title: Differential effects of depression and mania symptoms on social adjustment: prospective study in bipolar disorder.
abstract: OBJECTIVE
  Previous studies of social adjustment in bipolar disorder have been cross-sectional and small in sample size, have examined a limited number of roles, or were not controlled for baseline mood and other clinical, social, or treatment confounders. We aimed to prospectively explore the strength and stability of correlations between depression and mania-type symptoms and impairment in a broad range of social adjustment roles and domains.
  
  
  METHODS
  Multilevel modeling analysis of correlation coefficients between depression and mania-type symptoms with roles and domains of the modified social adjustment scale (overall, work, social/leisure, extended family, marital, parental social adjustment roles, performance, interpersonal behavior, friction, dependency, overactivity domains) was used. Interview assessments were made at eight-week intervals beginning at eight weeks and continuing through 72 weeks after baseline in 253 patients in a multicenter randomized controlled trial.
  
  
  RESULTS
  After controlling for baseline mood episodes, and other clinical, social, and treatment variables, depression symptoms showed strong and stable correlations over time with performance, overall social adjustment, and the work role; and a moderate but stable relationship with interpersonal behavior. The relationships of depression symptoms with the other roles were weak, non-significant, or not stable. For mania-type symptoms, only the correlation with interpersonal friction was moderately strong and reasonably stable over time. Mood episodes, substance use disorder, and borderline/antisocial personality disorder increased role impairment, while employment and marriage mildly decreased it.
  
  
  CONCLUSIONS
  Depression and mania-type symptoms have specific effects on social adjustment in bipolar I disorder. Depression symptoms are correlated strongly with performance and moderately with interpersonal behavior, while mania-type symptoms are correlated moderately with interpersonal friction.
authors.affiliation: Department of Psychiatry and Community Mental Health, Institute of Mental Health, University of Nottingham, Nottingham, UK. richard.morriss@nottingham.ac.uk
authors.forename: Richard
authors.initials: R
authors.lastname: Morriss
authors.forename: Min
authors.initials: M
authors.lastname: Yang
authors.forename: Arun
authors.initials: A
authors.lastname: Chopra
authors.forename: Richard
authors.initials: R
authors.lastname: Bentall
authors.forename: Eugene
authors.initials: E
authors.lastname: Paykel
authors.forename: Jan
authors.initials: J
authors.lastname: Scott
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology* / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012917:Social Adjustment; D013223:Statistics as Topic; D013997:Time Factors; D055815:Young Adult