Factors linked to relapse risk in bipolar disorder identified

By Mark Cowen

A higher number of previous mood episodes and living in a mixed urban/rural area are associated with an increased risk for relapse in patients with bipolar disorder, Spanish researchers report.

The team suggests that restricted access to healthcare services may explain the increased risk for relapse among patients living in mixed urban/rural areas.

Consuelo de Dios (University Hospital La Paz, Madrid) and team investigated factors associated with relapse over a 12-month period among 595 bipolar disorder patients (59.9% women), aged at least 18 years, who were in remission at baseline.

In total, 141 (23.8%) patients experienced a mood episode during the follow-up period, of whom 66 experienced an episode of depression, 66 an episode of mania, and nine a mixed episode.

Patients who experienced a relapse were more likely to have a severe disability at baseline, to be out of work, to live in a mixed urban/rural catchment area, to have initial depressive polarity, and to have experienced more previous affective episodes than those who did not relapse.

After accounting for sociodemographic and clinical characteristics, logistic regression analysis revealed that environment and the number of previous affective episodes significantly predicted risk for affective recurrence.

Specifically, patients living in mixed urban/rural catchment areas were 1.57 times more likely to relapse than those living in cities of more than 100,000 residents.

And the risk for relapse increased 1.03-fold with each previous affective episode.

The researchers also found that patients with a severe disability and those from mixed urban/rural catchment areas had a significantly shorter time to relapse than other patients.

The researchers conclude in the Journal of Affective Disorders: "Our study suggests that health care access, occupational functioning, and the previous course of the disease are critical features to predict the course and outcome of bipolar disorder."

They add that the findings indicate "potential pathways to improve the effectiveness of secondary prevention policies for this condition."

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