title: Residual depressive symptoms, sleep disturbance and perceived cognitive impairment as determinants of functioning in patients with bipolar disorder.
abstract: Many patients with bipolar disorder (BD) experience residual symptoms during their inter-episodic periods. The study aimed to analyse the relationship between residual depressive symptoms, sleep disturbances and self-reported cognitive impairment as determinants of psychosocial functioning in a large sample of euthymic BD patients.
  
  
  
  This was a cross-sectional study of 468 euthymic BD outpatients. We evaluated the residual depressive symptoms with the Bipolar Depression Rating Scale, the sleep disturbances with the Pittsburgh Sleep Quality Index, the perceived cognitive performance using visual analogic scales and functioning with the Functioning Assessment Short Test. Structural equation modelling (SEM) was used to describe the relationships among the residual depressive symptoms, sleep disturbances, perceived cognitive performance and functioning.
  
  
  
  SEM showed good fit with normed chi square=2.46, comparative fit index=0.94, root mean square error of approximation=0.05 and standardized root mean square residuals=0.06. This model revealed that residual depressive symptoms (path coefficient =0.37) and perceived cognitive performance (path coefficient=0.27) were the most important features significantly related to psychosocial functioning. Sleep disturbances were indirectly associated with functioning via residual depressive symptoms and perceived cognitive performance (path coefficient=0.23).
  
  
  
  This study contributes to a better understanding of the determinants of psychosocial functioning during the inter-episodic periods of BD patients. These findings should facilitate decision-making in therapeutics to improve the functional outcomes of BD during this period.
authors.affiliation: CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France; Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Fondation FondaMental, Créteil, France. Electronic address: lsamalin@chu-clermontferrand.fr.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Samalin
authors.affiliation: Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
authors.affiliation: Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Murru
authors.affiliation: Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Isabella
authors.initials: I
authors.lastname: Pacchiarotti
authors.affiliation: Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Reinares
authors.affiliation: Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Caterina Mar
authors.initials: CM
authors.lastname: Bonnin
authors.affiliation: Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Torrent
authors.affiliation: Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
authors.forename: Norma
authors.initials: N
authors.lastname: Verdolini
authors.affiliation: Policlinico Umberto I of Rome, La Sapienza University of Roma, Department of Neurology and Psychiatry, Rome, Italy.
authors.forename: Corinna
authors.initials: C
authors.lastname: Pancheri
authors.affiliation: CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France.
authors.forename: Ingrid
authors.initials: I
authors.lastname: de Chazeron
authors.affiliation: Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, Marseille, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Boucekine
authors.affiliation: Fondation FondaMental, Créteil, France; Inserm U1144, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisiére - F. Widal,Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.
authors.forename: Pierre-Alexis
authors.initials: PA
authors.lastname: Geoffroy
authors.affiliation: Fondation FondaMental, Créteil, France; Inserm U1144, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisiére - F. Widal,Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Bellivier
authors.affiliation: CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, Clermont-Ferrand, France; Fondation FondaMental, Créteil, France.
authors.forename: Pierre-Michel
authors.initials: PM
authors.lastname: Llorca
authors.affiliation: Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology*; D003430:Cross-Sectional Studies; D003527:Cyclothymic Disorder / Q000523:psychology; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012893:Sleep Wake Disorders / Q000209:etiology*; D058992:Social Participation / Q000523:psychology
keywords: Bipolar disorder; Cognitive functioning; Functioning; Residual depressive symptoms; Sleep disturbances; Structural equation modelling