Study of Association of Social Functioning with Stress, Insight, and Illness Variables in Patients with Bipolar Disorder in Remission

Background: Bipolar disorder is characterized by incomplete remission of notable proportion of symptoms, leading to impairment of functioning at work, social and family levels, even during the periods of remission. Not all studies have found direct correlation between various illness variables and functioning. There has also been a dearth of adequate Indian literature regarding the impact of insight and perceived stress on social functioning of remitted bipolar patients. Aims: To study stress, insight, and various illness variables in patients with bipolar disorder in remission and association of these factors with social functioning. Methods: Fifty patients with bipolar disorder, of age 18 years and above and illness duration at least 2 years, without any other psychiatric or medical comorbidities and satisfying the DSM-5 criteria of being in full remission were selected for the study. Social functioning of the participants was measured using the Social Functioning Scale (SFS). The SFS scores were compared with respect to their Perceived Stress Scale (PSS) and Mood Disorders Insight Scale (MDIS) scores and with various illness variables. SPSS software version 22.0 was applied for the statistical analysis. Data obtained were analyzed using unpaired-‘t’ and Pearson correlation tests. Results: Statistically significant positive correlation was obtained between mean SFS and mean total MDIS scores. A negative correlation was obtained between mean SFS and PSS scores, although statistically not quite significant. Among illness variables, the difference in social functioning for age at illness onset up to 30 years and that for more than 30 years was found to be statistically extremely significant, with later age at onset having poorer functioning. Conclusions: Patients with bipolar disorder having better insight have better social functioning. Even when in remission, they lead a “moderately stressful” life and the impairment in social functioning seems to worsen with increase in their stress levels. Compared to other variables, age at illness onset was found to best predict functioning. Our findings suggest that social impairment must be an important treatment target, besides symptom reduction and relapse prevention in bipolar disorder. A holistic approach, including awareness programs, stigma reduction, intensive psychosocial interventions, and vocational rehabilitation, would be the way forward to enhance the social outcomes.