Authors' reply

We would like to provide some clarifications in response to Gaur & Grover's queries.

First, only those patients with ‘severe’ Axis I comorbidity diagnoses were excluded. This means that patients were excluded if they presented with a coexisting Axis I condition that might have a major impact on their ability to effectively participate in the groups, such as severe social phobia or obsessive–compulsive disorder.

Second, regarding details of status and/or type of Axis I/II comorbidities, we would like to point out that this was already covered for the 2-year follow-up in a previous paper. ¹

Third, we defined recurrence both based on severity ratings and DSM–IV criteria; these are narrow criteria which are much more reliable than just asking for diagnostic criteria alone or rating scale scores. We disregarded the possibility of using a life-chart method to catch subsyndromal fluctuations because this method has not shown good reliability and would likely capture a lot of noise.

Fourth, criteria for hospitalisation were those used at the Barcelona Bipolar Disorders Program: any patient presenting an episode that, owing to its severity, cannot be managed in an out-patient setting and/or any patient presenting suicide risk or representing a risk for third persons.

Fifth, as clearly explained in our manuscript, the primary outcome of the trial was time to recurrence. Secondary outcomes included time spent ill and number of recurrences. Our original submission included a full data report on those secondary variables, which had to be condensed owing to space constraints. The analysis of the number of recurrences was, as explained in the Method, performed by means of ANCOVA and therefore the mean values for each group are just orientive.

Finally, we acknowledge a typing error in Table 2 referring to the number of days spent in depression. The right values should be: control group, mean = 398.55 days (s.d. = 364.16); psychoeducation group, mean = 93.28 days (s.d. = 165.46). The standard deviation for the control group was mistakenly repeated replacing the mean number of days spent in depression for the psychoeducation group. After correcting this error, data regarding mean number of days spent in each episode tally with the total duration for both groups. As this was only a typing error, it does not change any statistics. We have been informed of this mistake by other readers and have already proceeded to issue the corresponding erratum.