Employment status is often indicative of the extent of functional ability in people with bipolar disorder. Low rates of employment places burden on social support and disability services, and on an individual’s quality of life. Employment outcomes involve rates of employment and factors that predict success in obtaining and retaining employment.

What is the evidence regarding employment?

Moderate to low quality evidence suggests around 40% to 60% of people with bipolar disorder are employed and have effective work functioning. However, around 40% to 50% report workplace under performance and see a decline in their occupational status over time.

Large associations were found between favourable employment outcomes and having better interpersonal functioning and not having a comorbid personality disorder. Medium-sized associations were found between favourable employment outcomes and having good cognitive functioning; in particular having good verbal learning, visual memory, verbal memory, concentration, insight about psychotic symptoms (if apparent), and executive functioning. Also having fewer psychiatric hospitalisations, less severe psychotic symptoms, less severe depression, high income, more years of education, shorter duration of illness, and being married predicted favourable employment outcomes. Small associations were found between favourable employment outcomes and being young, taking fewer psychotropic medications, having less severe symptoms in general, fewer electroconvulsive treatments, less rapid cycling, being Caucasian, being older at illness onset, being in a relationship (living together), and having independent housing. No significant associations were found between favourable employment outcomes and the severity of mania or negative symptoms, or for maternal education levels.

Moderate to low quality evidence finds a medium-sized, increased odds of being competitively employed following individual placement and support interventions compared to treatment as usual. However, there were no differences in the number of hours or weeks worked.

November 2021

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