“…A more severe illness history -including a younger age at onset (Hays, Krishnan, George, & Blazer, 1998) and a greater number of mood episodes (MacQueen et al, 2000) and psychiatric hospitalizations (Altshuler et al, 2007) -yields reduced functioning even during euthymia (Martinez-Aran et al, 2004;Zubieta, Huguelet, O'Neil, & Giordani, 2001). In addition, common comorbidities of BD, such as anxiety (Boylan et al, 2004;Kauer-Sant Anna et al, 2007) and substance use disorders (SUD; Jaworski et al, 2011;Lagerberg et al, 2010), disrupt identity development (Michalak et al, 2011), increase symptoms and social avoidance (Jaworski et al, 2011;Otto et al, 2006), interfere with interpersonal engagement (Elgie & Morselli, 2007), exacerbate cognitive impairment (Latvala et al, 2009;Levy & Weiss, 2009;Silva & Leite, 2000), and generally reduce functioning (Goldstein & Levitt, 2008;Sanchez-Moreno et al, 2009 In euthymic BD, two of the strongest predictors of social and occupational functioning are subsyndromal depressive symptoms and cognitive impairment (Bearden et al, 2011;Bonnin et al, 2010;Dickerson et al, 2010;Martínez-Arán et al, 2011;Martino et al, 2009;Tabares-Seisdedos et al, 2008). Even very mild subsyndromal depression leads to reduced functioning including poorer vocational performance (Bearden et al, 2011;Gitlin, Mintz, Sokolski, Hammen, & Altshuler, 2010).…”