Labor market marginalization in individuals with bipolar disorder: a Swedish nationwide register-based sibling comparison study.

Background: There is a lack of large-scale studies exploring labor market marginalization (LMM) among individuals diagnosed with bipolar disorder (BD). We aimed to investigate the association of BD with subsequent LMM in Sweden, and the effect of sex on LMM in BD.

Methods: Individuals aged 19-60 years living in Sweden with a first-time BD diagnosis between 2007 and 2016 (n = 25 231) were followed from the date of diagnosis for a maximum of 14 years. Risk of disability pension (DP), long-term sickness absence (SA) (>90 days), and long-term unemployment (>180 days) was compared to a matched comparison group from the general population, matched 1:5 on sex and birth year (n = 126 155), and unaffected full siblings (n = 24 098), using sex-stratified Cox regression analysis, yielding hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: After adjusting for socioeconomic factors, baseline labor market status, and comorbid disorders, individuals with BD had a significantly higher risk of DP compared to the general population (HR = 16.67, 95% CI 15.33-18.13) and their unaffected siblings (HR = 5.54, 95% CI 4.96-6.18). Individuals with BD were also more likely to experience long-term SA compared to the general population (HR = 3.19, 95% CI 3.09-3.30) and their unaffected siblings (HR = 2.83, 95% CI 2.70-2.97). Moreover, individuals diagnosed with BD had an elevated risk of long-term unemployment relative to both comparison groups (HR range: 1.75-1.78). Men with BD had a higher relative risk of SA and unemployment than women. No difference was found in DP.

Conclusions: Individuals with BD face elevated risks of LMM compared to both the general population and unaffected siblings.