title: The role and impact of contextual factors on functioning in patients with bipolar disorder.
abstract: OBJECTIVE
  The International Classification of Functioning, Disability and Health, provides the framework to describe individual's functioning and allows the study of the interaction between patient's health status and the environmental factors involved. The main aim of this study was to analyse systematically those factors involved in the functioning of bipolar patients including the role of contextual factors.
  
  
  METHODS
  Eighty-eight euthymic patients with a diagnosis of bipolar disorder were included. To examine the importance of contextual factors above and over clinical variables after controlling of potential socio-demographic variables, a hierarchical multiple regression was used.
  
  
  RESULTS
  Clinical variables that significantly predicted patient functioning were the total number of episodes, number of depressive episodes, family history of psychiatric disorders and mild subdepressive symptoms, accounting for 34.1% of the variance of functioning (F=2.14, p =0.011). Contextual factors, including dysfunctional attitudes and perceived social support, accounted for 17.5% of the variance (F=3.04, p <0.001).
  
  
  CONCLUSIONS
  Contextual factors appear to play a significant role in explaining bipolar patients' functioning after controlling for socio-demographic and clinical factors. These findings suggest that psychosocial interventions might be helpful to reduce or prevent disability associated to bipolar disorder. From an ICF model, understanding those factors may be useful to produce policy recommendations and guidelines.
authors.affiliation: Instituto de Salud Carlos III, Centro de Investigacion en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Sanchez-Moreno
authors.forename: Anabel
authors.initials: A
authors.lastname: Martinez-Aran
authors.forename: Hesham F
authors.initials: HF
authors.lastname: Gadelrab
authors.forename: Maria
authors.initials: M
authors.lastname: Cabello
authors.forename: Carla
authors.initials: C
authors.lastname: Torrent
authors.forename: Caterina del Mar
authors.initials: Cdel M
authors.lastname: Bonnin
authors.forename: Montse
authors.initials: M
authors.lastname: Ferrer
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
authors.forename: José Luís
authors.initials: JL
authors.lastname: Ayuso-Mateos
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D001290:Attitude; D001714:Bipolar Disorder / Q000523:psychology*; D057189:Checklist; D004185:Disability Evaluation; D005190:Family; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D015233:Models, Statistical; D012044:Regression Analysis; D012931:Social Environment; D012944:Social Support