Social adjustment and the course of affective illness: a one-year controlled longitudinal study involving bipolar and unipolar outpatients

The association between social adjustment and recurrent affective episodes was examined in 27 recovered bipolar patients and 24 recovered unipolar patients who had been receiving maintenance treatment for at least 1 year. Social adjustment variables and psychiatric status were assessed by bimonthly interviews over the 1-year period using the Social Adjustment Scale (SAS) and the Research Diagnostic Criteria (RDC). Variations in the social adjustment scores were analyzed in the 2 months preceding the onset of a recurrent affective episode. Furthermore, social adjustment variables at entry into the study were assessed to investigate whether there was any association between these and the potential timing of a recurrent episode. Results revealed no significant deterioration in social adjustment during the 2 months preceding a recurrent affective episode. However, it was demonstrated that there was a relationship between a patient's overall social adjustment score at entry into the study and the onset of recurrent affective episodes, independent of any residual depressive symptomatology. Specifically, impaired work adjustment in bipolar and unipolar patients was associated with recurrent episodes. Impaired social and leisure activities adjustment in bipolar patients was also associated with recurrent episodes, and impaired marital adjustment in unipolar patients was associated with recurrent episodes. These results suggest that social maladjustment could be a risk factor for both unipolar and bipolar recurrent affective episodes and that impairment in specific areas of social functioning could be used to predict outcome.