Employment functioning and disability among community residents with bipolar affective disorder: results from an Australian community survey

Objectives: To compare employment functioning and disability among people with bipolar affective disorder in comparison to adults with schizophrenia. Methods: A secondary analysis was conducted using data from the Australian National Survey of Mental Health and Wellbeing 1997-1998. Participants were aged 18-64 years with a DSM-III-R diagnosis of either bipolar affective disorder (BPD, n = 156) or schizophrenia (n = 385) and were community residents with either outpatient or short-stay inpatient status. The survey began by screening 5,710 people for psychosis, hence the sample consists mostly of bipolar disorder with psychotic features. Those with BPD were examined both in aggregation with and in contrast to people with schizophrenia on 24 independent variables covering demographic, clinical, and functioning characteristics with respect to two employment status variables and a global rating of social and occupational functioning. Results: The unadjusted and fully adjusted models revealed key functioning differences between BPD and schizophrenia. Adjusted correlates of employment functioning unique to people with BPD were: age, course of disorder, insight into positive symptoms, impairment attributed to medication, family history of schizophrenia, lifetime substance dependence, and lifetime repeated use of illicit or non-prescription drugs. Conclusions: The population-level correlates of employment functioning among people with BPD warrant special attention when providing both clinical and vocational assistance. Employment functioning in both BPD and schizophrenia is partly explained by demographic, clinical and functioning correlates, which can be independent of global assessments of social and occupational functioning.