Bipolar disorder is the curse of the working class

I would so like to start this post by talking about “the other people” in a slightly superior way. You know, the way people talk about schoolteachers (I was one for 9 years, so I really know), or about people who never finished college, or about people who have divorced three or more times.

We all know objectively there’s nothing wrong with them, yet we have a certain sense—if we’re honest with ourselves–of being better than they are.

And I’d so love to write this from the perspective, say, of a professor at—why not?—Yale, fully employed, benefits, the works. But instead I write it from the lovely perspective of one on disability.  And although there’s not much you can tell me to make me feel good about that, there’s always that truism that misery loves company, and it turns out that, well, those with bipolar disorder—even after significant symptom relief—have a terrible time getting back to the work force.  In fact, the World Health Organization estimates bipolar disorder (BD) to be the sixth-leading cause of disability for those aged 15-44  (Murrary & Lopez, 1996). (I tell you, I’m just feeling so much better already.)

It’s somewhat of a mystery.  Even with significant improvement, those with BD still don’t make it back to the work in the numbers they should.   Dion et al  (1988) analyzed a cohort of patients who had been hospitalized for mania.  Six months after discharge 80% were symptom-free or what they termed “mildly symptomatic” (which makes me wonder. . .).

Only 43% were working, and only 21% were working at what they called the patients’ “expected level of employment.”

Truthfully, I was finding that pretty shabby until I ran into another study, which started off its objective with the upbeat line—I am not making this up—“Recent studies have shown that outcome in mania is worse than previously thought.”   Makes you want to jump up and cheer, no?

Conus et al (2006) reinforces that functionally poor outcome.  They followed patients a year after their first manic episodes, finding that, while 90% had achieved what they call refer to in the business as syndromal recovery (I’ll come back), 61% had “failed to return to previous level of functioning.”

A brief review of this syndromal business.  A patient can be declared ‘syndromically recovered,’ I suppose with much fanfare, if they have stopped meeting the full DSM criteria for a bipolar episode.  However, that can leave them far from symptom free; they can graduate to “symptomatically recovered,”  defined as having (do you want to guess here?)–no symptoms–or just one. In fact, in the Conus study, a full 40% had not recovered symptomatically.

Previously Harrow et al (1990) evaluated 73 patients who had been hospitalized for mania . They found that 1.7 years later.a surprisingly low 42% had steady employment throughout, while 23% had never made it back to work at all.

In fact, after analyzing a number of studies that looked at psychosocial outcomes in BD, MacQueen et al (2001) estimated that “as many as 30 to 60 percent of persons with bipolar disorder do not regain full social or occupational functioning after the onset of their illness.” The National Depressive and and Manic-Depressive Association one-upped them, indicating that approximately 60% of those with BD were unemployed. Kupfer et al backed that up in their 2002 study of 2389 patients:  a 64% unemployment rate.  Finally, Zwerling et al (2002) studied workforce participation by people with disabilities, and, using National Health Interview Survey Disability Supplement forms, found that BD was correlated with a 40% reduction in paid employment.

But it is important to know that, in BD-land,  things could always be worse.  I imagine (and it doesn’t take a Roald-Dahl-leap of imagination to move to this next step) that most people wonder why, if symptoms have cleared, or at least eased, those with BD aren’t able to move back to the work force.  There are a number of theories,  one of which both interests me enough to serve as fodder for a new blog post and upsets me greatly at the same time.  In a 2004 study of 117 people with BD in remission, so to speak, 51% didn’t work at all, 21% worked part-time or volunteered, and only 27% had what the study authors termed “full-time competitive employment.”  And what determined who fell into which category?  “Current employment status was significantly associated with cognitive performance,” they wrote.

It was a lovely sentence structure, which left out the crucial word: impaired. It turns out that those with BD suffer from cognitive impairments in distressingly high rates (the numbers are all over, one study’s got 3-42% [which seems a pretty big range.  Seems like they’d better go back and check those statistics], another has 26%,one has up to 47%.

I think I’m going to leave it here.  It’s a full day already when you go to look up your chances  of getting back to work,  find out they’re in the dog house–and, along the way, just for fun, find out you’re losing IQ points as fast as you can type.  I think I need another infographic.

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