Depression and executive functioning deficits predict poor occupational functioning in a large longitudinal sample with bipolar disorder.
Bipolar Disorder (BD) is characterized by impairments in psychosocial functioning with occupational disability being one of the most significant. Depression and neurocognitive deficits are features of BD most commonly associated with poor occupational functioning (OF). Few studies have examined these features over an extended period of time focusing on distinct aspects of work functioning.



This longitudinal study included 273 adults with bipolar I disorder (N=173), bipolar II disorder (N=69), and bipolar not otherwise specified (N=31). The participants underwent an annual clinical assessment, neuropsychological testing, and work functioning measures over 5 years. We employed multilevel modeling (MLM) to determine which demographic, clinical, and neurocognitive characteristics influence 4 aspects of work functioning (work attendance, conflict, enjoyment, performance) over this 5-year period.



Work functioning was measured using a self-report measure, which may be confounded by responder bias and is not tailored for distinct occupations. Due to insufficient power, medication use was not accounted for and our sample may not generalize to the broader BD population.



Using MLM, those with higher levels of depression and greater cognitive flexibility deficits were more likely to experience poorer work attendance (p<0.01), lower quality of work (p<0.01), and reduced satisfaction from work (p<0.001). These occupational hardships persisted over the 5-year period.



This study emphasizes the need for interventions that specifically focus on the treatment of depressive symptoms and neurocognitive deficits within the context of work functioning, particularly attendance at work, to enable BD patients to live more productive, financially secure, and satisfying lives.
Departments of Social Work and Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA. Electronic address: lisa.odonnel@gmail.com.
Lisa A
LA
O'Donnell
Department of Psychology, University of Michigan, 2255 East Hall, Ann Arbor, MI 48109, USA. Electronic address: pjdeldin@umich.edu.
Patricia J
PJ
Deldin
Department of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109, USA. Electronic address: agrogan@umich.edu.
Andrew
A
Grogan-Kaylor
Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA. Electronic address: mmcinnis@med.umich.edu.
Melvin G
MG
McInnis
Department of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109, USA. Electronic address: jmweintr@umich.edu.
Jenna
J
Weintraub
Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA. Electronic address: karyan@med.umich.edu.
Kelly A
KA
Ryan
Department of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109, USA. Electronic address: himlej@umich.edu.
Joseph A
JA
Himle
D000041:Absenteeism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D056344:Executive Function; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007588:Job Satisfaction; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009483:Neuropsychological Tests; D000066477:Work Performance; D055815:Young Adult