Sustained unemployment in psychiatric outpatients with bipolar disorder: frequency and association with demographic variables and comorbid disorders.
ABSTRACT The negative impact of bipolar disorder on occupational functioning is well established. However, few studies have examined the persistence of unemployment, and no studies have examined the association between diagnostic comorbidity and sustained unemployment. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we described the amount of time unemployed in the five years before the evaluation in a large cohort of outpatients diagnosed with bipolar disorder, and determined the demographic and clinical correlates of sustained unemployment.
A total of 206 patients diagnosed with DSM-IV bipolar I or bipolar II disorder were interviewed with semi-structured interviews assessing comorbid Axis I and Axis II disorders, demographic and clinical variables. The interview included an assessment of the amount of time missed from work due to psychiatric reasons during the past five years. Persistent unemployment was defined as missing up to two years or more from work.
Less than 20% of the patients reported not missing any time from work due to psychiatric reasons, and more than one-third missed up to two years or more from work. Prolonged unemployment was associated with increased rates of current panic disorder and a lifetime history of alcohol abuse or dependence. Patients with prolonged unemployment were older and experienced more episodes of depression.
Most patients presenting for the treatment of bipolar disorder have missed some time from work due to psychiatric reasons, and the persistence of employment problems is considerable. Comorbid psychiatric disorders are a potentially treatable risk factor for sustained unemployment. It is therefore of public health significance to determine if current treatments are effective in bipolar disorder patients with current panic disorder, and if not, to attempt to develop treatments that are effective.
- SourceAvailable from: Allan H YoungActa Psychiatrica Scandinavica 05/2013; 127(s442). · 4.86 Impact Factor
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ABSTRACT: The aim of this study was to study the clinical and neurocognitive variables that best explain poor work adjustment in a sample of bipolar I euthymic patients. Eighty-five euthymic patients at the Hospital Clinic of Barcelona were assessed for this study by means of a comprehensive neuropsychological battery and a work-focused interview to determine work adjustment. Clinical and sociodemographic variables were also collected. Direct logistic regression was performed to assess the impact of demographic, clinical and neuropsychological variables on the likelihood of presenting poor work adjustment. The model that best fitted contained five variables (Hamilton Depression Rating scores, number of manic episodes, number of perseverative errors in the Wisconsin Card Sorting Test (WCST), number of depressive episodes and Trail Making Test-part B). However, only two out of these variables made a unique statistically significant contribution to the model, which were number of manic episodes (OR 1.401; CI 1.05-1.86; p = 0.021) and number of perseverative errors in the WCST (OR 1.062; CI 1.00-1.12; p = 0.044). The model explained up to 36 % of the variance in work adjustment. This study highlights the role of manic relapses and neurocognitive impairment, specifically the role of executive function, in work adjustment.European Archives of Psychiatry and Clinical Neuroscience 08/2013; · 3.36 Impact Factor
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