title: Predictors of long-term work disability among patients with type I and II bipolar disorder: a prospective 18-month follow-up study.
abstract: OBJECTIVE
  Bipolar disorder (BD) is one of the leading causes of disability worldwide. However, vocational ability and predictors of long-term work disability have rarely been studied among patients with BD. We investigated clinical predictors of work disability among patients with BD in psychiatric care.
  
  
  METHODS
  The Jorvi Bipolar Study (JoBS) is a naturalistic prospective cohort study (N = 191) representing adult (18-59 years) psychiatric inpatients and outpatients with DSM-IV bipolar I disorder (BD-I) and bipolar II disorder (BD-II) in three Finnish cities. Within the JoBS, we investigated the prevalence of disability pensions at baseline, and predictors for being granted a disability pension during an 18-month follow-up of the 151 patients in the labor force at baseline. Cox models were used to determine predictors for onset of disability pension.
  
  
  RESULTS
  At baseline, 21% (40/191) of the patients already had a disability pension. During the follow-up, a further 38 patients (25% of the 151 followed) were granted a new disability pension. The predictors included older age, male gender, depressive index episode, higher number of psychiatric hospitalizations, generalized anxiety disorder, avoidant personality disorder, and depressive burden during follow-up. However, the predictors differed depending on bipolar subtype, age, and gender.
  
  
  CONCLUSIONS
  BD-I and BD-II are associated with a major risk of long-term work disability, the proportion of patients with a disability pension rising to 41% in the medium-term follow-up of the Finnish cohort investigated in the present study. Severe clinical course, depression, comorbidities, age, and gender are likely to be the main predictors but predictors may vary depending on the subgroup.
authors.affiliation: Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.|Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Arvilommi
authors.affiliation: Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.|Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Suominen
authors.affiliation: Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.|Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Mantere
authors.affiliation: Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.|Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Valtonen
authors.affiliation: Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.|Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Sami
authors.initials: S
authors.lastname: Leppämäki
authors.affiliation: Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.|Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Erkki
authors.initials: E
authors.lastname: Isometsä
mesh_terms: D000328:Adult; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018582:Sick Leave / Q000706:statistics & numerical data; D013995:Time
keywords: bipolar disorder; cohort studies; disability; disability pension; functioning; prospective studies; work