Relationships between cognition and daily functioning in adults with bipolar disorder: A systematic review and multilevel meta-analysis

Amanda McCleery; Gerhard Stefan Hellemann; Junghee Lee

doi:10.1037/bul0000509

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Relationships between cognition and daily functioning in adults with bipolar disorder: A systematic review and multilevel meta-analysis

Journal article

Open access

Peer reviewed

Relationships between cognition and daily functioning in adults with bipolar disorder: A systematic review and multilevel meta-analysis

Amanda McCleery, Gerhard Stefan Hellemann and Junghee Lee

Psychological bulletin, Vol.152(3), pp.326-348

03/2026

DOI: 10.1037/bul0000509

PMID: 42207659

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Abstract

Cognitive impairment is a common, yet underrecognized, feature of bipolar disorder (BD). While cognition has emerged as a contributing factor to poor functioning in BD, previous reviews did not examine the role of cognitive domains (i.e., social cognition, nonsocial cognition) or the role of key potential moderators, including age and sex. A systematic literature search identified studies that included assessments of cognition and functioning in BD (103 reports, 2,200 effect sizes, 9,323 BD participants). Multilevel models tested the association between cognition and functioning, as well as moderation by cognitive domain, functional domain, biological factors, and clinical factors. Better overall cognitive performance was associated with better overall functioning (r = .20, p < .001). In contrast to the schizophrenia literature, nonsocial cognition was more strongly related to functioning (r = .21, p < .001) than social cognition (r = .16, p < .001). The magnitude of the relationship differed across cognitive and functional domains and was moderated by age, sex, clinical factors, and risk of bias. Social and nonsocial cognition make small, but statistically significant, contributions (i.e., 4% variance) to daily functioning in people with BD. This finding supports cognition as a viable treatment target to improve functioning in BD, with appropriate consideration of key moderators. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Activities of Daily Living

Adult

Bipolar Disorder - complications

Bipolar Disorder - physiopathology

Bipolar Disorder - psychology

Cognition

Cognitive Dysfunction - etiology

Cognitive Dysfunction - physiopathology

Female

Humans

Male

Social Cognition

Details

Title: Subtitle: Relationships between cognition and daily functioning in adults with bipolar disorder: A systematic review and multilevel meta-analysis
Creators: Amanda McCleery - University of Manitoba
Gerhard Stefan Hellemann - University of Alabama at Birmingham
Junghee Lee - University of Alabama at Birmingham
Resource Type: Journal article
Publication Details: Psychological bulletin, Vol.152(3), pp.326-348
DOI: 10.1037/bul0000509
PMID: 42207659
ISSN: 0033-2909
eISSN: 1939-1455
Publisher: AMER PSYCHOLOGICAL ASSOC
Grant note: National Institute of Mental Health; National Institutes of Health
Language: English
Date published: 03/2026
Academic Unit: Psychological and Brain Sciences; Iowa Neuroscience Institute
Record Identifier: 9985166832302771

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