Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-30T16:18:05.812Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of current anxiety disorders in people with bipolar disorder during euthymia: a meta-analysis

Published online by Cambridge University Press:  20 December 2016

B. Pavlova ,
R. H. Perlis ,
O. Mantere ,
C. M. Sellgren ,
E. Isometsä ,
P. B. Mitchell ,
M. Alda  and
R. Uher
B. Pavlova*
Affiliation:
Nova Scotia Health Authority, Halifax, Nova Scotia, Canada Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
R. H. Perlis
Affiliation:
Department of Psychiatry, Harvard Medical School, Boston, MA, USA
O. Mantere
Affiliation:
Douglas Mental Health University Institute, Montréal, Québec, Canada McGill University, Montréal, Québec, Canada
C. M. Sellgren
Affiliation:
Department of Psychiatry, Harvard Medical School, Boston, MA, USA Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
E. Isometsä
Affiliation:
Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
P. B. Mitchell
Affiliation:
University of New South Wales, School of Psychiatry, Sydney, Australia Black Dog Institute, Sydney, New South Wales, Australia
M. Alda
Affiliation:
Nova Scotia Health Authority, Halifax, Nova Scotia, Canada Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
R. Uher
Affiliation:
Nova Scotia Health Authority, Halifax, Nova Scotia, Canada Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
*
*Address for correspondence: B. Pavlova, Department of Psychiatry, Dalhousie University, Mood Disorders Program, 5909 Veterans’ Memorial Lane, Halifax, B3H 2E2, NS, Canada. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Anxiety disorders are highly prevalent in people with bipolar disorder, but it is not clear how many have anxiety disorders even at times when they are free of major mood episodes. We aimed to establish what proportion of euthymic individuals with bipolar disorder meet diagnostic criteria for anxiety disorders.

Method

We performed a random-effects meta-analysis of prevalence rates of current DSM-III- and DSM-IV-defined anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, specific phobia, obsessive–compulsive disorder, post-traumatic stress disorder, and anxiety disorder not otherwise specified) in euthymic adults with bipolar disorder in studies published by 31 December 2015.

Results

Across 10 samples with 2120 individuals with bipolar disorder, 34.7% met diagnostic criteria for one or more anxiety disorders during euthymia [95% confidence interval (CI) 23.9–45.5%]. Direct comparison of 189 euthymic individuals with bipolar disorder and 17 109 population controls across three studies showed a 4.6-fold increase (risk ratio 4.60, 95% CI 2.37–8.92, p < 0.001) in prevalence of anxiety disorders in those with bipolar disorder.

Conclusions

These findings suggest that anxiety disorders are common in people with bipolar disorder even when their mood is adequately controlled. Euthymic people with bipolar disorder should be routinely assessed for anxiety disorders and anxiety-focused treatment should be initiated if indicated.

