Meta-analysis of predictors of favorable employment outcomes among individuals with bipolar disorder.
OBJECTIVE
Although several studies have reported on predictors of employment in individuals with bipolar disorder (BD), the magnitude of the impact of these variables is unclear as no previous studies have estimated the collective effect sizes (ESs). The present meta-analysis estimated ESs and explored which of these variables are associated with positive employment outcomes.


METHODS
We searched for articles published between 2000 and 2011 that reported associations between sociodemographic, clinical, psychosocial, and/or cognitive variables with employment outcomes in BD. Of the 781 articles identified, 22 met the inclusion criteria and were included in the final analysis (n = 6,301). Weighted correlation coefficients (r-index) were computed as ESs for each of the predictor variables, which were grouped into six categories: cognitive performance, symptomatology, sociodemographic factors, course of illness, clinical variables, and other personal factors. The overall ES (Rw) was estimated by assuming random-effect models. Sensitivity analyses were also performed to determine the robustness of the findings.


RESULTS
Significant predictors of favorable employment outcomes included: cognitive performance (e.g., verbal memory, Rw = 0.33; executive function, Rw = 0.26), sociodemographic factors (e.g., years of education, Rw = 0.23), course of illness (e.g., number of lifetime psychiatric hospitalizations, Rw = -0.35), symptomatology (e.g., depression, Rw = -0.25), and other personal factors (e.g., personality disorder, Rw = -0.49).


CONCLUSIONS
Overall, the cognitive performance and course of illness had larger average ESs than symptomatology or sociodemographic factors on favorable employment outcomes. These findings may help to guide the design of more effective work interventions for people with BD.
Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong.
Samson
S
Tse
Sunny
S
Chan
King Lam
KL
Ng
Lakshmi N
LN
Yatham
D001714:Bipolar Disorder / Q000523:psychology* / Q000534:rehabilitation*; D003071:Cognition / Q000502:physiology; D004651:Employment / Q000523:psychology*; D006801:Humans; D011237:Predictive Value of Tests; D016896:Treatment Outcome
functional recovery; mood disorders; paid employment; unemployment; vocational rehabilitation; work impairment