The Role of Diabetes in Predicting Employment Status for Individuals with Bipolar Disorder

Background and Purpose:  Current data cite the increasing prevalence of diabetes among adults with a mental illness.  Research suggests diabetes is related to worse outcomes in terms of hospitalization and health-status for this population.  One of the Grand Challenges for Social Work is to create greater health equity, including the cumulative effects of poverty and race on health outcomes. Social selection theory suggests that adults with bipolar disorder and diabetes may experience worse social and economic outcomes, particularly for minorities and those living in poverty.  Social workers employed at Community Mental Health Centers (CMHC) frequently engage in goal-setting with clients regarding employment, and predominately serve low-income individuals.  While research on clinical, cognitive, and educational factors associated with employment exists, there is a dearth of literature exploring the relationship between diabetes and employment for those with mental illnesses.  The aim of this study is to explore the association between diabetes and employment status for individuals with bipolar disorder.

Methods:  This study used the Sample Adult File from the 2012 National Health Interview Survey (NHIS), which consisted of approximately 42,000 households. The Sample Adult file contains health-related data from a randomly selected adult in each household.  The sample for this study consisted of 748 individuals between 18-69 years of age who self-reported a diagnosis of bipolar disorder.  The outcome variable used was employment status the prior week.  The variable of interest was self-reported diagnosis of diabetes or prediabetes.  Using SPSS, descriptive statistics were completed and the variables were entered into a logistic regression model with the following covariates:  sex, race, age, marital status, activity limitation, and income. 

Results:  About 17% of the sample reported diagnoses of diabetes or prediabetes and 69% were unemployed the prior week.  Results indicated that individuals with a diagnosis of bipolar disorder, and comorbid diabetes, are almost 2.5 times more likely to be unemployed (OR=2.431, p<.01).  Additionally, individuals with an activity limitation were nearly 3.5 times more likely to be unemployed compared to bipolar adults without a limitation (OR=3.495, p<.001).  Regarding race, Whites were 62% less likely to be unemployed than Blacks (OR=.381, p<.01).  Finally, adults with bipolar disorder with an income under $35,000 were about 2 times more likely to be unemployed the prior week than those making over $35,000 (OR=1.9, p<.05).

Conclusion and Implications:  Results indicate diabetes increases the likelihood an individual with bipolar disorder will be unemployed.  Race and income are also significantly related to employment for adults with bipolar disorder.  This suggests that diabetes may impact employment outcomes for individuals with bipolar disorder served at a CMHC.  When working with clients with bipolar disorder on employment goals, social workers should assess for chronic health conditions, such as diabetes.  Further research is needed to expand on these results and understand disparities related to employment for bipolar adults with diabetes.  It is imperative social workers promote a research agenda investigating the association between mental illness, chronic health conditions and psychosocial outcomes to improve treatment outcomes, quality of life, and health equity for at-risk clients.