Labor market marginalization in individuals with bipolar disorder – effect of treatment and the COVID-19 pandemic

Bipolar disorder (BP) is a common cause of disability in the working population worldwide.

BP often leads to different types of exclusion and inequality and people with BP face a higher risk of labor market marginalization (LMM), characterized by unemployment, sickness absence, and disability pension.

Still, knowledge on pathways to LMM as well as the role of treatment and individual factors in determining these pathways is limited to date.

Moreover, the impact of a severe public health crisis as the current COVID-19 pandemic on treatment and wellbeing of patients with BP is unknown.The overall aim is to characterize patterns and pathways to LMM in individuals with BP.

We will investigate how pharmacotherapy for BP impacts LMM, and assess the role of comorbidity, socioeconomic and work-related factors.

Last, we will examine if there are differences in LMM, health care utilization, treatment and suicide attempt in patients with BP before compared to during/after the COVID-19 outbreak in Sweden and Finland, two countries with different regulations to handle the pandemic.The studies build on linked register data and include 53,352 persons, diagnosed with BP during 2006-2016.

In studies related to COVID-19, the Swedish cohorts will comprise individuals with a BP diagnosis in 2007-2011 (n=28,117) and 2015-2019 (n=35,412) respectively. Similar Finnish cohorts will include 25,336 and 32,128 persons, respectively. Health and social development will be compared in both countries in a period of 2012-2014 to 2020-2022.

By using advanced methodological approaches with respect to both design choice and analytical strategies, this project offers not only a cross-national value, but will also contribute substantially with detailed information on identifying potential mechanisms that lead to exclusion and inequality of people with BP.

This will in turn provide crucial knowledge for the design of tailor-made intervention for vulnerable individuals with severe functional impairment.