Keywords

Anxiety disordersbipolar disorderco-morbidityeuthymiameta-analyses
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 6 , April 2017 , pp. 1107 - 1115
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agnew-Blais, J, Danese, A (2016). Childhood maltreatment and unfavourable clinical outcomes in bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry 3, 342–349.Google Scholar
Albert, U, Rosso, G, Maina, G, Bogetto, F (2008). Impact of anxiety disorder comorbidity on quality of life in euthymic bipolar disorder patients: differences between bipolar I and II subtypes. Journal of Affective Disorders 105, 297–303.CrossRefGoogle ScholarPubMed
Baxter, AJ, Scott, KM, Vos, T, Whiteford, HA (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological Medicine 43, 897–910.CrossRefGoogle ScholarPubMed
Bender, RE, Alloy, LB, Sylvia, LG, Urosevic, S, Abramson, LY (2010). Generation of life events in bipolar spectrum disorders: a re-examination and extension of the stress generation theory. Journal of Clinical Psychology 66, 907–926.Google Scholar
Birmaher, B, Kennah, A, Brent, D, Ehmann, M, Bridge, J, Axelson, D (2002). Is bipolar disorder specifically associated with panic disorder in youths? Journal of Clinical Psychiatry 63, 414–419.CrossRefGoogle ScholarPubMed
Boylan, KR, Bieling, PJ, Marriott, M, Begin, H, Young, LT, MacQueen, GM (2004). Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder. Journal of Clinical Psychiatry 65, 1106–1113.Google Scholar
Bradburn, MJ, Deeks, JJ, Altman, DG (2009). Meta-analysis in Stata: metan, metacum and metap. In Meta-analysis in Stata (ed. Sterne, JAC, Newton, HJ and Cox, NJ). Stata Press: College Station, TX.Google Scholar
Coryell, W, Fiedorowicz, JG, Solomon, D, Leon, AC, Rice, JP, Keller, MB (2012). Effects of anxiety on the long-term course of depressive disorders. British Journal of Psychiatry 200, 210–215.Google Scholar
Coryell, W, Solomon, DA, Fiedorowicz, JG, Endicott, J, Schettler, PJ, Judd, LL (2009). Anxiety and outcome in bipolar disorder. American Journal of Psychiatry 166, 1238–1243.Google Scholar
Cuijpers, P, Sijbrandij, M, Koole, SL, Andersson, G, Beekman, AT, Reynolds, CF III (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry 12, 137–148.Google Scholar
Duffy, A, Horrocks, J, Doucette, S, Keown-Stoneman, C, McCloskey, S, Grof, P (2013). Childhood anxiety: an early predictor of mood disorders in offspring of bipolar parents. Journal of Affective Disorders 150, 363–369.Google Scholar
Fracalanza, K, McCabe, RE, Taylor, VH, Antony, MM (2014). The effect of comorbid major depressive disorder or bipolar disorder on cognitive behavioral therapy for social anxiety disorder. Journal of Affective Disorders 162, 61–66.Google Scholar
Gao, K, Chan, PK, Verduin, ML, Kemp, DE, Tolliver, BK, Ganocy, SJ, Bilali, S, Brady, KT, Findling, RL, Calabrese, JR (2010). Independent predictors for lifetime and recent substance use disorders in patients with rapid-cycling bipolar disorder: focus on anxiety disorders. American Journal on Addictions 19, 440–449.Google Scholar
Gaudiano, BA, Miller, IW (2005). Anxiety disorder comobidity in bipolar I disorder: relationship to depression severity and treatment outcome. Depression and Anxiety 21, 71–77.Google Scholar
Goes, FS, McCusker, MG, Bienvenu, OJ, Mackinnon, DF, Mondimore, FM, Schweizer, B, Depaulo, JR, Potash, JB (2012). Co-morbid anxiety disorders in bipolar disorder and major depression: familial aggregation and clinical characteristics of co-morbid panic disorder, social phobia, specific phobia and obsessive–compulsive disorder. Psychological Medicine 42, 1449–1459.CrossRefGoogle ScholarPubMed
Hawke, LD, Provencher, MD, Parikh, SV, Zagorski, B (2013). Comorbid anxiety disorders in Canadians with bipolar disorder: clinical characteristics and service use. Canadian Journal of Psychiatry 58, 393–401.CrossRefGoogle ScholarPubMed
