Functional outcomes refer to aspects of general life and day-to-day function that may be impacted as a consequence of illness-related impairments. For example, symptom severity has been significantly associated with community functioning, including social functioning, work performance, and social skills. Impaired social cognition may impact on functional outcome in terms of maintaining efficient social interactions and independent living skills. Interventions to improve symptom severity or cognitive impairments may have additional benefit for general functional outcomes.

What is the evidence for functional outcomes in people with bipolar disorder?

Moderate quality evidence found only around 16% of people with bipolar disorder are estimated to function at a high level. There is less autonomy, poorer occupational, cognitive, financial, and interpersonal functioning, and fewer leisure activities reported in patients compared to people without the disorder.

High quality evidence finds poor cognitive ability across multiple domains is associated with poor general functioning. Moderate to low quality evidence finds a relationship between poor emotion identification and regulation and poor general functioning, particularly in people with more severe depressive symptoms.

November 2021

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Functional outcomes refer to aspects of general life and day-to-day functioning that may be impacted as a consequence of illness-related impairments. Impaired cognition may impact on such functional outcomes, and may vary across different cognitive domains and functional indicators. Interventions to improve cognitive impairments may have additional benefit for general functional outcomes.

What is the evidence for the relationship between cognition and functional outcomes?

High quality evidence suggests poor cognitive ability across multiple domains is associated with poor general functioning. Moderate to low quality evidence suggests a relationship between poor emotion identification and regulation and poor general functioning, particularly in people with more severe depressive symptoms. There was no relationship found between general functioning and mania symptoms.

September 2021

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Defeatist performance beliefs are over-generalised negative thoughts about one’s ability to successfully perform goal-directed behaviour. This prevents the initiation of and engagement in social and employment opportunities and therefore is considered a possible contributing factor to negative symptoms and poor functional outcomes.

Neurocognitive deficits in memory and attention for example may contribute to unsuccessful goal attainment, which over time can give rise to dysfunctional attitudes, including defeatist performance beliefs. These dysfunctional attitudes, in turn, may lead to a decrease in motivation for future goal-related activities, which may contribute to functional outcome deficits. Reduction in goal-directed behaviour reinforces further disengagement with the social world.

What is the evidence for defeatist performance beliefs?

High quality evidence suggests significant but small relationships between increased defeatist performance beliefs and worse negative symptoms and functional outcomes (e.g. general functioning, quality of life, life skills).

March 2022

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