Sustained unemployment in psychiatric outpatients with bipolar disorder: Frequency and association with demographic variables and comorbid disorders

Department of Psychiatry and Human Behavior, Brown Medical School, 135 Plain Street, Providence, RI 02905, USA.
Bipolar Disorders (Impact Factor: 4.97). 11/2010; 12(7):720-6. DOI: 10.1111/j.1399-5618.2010.00869.x
Source: PubMed


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.

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    • "Both bipolar disorder and borderline personality disorder are serious mental health disorders resulting in significant psychosocial morbidity, reduced health related quality of life, and excess mortality. In largely separate literatures both disorders have been associated with impaired occupational functioning (Skodol et al., 2002; Morgan et al., 2005; Kessler et al., 2006; Ansell et al., 2007; Zanarini et al., 2009; Zimmerman et al., 2010), impaired social functioning (Jovev and Jackson, 2006; Grant et al., 2008; Judd et al., 2008; Gunderson et al., 2011; Miklowitz, 2011; Jeung and Herpertz, 2014; Lazarus et al., 2014), substance use problems (Trull et al., 2000; Goldberg, 2001; Grant et al., 2008; Oquendo et al., 2010; Farren et al., 2012; Di Florio et al., 2014), high rates of suicide (Isometsa et al., 1994; Angst et al., 2002; Pompili et al., 2005; Baldessarini et al., 2006; McIntyre et al., 2008; Oquendo et al., 2010;) and suicide attempts, (Baldessarini et al., 2006; McIntyre et al., 2008; Oquendo et al., 2010; Zimmerman et al., 2014), and high health care utilization and costs (Bender et al., 2001; Morgan et al., 2005; Kessler et al., 2006; van Asselt et al., 2007; Soeteman et al., 2008; Dilsaver, 2011; Williams et al., 2011; Kleine-Budde et al., 2013). While both disorders are associated with high levels of morbidity and mortality, they are perceived differently. "
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    ABSTRACT: The relationship between bipolar disorder and borderline personality disorder has generated intense interest. Similar to patients with bipolar disorder, patients with borderline personality disorder are frequently hospitalized, are chronically unemployed, abuse substances, attempt and commit suicide. However, one significant difference between the two disorders is that patients with borderline personality disorder are often viewed negatively by mental health professionals. In the present paper we examined whether this negative bias against borderline personality disorder might be reflected in the level of research funding on the disorder. We searched the National Institute of Health (NIH) Research Portfolio Online Portfolio Reporting Tool (RePORT) for the past 25 years and compared the number of grants funded and the total amount of funding for borderline personality disorder and bipolar disorder. The yearly mean number of grants receiving funding was significantly higher for bipolar disorder than for borderline personality disorder. Results were the same when focusing on newly funded grants. For every year since 1990 more grants were funded for bipolar disorder than borderline personality disorder. Summed across all 25 years, the level of funding for bipolar disorder was more than 10 times greater than the level of funding for borderline personality disorder ($622 million vs. $55 million). These findings suggest that the level of NIH research funding for borderline personality disorder is not commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder.
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    • "The course and chronicity of bipolar disorder may be an important part of predicting occupational outcomes. Several studies have found that among individuals with bipolar disorder, it is the depressive symptoms that are more disabling than the manic phase symptoms (Simon et al. 2008; Zimmerman et al. 2010). While we did not distinguish those with bipolar disorder based on manic or depressive symptoms in this study, it is possible that those who had new onset 12-month bipolar disorder may have been in a manic phase and thus their functioning may not have been as negatively impacted. "
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    ABSTRACT: In this study we examine the longitudinal effects of psychiatric and substance use disorders on employment, in an employed population. The sample included respondents to the National epidemiologic survey on alcohol related conditions (NESARC) who were employed at Wave 1 (N = 22,407). Bivariate and multivariable analyses were conducted examining the associations between 12-month and new onset 12-month psychiatric diagnoses at Wave 1 and employment status at Wave 2. Past year and new onset 12-month depression, 12-month bipolar, new onset 12-month drug abuse, and 12-month and new onset 12-month drug dependence were associated with a decreased odds of being employed at Wave 2. This study suggests that it would be beneficial for employers to support their employees in participating in mental health treatment. Additionally, understanding how psychiatric disorders influence employment over the life course might inform the development of preemptive interventions to treat mental health symptoms.
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