Psychosocial functional recovery in patients with bipolar disorder in remission: Which symptoms hold them back?

Subthreshold depressive symptoms significantly hinder functional recovery in bipolar disorder (BD). While most studies use a global score to assess the impact of these symptoms on functioning, this study examines which specific subthreshold depressive symptoms mostly impede functional recovery in patients with BD in remission.

The sample comprised a total of 413 patients with BD. Subthreshold depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAM-D), and psychosocial functioning was measured with the Functioning Assessment Short Test (FAST). Bivariate analyses were performed to identify items from the HAM-D as well as other clinical and demographic variables associated with functional impairment. Multivariate linear regression analyses were conducted including the variables that demonstrated significant associations in the bivariate analyses.

The linear regression model for the FAST total score demonstrated that "psychomotor retardation" (item 8) had the strongest association on psychosocial functioning (β = 6,9; p < 0,001), followed by "feelings of guilt" (item 2) (β = 5,75; p < 0,001) "work and activities" (item 7) (β = 5,38; p < 0,001) and "somatic anxiety" (item 11) (β = 3,45; p < 0,001). Other significant clinical variables included antipsychotic use, older age, fewer years of education and male sex. This model explained 39,6% of the variance in the FAST total score (R² = 0,396; Adjusted R² = 0,375; F_(399,13) = 20,04; p < 0,001).

Specific subthreshold symptoms, including psychomotor retardation, apathy, guilt and somatic anxiety significantly influence psychosocial functioning. These findings highlight the importance of specifically targeting these symptoms to achieve functional recovery, even when patients are clinically stable.