Workplace productivity, employment issues, and resource utilization in patients with bipolar I disorder

Figures & data

Table 1. Demographic and clinical characteristics of the study sample.

Characteristic	Bipolar group	Normative group	p-value
	n=219	n=198
Age at enrollment
Mean±SD, years	39.6±10.9	39.4±10.6	0.877
Median age (range), years	40 (19–63)	38 (18–64)
Age category, n (%)
18–29 years	54 (24.7)	37 (18.7)	0.140
30–39 years	54 (24.7)	66 (33.3)	0.051
40–49 years	64 (29.2)	59 (29.8)	0.898
≥50+ years	47 (21.5)	36 (18.2)	0.402
Gender, n (%)
Male	69 (31.5)	60 (30.3)	0.791
Female	150 (68.5)	138 (69.7)
Race, n (%)
White	190 (86.8)	153 (77.3)	0.011
Black	16 (7.3)	30 (15.2)	0.011
American Indian/Native American	3 (1.4)	1 (0.51)	0.366
Asian	3 (1.4)	2 (1.01)	0.736
Native Hawaiian/Pacific Islander	0 (0)	1 (0.51)	0.292
Other	9 (4.1)	11 (5.6)	0.490
Mixed race	1 (0.5)	0 (0)	0.341
Highest level of education
Some high school	9 (4.1)	7 (3.5)	0.760
High school graduate	45 (20.6)	42 (21.2)	0.868
Some college, no degree	68 (31.1)	57 (28.8)	0.615
Associate degree	33 (15.1)	28 (14.1)	0789
Bachelor's degree	45 (20.6)	43 (21.7)	0.770
Master's degree or higher	19 (8.7)	21 (10.6)	0.504
Employer-sponsored health care coverage, n (%)
Yes	108 (49.3)	137 (69.2)	< 0.001
No	111(50.7)	61 (30.8)
History of medical condition, n (%)
Cancer	7 (3.2)	6 (3.0)	0.922
Hypertension	44 (20.1)	35 (17.7)	0.530
Hypercholesterolemia	26 (11.9)	25 (12.6)	0.814
Cardiovascular disease	3 (1.4)	5 (2.5)	0.390
Diabetes	15 (6.9)	5 (2.5)	0.039
Arthritis	21 (9.6)	16 (8.1)	0.589
Autoimmune disorders	2 (0.9)	5 (2.5)	0.201
Neurologic disorders	7 (3.2)	1 (0.5)	0.045
Epilepsy or other seizure	2 (0.9)	1 (0.5)	0.622
Other	33 (15.1)	24 (12.1)	0.382
At least one medical condition	96 (43.8)	81 (40.9)	0.546
History of psychiatric condition, n (%)*
Any psychiatric condition	139 (63.5)	20 (10.1)	< 0.001
No psychiatric condition	79 (36.1)	178 (89.9)	< 0.001
Receiving medication for any psychiatric condition other than bipolar disorder	22 (10.1)	5 (2.5)	0.002

*Other psychiatric conditions include unipolar depression, generalized anxiety disorder, obsessive compulsive disorder, attention deficit disorder, alcohol abuse or alcoholism, substance abuse or addiction, borderline personality disorder, posttraumatic stress disorder, panic disorder, and anorexia, bulimia, or other eating disorder.

Table 2. Results from Endicott Workplace Productivity Scale.

Productivity	Bipolar group n=219	Normative group n=198	p-value
Overall score
n	177	178
Mean±SD	37.2±19.2	15.8±11.1	< 0.001
Range	2.1–84.0	0.0–70.0
Cronbach's alpha	0.94	0.91
Hours of work
Usual number of hours per week
n	180	180
Mean±SD	39.3±12.5	41.8±11.6	0.051
Range	4.0–90.0	0.0–95.0
Number of hours worked during the previous week
n	180	180
Mean±SD	35.9±15.4	40.4±15.3	0.005
Range	0.0–85.0	0.0–95.0

Table 3. Results from employment questions.

Question asked of participants	Bipolar group n=219		Normative group n=198		p-value
	Valid n	n answering ‘yes’ (%)	Valid n	n answering ‘yes’ (%)
Are you working a reduced schedule for pay for a medical reason?	170	21 (12.4)	170	4 (2.4)	< 0.001
Are you working a reduced schedule for pay for a mental health reason?	174	40 (23.0)	173	0 (0)	< 0.001
Have you ever been fired from a job or laid off?	219	145 (66.2)	198	77 (38.9)	< 0.001
If yes, was this because your supervisor was not happy with your work, behavior, or mental attitude?	142	100 (70.4)	74	14 (18.9)	< 0.001
Have you received short- or long-term disability benefits for a medical reason?	218	73 (33.5)	198	42 (21.2)	0.005
Have you received workers' compensation benefits for any reason?	218	44 (20.2)	197	29 (14.7)	0.144
Have you been in jail, arrested, or convicted of a crime other than drunk driving?	219	64 (29.2)	198	14 (7.1)	< 0.001

Table 4. Results from patient-reported resource utilization questions.

Resource utilization	Bipolar group n=219	Normative group n=198	p-value
Number of visits to a psychiatrist in the previous 30 days
n	218	198
Mean±SD	1.7±1.5	0.08±0.40	< 0.001
Range	0–11	0–3
Number of visits to other physicians in the previous 30 days
n	215	198
Mean±SD	1.2±1.6	1.3±1.1	0.413
Range	0–9	0–9
Number of visits to a psychotherapist in the previous 30 days
n	218	198
Mean±SD	0.7±1.6	0.1±0.3	< 0.001
Range	0–14	0–2
Number of visits to an emergency department in the previous 30 days
n	218	198
Mean±SD	0.1±0.5	0.1±0.3	0.027
Range	0–3	0–2

Table 5. Comparison of survey administration modes.

Measure	Statistic	Telephone n=204	Internet n=213	p-value
Study cohort
Bipolar I disorder	n (%)	120 (58.82)	99 (46.48)	0.012
Normative	n (%)	84 (41.18)	114 (53.52)
Gender
Male	n (%)	72 (35.29)	57 (26.76)	0.059
Female	n (%)	132 (64.71)	156 (73.24)
Age	Mean±SD	40.3±10.85	38.6±10.55	0.061
Education
High school or less	n (%)	53 (25.98)	50 (23.47)	0.553
Some college	n (%)	151 (74.02)	163 (76.53)
EWPS score	Valid n	176	179
	Mean score±SD	24.3±15.8	28.6±21.5	0.032

EWPS indicates Endicott Workplace Productivity Scale.

Table 6. Regression analysis: EWPS results including significant interaction terms (n=417)

Variable	Coefficient (β)	p-value
Intercept	15.64
Bipolar I group (vs. normative)	12.45	0.028
Age	–0.10	0.20
Male (vs. female)	2.20	0.21
Nonwhite race (vs. white race)	3.18	0.13
Some college (vs. high school or less)	1.85	0.479
Internet survey (vs. telephone survey)	5.99	0.94
At least one medical condition (vs. no medical condition)*	3.16	0.06
History of medication use (vs. no medication use)^†	3.21	0.11
Interaction: bipolar I group and some college	–13.91	< 0.001
Interaction: bipolar I group and Internet survey	12.41	< 0.001

*Medical conditions include cancer, hypertension, hypercholesterolemia, cardiovascular disease, diabetes, arthritis, autoimmune disorder, neurological disorder, epilepsy, or other seizure disorders.

^†Medications include antidepressants, benzodiazepine or other antianxiety medications, hypnotics, and other medications not including antimanics. EWPS indicates Endicott Workplace Productivity Scale.