O'Donnell Lisa A, Deldin Patricia J, Grogan-Kaylor Andrew, McInnis Melvin G, Weintraub Jenna, Ryan Kelly A, Himle Joseph A
Departments of Social Work and Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA.
Department of Psychology, University of Michigan, 2255 East Hall, Ann Arbor, MI 48109, USA.
J Affect Disord. 2017 Jun;215:135-142. doi: 10.1016/j.jad.2017.03.015. Epub 2017 Mar 16.
Bipolar Disorder (BD) is characterized by impairments in psychosocial functioning with occupational disability being one of the most significant. Depression and neurocognitive deficits are features of BD most commonly associated with poor occupational functioning (OF). Few studies have examined these features over an extended period of time focusing on distinct aspects of work functioning.
This longitudinal study included 273 adults with bipolar I disorder (N=173), bipolar II disorder (N=69), and bipolar not otherwise specified (N=31). The participants underwent an annual clinical assessment, neuropsychological testing, and work functioning measures over 5 years. We employed multilevel modeling (MLM) to determine which demographic, clinical, and neurocognitive characteristics influence 4 aspects of work functioning (work attendance, conflict, enjoyment, performance) over this 5-year period.
Work functioning was measured using a self-report measure, which may be confounded by responder bias and is not tailored for distinct occupations. Due to insufficient power, medication use was not accounted for and our sample may not generalize to the broader BD population.
Using MLM, those with higher levels of depression and greater cognitive flexibility deficits were more likely to experience poorer work attendance (p<0.01), lower quality of work (p<0.01), and reduced satisfaction from work (p<0.001). These occupational hardships persisted over the 5-year period.
This study emphasizes the need for interventions that specifically focus on the treatment of depressive symptoms and neurocognitive deficits within the context of work functioning, particularly attendance at work, to enable BD patients to live more productive, financially secure, and satisfying lives.
双相情感障碍（BD）的特点是社会心理功能受损，职业残疾是其中最显著的方面之一。抑郁和神经认知缺陷是BD最常与不良职业功能（OF）相关的特征。很少有研究在较长时间内关注工作功能的不同方面来考察这些特征。
这项纵向研究纳入了273名患有I型双相情感障碍（N = 173）、II型双相情感障碍（N = 69）和未特定型双相情感障碍（N = 31）的成年人。参与者在5年时间里每年接受一次临床评估、神经心理学测试和工作功能测量。我们采用多层次建模（MLM）来确定在这5年期间哪些人口统计学、临床和神经认知特征会影响工作功能的4个方面（出勤、冲突、乐趣、绩效）。
工作功能是通过自我报告测量的，这可能会受到应答偏差的影响，并且没有针对不同职业进行定制。由于样本量不足，未考虑药物使用情况，我们的样本可能无法推广到更广泛的BD人群。
使用MLM分析发现，抑郁程度较高且认知灵活性缺陷较大的人更有可能出现较差的工作出勤情况（p < 0.01）、较低的工作质量（p < 0.01）以及工作满意度降低（p < 0.001）。这些职业困境在5年期间持续存在。
本研究强调需要采取干预措施，特别是在工作功能背景下，专门针对抑郁症状和神经认知缺陷进行治疗，尤其是提高工作出勤率，以使BD患者能够过上更有成效、经济上更有保障且更满意的生活。
