Work impairment in bipolar disorder compared to the healthy population: a systematic review

Bipolar disorder is a chronic condition that has been insufficiently explored in terms of its predictors of work impairment and its long-term impact on employment. This study aims to compare work impairment in individuals with bipolar disorder to that of a healthy population. A systematic review of the scientific literature was conducted by using PubMed/MEDLINE, SciELO, and PsycINFO databases. Search terms used were: ("bipolar") and ("work" or "occupational"), with a publication date restriction from 2013 to 2023. A total of 20 articles were selected. All included assessments of employability and work performance using work-specific scales or scales containing work-related items. Most studies showed that a diagnosis of bipolar disorder, along with its long-term effects on behavior, neurocognition, emotional regulation, decision-making, sustained attention, volition, and interpretation of interpersonal events, significantly increases susceptibility to unemployment and dependence on government assistance. Even during periods of clinical stability, maintaining employment at levels comparable to healthy individuals remains highly challenging. Furthermore, the impact of bipolar disorder on employment outcomes appears to be distinct from that of major depressive disorder, schizoaffective disorder, and schizophrenia. Clinical studies consistently indicate that bipolar disorder severely compromises both employability and work performance. However, few effective interventions for improving employability and productivity in this population are currently available.