Henry, C, Van den Bulke, D, Bellivier, F, Etain, B, Rouillon, F, Leboyer, M (2003). Anxiety disorders in 318 bipolar patients: prevalence and impact on illness severity and response to mood stabilizer. Journal of Clinical Psychiatry 64, 331–335.Google Scholar
Judd, LL, Akiskal, HS, Schettler, PJ, Coryell, W, Endicott, J, Maser, JD, Solomon, DA, Leon, AC, Keller, MB (2003). A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Archives of General Psychiatry 60, 261–269.Google Scholar
Judd, LL, Akiskal, HS, Schettler, PJ, Endicott, J, Maser, J, Solomon, DA, Leon, AC, Rice, JA, Keller, MB (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry 59, 530–537.CrossRefGoogle ScholarPubMed
Kendler, KS, Hettema, JM, Butera, F, Gardner, CO, Prescott, CA (2003). Life event dimensions of loss, humiliation, entrapment, and danger in the prediction of onsets of major depression and generalized anxiety. Archives of General Psychiatry 60, 789–796.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005 a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.Google Scholar
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005 b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.Google Scholar
Koukopoulos, A, Sani, G (2014). DSM-5 criteria for depression with mixed features: a farewell to mixed depression. Acta Psychiatrica Scandinavica 129, 4–16.Google Scholar
Kruger, S, Braunig, P, Cooke, RG (2000). Comorbidity of obsessive–compulsive disorder in recovered inpatients with bipolar disorder. Bipolar Disorders 2, 71–74.Google Scholar
Mackinnon, DF, Zandi, PP, Cooper, J, Potash, JB, Simpson, SG, Gershon, E, Nurnberger, J, Reich, T, Depaulo, JR (2002). Comorbid bipolar disorder and panic disorder in families with a high prevalence of bipolar disorder. American Journal of Psychiatry 159, 30–35.Google Scholar
Mantere, O, Isometsa, E, Ketokivi, M, Kiviruusu, O, Suominen, K, Valtonen, HM, Arvilommi, P, Leppamaki, S (2010). A prospective latent analyses study of psychiatric comorbidity of DSM-IV bipolar I and II disorders. Bipolar Disorders 12, 271–284.CrossRefGoogle ScholarPubMed
Meier, SM, Uher, R, Mors, O, Dalsgaard, S, Munk-Olsen, T, Laursen, TM, Mattheisen, M, Nordentoft, M, Mortensen, PB, Pavlova, B (2016). Specific anxiety disorders and subsequent risk for bipolar disorder: a nationwide study. World Psychiatry 15, 187–188.Google Scholar
Mitchell, PB, Johnston, AK, Frankland, A, Slade, T, Green, MJ, Roberts, G, Wright, A, Corry, J, Hadzi-Pavlovic, D (2013). Bipolar disorder in a national survey using the World Mental Health Version of the Composite International Diagnostic Interview: the impact of differing diagnostic algorithms. Acta Psychiatrica Scandinavica 127, 381–393.Google Scholar
National Comorbidity Survey–Replication (2003) National Comorbidity Survey–Replication (http://www.hcp.med.harvard.edu/ncs). Accessed June 2015.Google Scholar
Nery-Fernandes, F, Quarantini, LC, Galvao-de-Almeida, A, Rocha, MV, Kapczinski, F, Miranda-Scippa, A (2009). Lower rates of comorbidities in euthymic bipolar patients. World Journal of Biological Psychiatry 10, 474–479.Google Scholar
O'Garro-Moore, JK, Adams, AM, Abramson, LY, Alloy, LB (2015). Anxiety comorbidity in bipolar spectrum disorders: the mediational role of perfectionism in prospective depressive symptoms. Journal of Affective Disorders 174, 180–187.Google Scholar
Otto, MW, Simon, NM, Wisniewski, SR, Miklowitz, DJ, Kogan, JN, Reilly-Harrington, NA, Frank, E, Nierenberg, AA, Marangell, LB, Sagduyu, K, Weiss, RD, Miyahara, S, Thas, ME, Sachs, GS, Pollack, MH (2006). Prospective 12-month course of bipolar disorder in out-patients with and without comorbid anxiety disorders. British Journal of Psychiatry 189, 20–25.Google Scholar
Päären, A, Bohman, H, von Knorring, L, Olsson, G, von Knorring, AL, Jonsson, U (2014). Early risk factors for adult bipolar disorder in adolescents with mood disorders: a 15-year follow-up of a community sample. BMC Psychiatry 14, 363.CrossRefGoogle ScholarPubMed
Pavlova, B, Perlis, RH, Alda, M, Uher, R (2015). Lifetime prevalence rates of anxiety disorders in people with bipolar disorder: a meta-analysis. Lancet Psychiatry 2, 710–717.Google Scholar
