Self-reported cognitive problems predict employment trajectory in patients with bipolar I disorder

Abstract

Background-Cognitive impairment in bipolar disorder has been associated with poor functional outcomes. We examined the relation of self-reported cognitive problems to employment trajectory in patients diagnosed with bipolar I disorder.Methods-154 bipolar I disorder patients were followed for 15-43 months at the Bipolar Disorders Center for Pennsylvanians. Using a multinomial logistic regression we examined predictors of employment group including self-reported cognitive problems, mood symptoms, education and age. Cognitive functioning was measured via 4 self-report items assessing memory/concentration at baseline and termination. Employment status was recorded at baseline and termination. Employment was categorized as working (full-time, part-time, homemaker, volunteer) or not working (leave of absence, disability, unemployed, no longer volunteering) at each time point. Patients were categorized as good stable, improving, worsening and poor stable.Results-Baseline self-reported concentration problems and years of education significantly predicted employment trajectory. Limitations-Post-hoc analyses of existing clinical dataConclusions-Self-reported concentration problems assessed in the context of specific areas of functioning may serve as a sensitive predictor of functional outcome in patients diagnosed with bipolar I disorder.

The relationship between neurocognitive functioning and occupational functioning in bipolar disorder: A literature review

“…Exceptions included Gilbert et al (2010) who used a self-report assessment and a clinical interview to collect information regarding memory and concentration and Altshuler et al (2007) who used a structured interview to assess executive functioning. Schoeyen and colleagues (2013) utilised a neurocognitive test battery to measure participants Full Scale IQ and premorbid intellectual functioning, arguing that the various neurocognitive domains reflect general intellectual ability.…”

“…Nine studies (Altshuler et al, 2007; Depp et al, 2012b; Dickerson et al, 2004; Dickerson et al, 2010; Gilbert et al, 2010; Mora, Portella, Forcada, Vieta, & Mur, 2013; Mur, Portella, Martínez-Arán, Pifarre, & Vieta, 2008; Mur, Portella, Martínez-Arán, Pifarre, & Vieta, 2009; Ryan et al, 2013) measured occupational functioning by categorising participants into groups based on their employment status. Of these studies, the most common method involved creating a ‘working vs not working’ dichotomy (Altshuler et al, 2007; Depp et al, 2012b; Dickerson et al, 2010; Gilbert et al, 2010; Mur et al, 2009; Ryan et al, 2013).…”

“…Of these studies, the most common method involved creating a ‘working vs not working’ dichotomy (Altshuler et al, 2007; Depp et al, 2012b; Dickerson et al, 2010; Gilbert et al, 2010; Mur et al, 2009; Ryan et al, 2013). Other studies created a third grouping with the inclusion of a "part-time" or "retired/disabled" group (Dickerson et al, 2004; Levy, Medina, & Weiss, 2013; Mora et al, 2013; Mur et al, 2008).…”

“…Other studies created a third grouping with the inclusion of a "part-time" or "retired/disabled" group (Dickerson et al, 2004; Levy, Medina, & Weiss, 2013; Mora et al, 2013; Mur et al, 2008). Definitions also varied within this employment status category, with Ryan et al (2013) and Dickerson et al (2010) describing their "working" group as having attained full-time employment, whilst others (Altshuler et al, 2007; Depp et al, 2012b; Gilbert et al, 2010; Mora et al, 2013; Mur et al, 2008; Mur et al, 2009) including participants who were part-time employed.…”

Occupational disability in bipolar disorder: analysis of predictors of being on severe disablement benefit (PREBIS study data)

“…Subscales for occupational status from the Functioning Assessment Short Test (FAST) (2), the Sheehan Disability Scale (SDS) (20), the Social and Occupational Functioning Assessment Scale (SOFAS) (21,22), the World Health Organization Disability Assessment Schedule (WHO-DAS) (23), and the Social Adjustment Scale (SAS) (24) have been employed as well as the Modified Vocational Status (10,24). Other investigators have measured psychosocial functioning with the Global Assessment of Functioning (9), or considered occupational adaptation (25), absenteeism (26), paid employment (1), turnover in employment status (1), occupational stability (27), semi-structured interviews (28) or selfreported functional impairment (29). In this context, we considered a tangible and socially relevant statement such as receiving a severe disablement benefit (SDB) because of BD, which indicates an absolute disability to work (20,30).…”