Bipolar disorder, self-stigma and functioning: a cross-sectional study conducted among a working population in Tunis

Bipolar disorder (BD) is a chronic illness that primarily affects working age patients. Even during clinical remission periods, it is often accompanied by impaired functioning. Its progression can be marked by the onset of self-stigma, a widely underestimated phenomenon, particularly in the workplace. This study aims to determine the prevalence of self-stigma among working patients with BD, to identify the associated socio-occupational and clinical factors and to assess its correlation with functioning. This was a cross-sectional analytical study conducted among 106 patients with BD who were recruited as part of a medical examination to determine their fitness for work. Self-stigma was assessed using the Internalised Stigma of Mental Illness (ISMI) scale. The Functioning Assessment Short Test (FAST) was used to study functioning. The average age of patients was 43.8 years, with a gender ratio of 0.53. The average ISMI score was 2.58 ± 0.87. Nearly 57% of patients were self-stigmatised. The functional assessment revealed overall impairment in the majority of patients (89.6%). Occupational (64.2%) and cognitive functioning (50%) were the most affected. The average ISMI score was significantly higher in patients under the age of 40 years, females, single or divorced, and with a low income. Similarly, the average self-stigma score was associated with atypical working hours, early onset of BD and the lack of cognitive behavioural therapy. Higher self-stigma scores were significantly associated with greater overall functional impairment, particularly related to perceived discrimination and social withdrawal. The high prevalence of self-stigma and its association with impaired functioning observed in our population highlights the need to address contributing factors, particularly in the workplace, in order to maintain employment and limit its adverse impact on the progression of BD.