Bipolar Disorder in the Working Population: The Occupational Health Nurse’s Role

Bipolar disorder (BD) among workers is an understudied phenomenon. Bipolar disorder is a mood disorder defined by chronic, extreme, cyclical mood and perception vacillations called mania, hypomania, and depression. Bipolar disorder affects approximately eight million U.S. adults (Nierenberg et al., 2023). High-stress jobs and shift work may increase mood episode risks (Rathbun-Grubb, 2019). In addition, workers with BD face high rates of unemployment, absenteeism, presenteeism, financial instability, interpersonal conflict, substance misuse, and “job hopping” (Dominiak et al., 2022; Rathbun-Grubb, 2019). Dire consequences of poorly managed BD may include suicide, hospitalization, and incarceration (Bessonova et al., 2020; Dominiak et al., 2022; Miller & Black, 2020).

Bipolar disorder management includes medication, psychotherapy, sleep hygiene, and stress avoidance (Nierenberg et al., 2023). Workers with well-managed BD can thrive in the workplace. However, workers may avoid treatment and disclosing their condition due to stigma despite protection from the Americans With Disabilities Act (ADA). Under the ADA, which has protected individuals with disabilities since 1990, employers must provide reasonable accommodations, such as modified breaks, flexible work schedules, and employee assistance programs. Additional supportive measures like financial counseling, flexible job duties, and workplace training can also be beneficial (Follmer et al., 2024; Gignac et al., 2023).

Occupational health nurses can lead BD awareness efforts within the workplace. Staying current with amendments to the ADA ensures that employers meet reasonable accommodation requirements. Understanding common medications used to manage BD is also crucial because many BD medications can lead to “brain fog” and slower reaction times, which may be misconstrued as substance misuse (Gignac et al., 2023). In addition, occupational health nurses are uniquely positioned as first points of contact for undiagnosed workers. Learning traditional signs and symptoms of BD, along with how they may present in a work environment, is crucial to ensuring the employee receives prompt care. Subtle signs that someone may be struggling with BD include a history of frequent job changes, consistent conflicts with co-workers or leadership, and cyclical exemplary performance alternating with poor performance (Rathbun-Grubb, 2019).

Depending on a company’s policies and procedures, the occupational health nurse may mediate communications between employees and their external medical providers, alerting them to workplace concerns. Occupational health nurses are integral in fostering an inclusive environment and facilitating educational programs among leadership, such as the Mental Health Awareness Training through the Substance Abuse and Mental Health Services Administration (2023). With proper medical management and supportive workplaces, employees with BD can excel in a variety of job roles.