Factors linked to occupational disability in BD identified

By Mark Cowen, Senior medwireNews Reporter

Occupational disability in patients with bipolar disorder (BD) is associated with the presence of axis II disorders, a greater number of previous manic episodes, older age, and not being in a stable relationship, researchers report.

The team also found that BD patients receiving severe disablement benefit (SDB) had a significantly greater number of mood episode recurrences over a 1-year follow-up period than those who were employed.

"The results of this study emphasize the importance of early diagnosis and treatment of BD, the clinical relevance of comorbidity with personality disorders, the impact of social support, and the need to closely monitor patients who are occupationally disabled, given their high tendency to recurrence," say Eduard Vieta (University of Barcelona, Spain) and team.

The researchers assessed factors associated with occupational disability among 327 euthymic patients (52.6% women), aged at least 18 years, with type I or II BD who participated in the Predictors of Recurrence in BD in Spain study. Of these patients, 226 were in full-time employment and 101 were receiving SDB.

The team found that patients receiving SDB had an older mean age than employed patients (49 vs 41 years), were less likely to have a stable partner (36.6 vs 50.4%), had poorer educational status, and were more likely to have axis II comorbidity (16.8 vs 8.5%).

Patients receiving SDB also had more previous mood episodes than employed patients (14.5 vs 7.8), were more likely to have attempted suicide (36.6 vs 16.9%), were more likely to have experienced rapid cycling in the past year (9.9 vs 3.1%), and had a higher number of previous hospital admissions (4.9 vs 2.6).

Furthermore, 35.6% of patients receiving SDB experienced a mood disorder recurrence during a 1-year follow-up period compared with 19.9% of employed patients.

Multivariate logistic regression analysis revealed that four factors significantly predicted receipt of SDB: axis II comorbidity (odds ratio [OR]=2.94); an increased number of manic episodes (OR=1.21 per episode); being without a stable partner (OR=2.44); and increasing age (OR=1.08 per year).

"Occupational adjustment is one functional domain with a major impact on personal and societal costs," comment Vieta and team in Acta Scandinavica Psychiatrica.

"This study sheds some light onto occupational disability in bipolar patients, the variables that influence this disability, and the outcome of this group of severe patients."

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