Executive function and employment status among veterans with bipolar disorder

Objective: This study assessed the relationship between neurocognitive function (measured by the Executive Interview [EXIT]) and occupational role function (measured by employment status) in a large cohort of Veterans Affairs patients with bipolar disorder. Methods: A total of 213 patients in a national bipolar disorder intervention study (Department of Veterans Affairs Cooperative Study 430) were dichotomized into two groups-employed (N=91) and unemployed (N=122)-on the basis of responses to a semistructured interview regarding past-year work history. Bivariate analysis was used to assess whether any participant characteristics and course-of-illness variables were significantly different between the employed and unemployed groups and thus could confound results. A stepwise logistic regression was then performed to investigate the association between neurocognitive function and employment status by using the significant demographic and course-of-illness variables as covariates. Results: There were significant differences in EXIT scores between the employed and unemployed groups, with the unemployed group showing greater executive impairment. Lifetime psychiatric hospitalizations and number of psychotropic medications prescribed had significant associations with employment status. When these variables were entered into a regression analysis, employment status could still be explained by executive functioning. Conclusions: This study found that poor executive function may be associated with poor work adjustment (unemployment) among patients with bipolar disorder. The etiology of this relationship and the contributory role of the prior number of hospitalizations and number of psychotropic medications to executive function remain to be further evaluated.