Coventry and Warwickshire Partnership Trust, Caludon Centre, Coventry, CV2 2TE, United Kingdom.
J Affect Disord. 2013 Feb 20;145(2):156-64. doi: 10.1016/j.jad.2012.07.009. Epub 2012 Aug 9.
Severe work impairment can be present for a considerable proportion of the course of bipolar disorder (BD) and is costly for governments, services and individuals. Understanding predictors of employment in BD is therefore crucial as some may be susceptible to interventions. We conducted a systematic review of prospective studies in order to identify predictors of employment in people with BD.
We searched Medline, PsychInfo, EMBASE and Web of Science databases, hand searched 3 journals and used predetermined criteria to select papers for full text inclusion. Sixty seven papers were identified. Nine met inclusion criteria, with a total sample of 3184.
Studies included in this review identified cognitive deficits (67%, n=4), depression (43%, n=3) and level of education (33%, n=2) as predictors of employment in BD patients. Bipolar depression not only affects whether someone is employed but also time off work. Even sub-syndromal depression appears to damage employment prospects. Verbal memory and executive functioning appear to be predictors of work functioning.
Conclusions are based on a relatively small number of studies and are therefore subject to change with the addition of further studies. A formal meta-regression was not possible due to differences between measures of employment and work functioning.
Better assessment and management of depression and cognitive difficulties could improve the occupational functioning of BD patients. There is a need for high quality longitudinal studies specifically designed to investigate predictors of employment in large bipolar disorder samples.
躁郁症（BD）病程中相当一部分患者会出现严重的工作障碍，这给政府、服务机构和个人都带来了巨大的经济负担。因此，了解躁郁症患者就业的预测因素至关重要，因为有些因素可能容易受到干预。我们进行了一项系统综述，旨在确定 BD 患者就业的预测因素。
我们检索了 Medline、PsychInfo、EMBASE 和 Web of Science 数据库，手检了 3 种期刊，并使用预定标准选择全文纳入的论文。确定了 67 篇论文，其中 9 篇符合纳入标准，总样本量为 3184 例。
本综述纳入的研究发现，认知缺陷（67%，n=4）、抑郁（43%，n=3）和受教育程度（33%，n=2）是 BD 患者就业的预测因素。双相情感障碍不仅会影响人们是否就业，还会影响他们的工作时间。即使是亚综合征性抑郁似乎也会损害就业前景。言语记忆和执行功能似乎是工作功能的预测因素。
结论基于相对较少的研究，因此随着更多研究的加入，结论可能会发生变化。由于就业和工作功能的测量方法不同，因此无法进行正式的荟萃回归分析。
更好地评估和管理抑郁和认知困难可能会改善 BD 患者的职业功能。需要有专门针对大型躁郁症样本的预测因素进行设计的高质量纵向研究。
