Meta-analysis of recurrence rate and influencing factors of bipolar disorder.

OBJECTIVE

To systematically evaluate relapse rates and influencing factors among patients with bipolar disorder (BD).

METHODS

Ten databases were searched for relevant literature on BD relapse rates and associated factors, from database inception to May 8, 2025. Two researchers independently screened the literature and extracted data. Meta-analysis was conducted using Stata 18.0.

RESULTS

Thirty-four studies were included, comprising 33,500 patients and 17,808 relapses, with 26 risk and protective factors examined. The pooled relapse rate for BD was 43.6 %. Risk factors for relapse included sleep disturbance (odds ratio [OR = 3.69]), moderate-to-severe residual symptoms (OR = 2.70), monotherapy (OR = 2.58), rapid discontinuation (OR = 1.98), out-of-pocket medical costs (OR = 1.97), comorbid anxiety disorder (hazard ratio [HR = 1.84]), number of hospitalizations (OR = 1.49; HR = 1.06), increased Hamilton Depression Rating Scale-17 (HAMD-17) scores (OR = 1.21), increased Young Mania Rating Scale (YMRS) scores (OR = 1.11), and a greater number of previous episodes (OR = 1.03). Protective factors included maintenance therapy (OR = 0.26), bipolar II (BD-II) subtype (OR = 0.47), higher Insight and Treatment Attitudes Questionnaire (ITAQ) score (OR = 0.47), female sex (OR = 0.69), higher psychosocial functioning Global Assessment of Functioning (GAF) score (OR = 0.97), and later age at onset (HR = 0.97).

CONCLUSIONS

Patients with BD have a high overall relapse rate, influenced by multiple risk and protective factors. Individualized, long-term management strategies are essential for addressing modifiable factors and reducing relapse risk.