Relationship of Functionality with Impulsivity and Coping Strategies in Bipolar Disorder

Objective: In patients with bipolar disorder, functional losses may be observed even during remission of the disease, and psychopathological traits such as impulsivity, subthreshold clinical symptoms, or stigmatization may influence functionality. Coping strategies are defined as a person's attitudes towards daily life events and their adaptedness. This study aimed to investigate the effects of coping strategies and impulsivity on functionality in bipolar disorder and whether the effect of impulsivity is mediated by dysfunctional coping strategies. Method: This study was conducted with patients suffering from bipolar disorder (n=74) in remission and healthy controls (n=74) matched with the patient group in terms of age, gender and education. Patients were assessed using the Bipolar Disorder Functioning Questionnaire (BDFQ), Coping Strategies Inventory (COPE), Barratt Impulsiveness Scale-11 (BIS-11), Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YRMS) and Hamilton Anxiety Rating Scale (HAM-A). Results: The functionality score of the bipolar disorder group was significantly lower than in the healthy control group (p=0.027). Moreover, attention (p=0.020) and motor (p=0.006) impulsivity scores were higher and the maladaptive coping strategies score (p=0.032) was lower in the bipolar disorder group. The correlation between the total score of the BIS and the maladaptive coping strategies subscale of the COPE in the bipolar disorder group was statistically significant (r=0.38, p<0.01). Hierarchical multiple regression analysis showed that adaptive coping strategies (B=0.23, p=0.020), attention (B=-0.31, p=0.037), motor (B=0.29, p=0.027) and nonplanning (B=-0.35, p=0.003) impulsivity were the determinants of the functionality in the regression model (F=8.44, p<0.001). Conclusion: The study has detected that functionality is affected negatively by impulsivity and positively by adaptive coping strategies in bipolar disorder, whereas the effect of coping strategies on functionality is not mediated by impulsivity. While there was a correlation between impulsivity and maladaptive coping strategies, there was no mediation between impulsivity and coping strategies, which may suggest that these dimensions are independent from each other. Prospective studies with large sample sizes should investigate the clinical determinants of functional losses in the future.