Coryell
William
W
Endicott
Jean
J
Akiskal
Hagop S
HS
D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D002140:California; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012050:Rehabilitation, Vocational / Q000706:statistics & numerical data*; D012737:Sex Factors; D012917:Social Adjustment