Journal of affective disordersJan 10, 2017

How leftover depression, sleep problems, and thinking difficulties affect daily functioning in people with bipolar disorder

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 6, 2026

Abstract

A sample of 468 euthymic bipolar disorder patients revealed that residual depressive symptoms and perceived cognitive performance significantly relate to psychosocial functioning.

Residual depressive symptoms have a direct association with psychosocial functioning, with a path coefficient of 0.37.
Perceived cognitive performance also directly impacts psychosocial functioning, indicated by a path coefficient of 0.27.
Sleep disturbances are indirectly linked to psychosocial functioning through their relationship with residual depressive symptoms and perceived cognitive performance, with a path coefficient of 0.23.
The structural equation model demonstrated a good fit, suggesting a reliable framework for understanding these relationships.

Simplified

BACKGROUND: Many patients with bipolar disorder (BD) experience residual symptoms during their inter-episodic periods. The study aimed to analyse the relationship between residual depressive symptoms, sleep disturbances and self-reported cognitive impairment as determinants of psychosocial functioning in a large sample of euthymic BD patients.

METHODS: This was a cross-sectional study of 468 euthymic BD outpatients. We evaluated the residual depressive symptoms with the Bipolar Depression Rating Scale, the sleep disturbances with the Pittsburgh Sleep Quality Index, the perceived cognitive performance using visual analogic scales and functioning with the Functioning Assessment Short Test. Structural equation modelling (SEM) was used to describe the relationships among the residual depressive symptoms, sleep disturbances, perceived cognitive performance and functioning.

RESULTS: SEM showed good fit with normed chi square=2.46, comparative fit index=0.94, root mean square error of approximation=0.05 and standardized root mean square residuals=0.06. This model revealed that residual depressive symptoms (path coefficient =0.37) and perceived cognitive performance (path coefficient=0.27) were the most important features significantly related to psychosocial functioning. Sleep disturbances were indirectly associated with functioning via residual depressive symptoms and perceived cognitive performance (path coefficient=0.23).

CONCLUSIONS: This study contributes to a better understanding of the determinants of psychosocial functioning during the inter-episodic periods of BD patients. These findings should facilitate decision-making in therapeutics to improve the functional outcomes of BD during this period.

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How leftover depression, sleep problems, and thinking difficulties affect daily functioning in people with bipolar disorder

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