Pavlova, B, Perroud, N, Cordera, P, Uher, R, Dayer, A, Aubry, J-M (2016). Childhood maltreatment and comorbid anxiety in people with bipolar disorder. Journal of Affective Disorders 192, 22–27.CrossRefGoogle ScholarPubMed
Provencher, MD, Guimond, AJ, Hawke, LD (2012). Comorbid anxiety in bipolar spectrum disorders: a neglected research and treatment issue? Journal of Affective Disorders 137, 161–164.Google Scholar
Rasic, D, Hajek, T, Alda, M, Uher, R (2014). Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: a meta-analysis of family high-risk studies. Schizophrenia Bulletin 40, 28–38.Google Scholar
Sala, R, Goldstein, BI, Morcillo, C, Liu, SM, Castellanos, M, Blanco, C (2012). Course of comorbid anxiety disorders among adults with bipolar disorder in the U.S. population. Journal of Psychiatric Research 46, 865–872.CrossRefGoogle ScholarPubMed
Schaffer, A, Isometsä, ET, Tondo, L, Moreno, H, Turecki, G, Reis, C, Cassidy, F, Sinyor, M, Azorin, JM, Kessing, LV, Ha, K, Goldstein, T, Weizman, A, Beautrais, A, Chou, YH, Diazgranados, N, Levitt, AJ, Zarate, CA Jr., Rihmer, Z, Yatham, LN (2015). International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disorders 17, 1–16.Google Scholar
Silk, JS, Davis, S, McMakin, DL, Dahl, RE, Forbes, EE (2012). Why do anxious children become depressed teenagers? The role of social evaluative threat and reward processing. Psychological Medicine 42, 2095–2107.Google Scholar
Simon, NM, Otto, MW, Wisniewski, SR, Fossey, M, Sagduyu, K, Frank, E, Sachs, GS, Nierenberg, AA, Thase, ME, Pollack, MH (2004). Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). American Journal of Psychiatry 161, 2222–2229.Google Scholar
Song, J, Bergen, SE, Kuja-Halkola, R, Larsson, H, Landen, M, Lichtenstein, P (2015). Bipolar disorder and its relation to major psychiatric disorders: a family-based study in the Swedish population. Bipolar Disorders 17, 184–193.Google Scholar
Strakowski, SM, Sax, KW, McElroy, SL, Keck, PE Jr., Hawkins, JM, West, SA (1998). Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization. Journal of Clinical Psychiatry 59, 465–471.CrossRefGoogle ScholarPubMed
Stratford, HJ, Cooper, MJ, Di Simplicio, M, Blackwell, SE, Holmes, EA (2015). Psychological therapy for anxiety in bipolar spectrum disorders: a systematic review. Clinical Psychology Review 35, 19–34.Google Scholar
Tamam, L, Ozpoyraz, N (2002). Comorbidity of anxiety disorder among patients with bipolar I disorder in remission. Psychopathology 35, 203–209.Google Scholar
Tasdemir, A, Tamam, L, Keskin, N, Evlice, YE (2016). Assessment of co-morbidity of adult separation anxiety in patients with bipolar disorder. Nordic Journal of Psychiatry 70, 93–102.Google Scholar
Thibodeau, MA, Welch, PG, Sareen, J, Asmundson, GJ (2013). Anxiety disorders are independently associated with suicide ideation and attempts: propensity score matching in two epidemiological samples. Depression and Anxiety 30, 947–954.CrossRefGoogle ScholarPubMed
Vazquez, GH, Baldessarini, RJ, Tondo, L (2014). Co-occurrence of anxiety and bipolar disorders: clinical and therapeutic overview. Depression and Anxiety 31, 196–206.Google Scholar
Vieta, E, Colom, F, Corbella, B, Martinez-Aran, A, Reinares, M, Benabarre, A, Gasto, C (2001). Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disorders 3, 253–258.Google Scholar
Viktorin, A, Lichtenstein, P, Thase, ME, Larsson, H, Lundholm, C, Magnusson, PK, Landen, M (2014). The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer. American Journal of Psychiatry 171, 1067–1073.Google Scholar
Zutshi, A, Reddy, YC, Thennarasu, K, Chandrashekhar, CR (2006). Comorbidity of anxiety disorders in patients with remitted bipolar disorder. European Archives of Psychiatry and Clinical Neurosciences 256, 428–436.CrossRefGoogle ScholarPubMed
Supplementary material: File

Pavlova supplementary material

Pavlova supplementary material 1

Download Pavlova supplementary material(File)
File 1.3 MB