The Relationship Between Theory of Mind, Executive Functions, and Quality of Life in Patients with Bipolar I Disorder: A Comparative Cross-sectional Study

Tayebi, Batoul; Omidi, Ebrahim; Amiri Sararoodi, Parinaz Sadat; Mousavi, Seyedeh Elnaz; Rasouli, Amirhossein; Nejad-Ebrahim Soumee, Zahra; Sarani Yaztappeh, Jafar

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Journal of Semnan University of Medical Sciences

e-ISSN 2345-3699

p-ISSN 1608-7046

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https://doi.org/10.69107/koomesh-161244

The Relationship Between Theory of Mind, Executive Functions, and Quality of Life in Patients with Bipolar I Disorder: A Comparative Cross-sectional Study

Authors

Batoul Tayebi

¹, Ebrahim Omidi

², Parinaz Sadat Amiri Sararoodi

¹, Seyedeh Elnaz Mousavi

¹, Amirhossein Rasouli

¹, Zahra Nejad-Ebrahim Soumee

¹, Jafar Sarani Yaztappeh

^3,*

1Department of Clinical Psychology, Zanjan University of Medical Sciences, Zanjan, Iran

2Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

3Department of Psychiatry, Clinical Research Development Unit, 22 Bahman Hospital, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran

*Corresponding Author: Department of Psychiatry, Clinical Research Development Unit, 22 Bahman Hospital, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Email: sarani.jafar@yahoo.com

Koomesh:Vol. 28, issue 1; e161244

Published online:Apr 05, 2026

Article type:Research Article

How to Cite:Tayebi B, Omidi E, Amiri Sararoodi PS, Mousavi SE, Rasouli A, et al. The Relationship Between Theory of Mind, Executive Functions, and Quality of Life in Patients with Bipolar I Disorder: A Comparative Cross-sectional Study. Koomesh. 2026;28(1):e161244. doi: https://doi.org/10.69107/koomesh-161244

Abstract

Background: Bipolar disorder (BD) is a significant global cause of disability, with substantial socioeconomic burdens. Cognitive impairments, including deficits in executive functions, theory of mind (ToM), and emotional regulation, have been widely documented in individuals with BD.

Objectives: The present study aimed to compare the relationship between ToM, executive functions, and quality of life (QoL) in individuals with BD type I and healthy controls.

Methods: This cross-sectional study was conducted using convenience sampling. The study population included individuals diagnosed with BD type I in Zanjan province, confirmed by psychiatrists and clinical psychologists. A total of 50 patients with BD type I and 50 healthy controls participated. Participants' executive functions, ToM, and emotional regulation were evaluated using the Reading the Mind in the Eyes Test, Go/No-Go Task, Balloon Analogue Risk Task, Wisconsin Card Sorting Test, and the Difficulties in Emotion Regulation Scale.

Results: The Wilks' Lambda test indicated a significant effect of group differences on the dependent variables, explaining 59% of the variance (F = 9.01, P < 0.001). Significant differences were found between the BD and control groups in all components of emotional regulation difficulties except for emotional awareness (P < 0.05). The BD group exhibited significantly lower ToM scores (F = 76.62, P < 0.001).

Conclusions: Individuals with BD type I demonstrate significant impairments in executive functions, ToM, and QoL compared to healthy controls. These findings underscore the significance of ToM deficits as an impactful feature of BD-I, which significantly affects quality of life, social relationships, and executive functioning. Therefore, addressing these deficits could contribute to improving treatments and enhancing the quality of life for BD-I patients.

Highlights

KeywordsBipolar Disorder Type I, Theory of Mind, Executive Functions, Quality of Life, Risky Decision-Making, Emotion Regulation, Cognitive Flexibility

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© 2026, Author(s). This open-access article is available under the Creative Commons Attribution 4.0 (CC BY 4.0) International License (https://creativecommons.org/licenses/by/4.0/), which allows for unrestricted use, distribution, and reproduction in any medium, provided that the original work is properly cited.

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The Relationship Between Theory of Mind, Executive Functions, and Quality of Life in Patients with Bipolar I Disorder: A Comparative Cross-sectional Study

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