Functional impairment and its associated factors in a working population with bipolar disorder
F. E. Boujmil, G. Bahri, Y. Yaich, G. Amri, Y. Tebourbi, K. Grissa, S. Chemingui, M. Mersni, D. Brahim, M. Bani, R. Ghachem, N. LadhariIntroduction
Bipolar disorder (BD) is commonly associated with a significant functional impairment across multiple domains. Even during euthymic phases, many individuals with BD exhibit deficits in cognitive, social and occupational functioning. These impairments are often under-diagnosed in clinical practice despite their strong association with relapse risk and long-term disability.
Objectives
To assess the overall functional impairment among working patients with BD using a validated questionnaire and to identify its main associated risk factors.
Methods
This cross-sectional study was conducted over a one-year period ( 2024–2025) among consenting patients with BD referred for fitness-for-work evaluation at Charles Nicolle Hospital in Tunisia. Socio-demographic, clinical and occupational data were collected via a self-administered questionnaire. Functional impairment was assessed using the Functioning Assessment Short Test (FAST), a 24-item clinician-rated scale covering six domains: autonomy, occupational functioning, cognitive functioning, financial management, interpersonal relationships, and leisure activities. Each item is scored on a four-point Likert scale, with a total score >11 indicating global functional impairment.
Results
A total of 106 patients were enrolled. The mean age was 43.8 ± 10.3 years with a gender ratio of 0.53 (F/H). Fifty six percent (n=59) were married and had at least one child. The majority had an average socio-economic status (72.6%). Among the patients, 41.5% (n=44) were active smokers and 12.3% (n=13) misused alcohol. The most common occupational categories were nurses (18.9%) and laborers (14.2%). The average length of service was 17.41 ± 8.7 years. Amid the patients, 33.9% (n=36) had atypical working hours. A history of long-term sick leave for psychiatric reasons was present in 88.7% of cases (n=94). More than half of the patients had type 2 BD (64.2%, n = 68) with an average age of onset of 29.7 ± 4.9 years. The mean number of mood episodes was 6.5 ± 3.5. The average length of hospitalization was 6.4 ± 14 days. The majority of patients (n=93, 86.9%) were receiving anticonvulsants and atypical antipsychotics. Good treatment compliance was observed in 73.6% of cases. The mean FAST score was 21,98 ± 8,20. More than threequarters of the patients (89,6%) had a global functional impairment. The most affected domains were occupational functioning (64,2%) and interpersonal relationships (63,2%). Univariate analysis has revealed statistically significant associations between higher FAST scores with gender (p = 0,02) and benzodiazepines use (p = 0,012).
Conclusions
These findings highlight the need for routine functional assessments and considered reducing benzodiazepine use and promoting targeted psychosocial interventions may help improve occupational functioning.
Disclosure of Interest
None Declared