Cognition and illness course predict bipolar employment

By Lucy Piper, Senior medwireNews Reporter

Patients with bipolar disorder are more likely to be successfully employed if they have good cognitive function and a more benign course of illness, suggest findings from a meta-analysis.

These factors had a greater effect on positive employment outcomes than symptomatology and sociodemographic factors, the study researchers, led by Samson Tse (The University of Hong Kong), note.

“[T]hese results might provide a first step toward designing more effective work interventions for people with [bipolar disorder], helping to reduce the massive social cost of this disorder and lost productivity,” they comment in Bipolar Disorders.

The researchers reviewed the medical literature and identified 22 articles (involving 6301 patients) published between 2000 and 2011 that reported the effect of sociodemographic, clinical, psychosocial, and cognitive variables on employment outcomes in patients with bipolar disorder.

Cognitive variables overall, and executive function and verbal memory specifically, had the greatest positive effect on employment outcomes, at moderate effect sizes (ESs) of 0.30, 0.26, and 0.33, respectively.

Given the size of the impact of cognitive variables on employment outcomes, which was greater than the contribution from sociodemographic (ES=0.23) or clinical factors (ES=0.25), the researchers believe “neurocognitive techniques and training as well as psychoeducation on cognition-related issues and problem solving would be vital for those with [bipolar disorder] to maintain optimal work functioning in the long run.”

Years of education also had a moderate and positive impact on employment outcomes, indicating a need for supported education for patients recovering from bipolar disorder, they add.

Course of bipolar illness had a moderate effect (ES=0.35) on employment outcomes, but the impact was negative; patients with more hospitalizations and longer durations of illness had worse employment outcomes.

The researchers therefore suggest that “the provision of community-based, recovery-orientated care… for people with [bipolar disorder] is paramount to shortening the duration of the illness and avoiding the disruptions often caused by hospitalization(s).”

Other factors contributing significantly to poor employment outcomes were depression and personality disorder.

“Overall, an integrated approach, involving working closely with those with [bipolar disorder]; soliciting support from family, workmates, and managers; establishing support systems within the workplace; and liaising with government agencies, is important to enhancing employment outcomes,” Tse and team conclude.

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