Rates and associations of relapse over 5 years of 2649 people with bipolar disorder: a retrospective UK cohort study.
Bipolar disorder
Epidemiology
Naturalistic
Relapse
Journal
International journal of bipolar disorders
ISSN: 2194-7511
Titre abrégé: Int J Bipolar Disord
Pays: Germany
ID NLM: 101622983
Informations de publication
Date de publication:
30 Jun 2023
30 Jun 2023
Historique:
received:
26
01
2023
accepted:
15
05
2023
medline:
1
7
2023
pubmed:
1
7
2023
entrez:
30
6
2023
Statut:
epublish
Résumé
Evidence regarding the rate of relapse in people with bipolar disorder (BD), particularly from the UK, is lacking. This study aimed to evaluate the rate and associations of clinician-defined relapse over 5 years in a large sample of BD patients receiving routine care from a UK mental health service. We utilised de-identified electronic health records to sample people with BD at baseline. Relapse was defined as either hospitalisation, or a referral to acute mental health crisis services, between June 2014 and June 2019. We calculated the 5-year rate of relapse and examined the sociodemographic and clinical factors that were independently associated with relapse status and the number of relapses, over the 5-year period. Of 2649 patients diagnosed with BD and receiving care from secondary mental health services, 25.5% (n = 676) experienced at least one relapse over 5 years. Of the 676 people who relapsed, 60.9% experienced one relapse, with the remainder experiencing multiple relapses. 7.2% of the baseline sample had died during the 5-year follow-up. Significant factors associated with experiencing any relapse, after adjustment for relevant covariates, were history of self-harm/suicidality (OR 2.17, CI 1.15-4.10, p = 0.02), comorbidity (OR 2.59, CI 1.35-4.97, p = 0.004) and psychotic symptoms (OR 3.66, CI 1.89-7.08, p < 0.001). Factors associated with the number of relapses over 5 years, after adjustment for covariates, were self-harm/suicidality (β = 0.69, CI 0.21-1.17, p = 0.005), history of trauma (β = 0.51, CI = 0.07-0.95, p = 0.03), psychotic symptoms (β = 1.05, CI 0.55-1.56, p < 0.001), comorbidity (β = 0.52, CI 0.07-1.03, p = 0.047) and ethnicity (β = - 0.44, CI - 0.87 to - 0.003, p = 0.048). Around 1 in 4 people with BD in a large sample of people with BD receiving secondary mental health services in the UK relapsed over a 5-year period. Interventions targeting the impacts of trauma, suicidality, presence of psychotic symptoms and comorbidity could help to prevent relapse in people with BD and should be considered in relapse prevention plans.
Sections du résumé
BACKGROUND
BACKGROUND
Evidence regarding the rate of relapse in people with bipolar disorder (BD), particularly from the UK, is lacking. This study aimed to evaluate the rate and associations of clinician-defined relapse over 5 years in a large sample of BD patients receiving routine care from a UK mental health service.
METHOD
METHODS
We utilised de-identified electronic health records to sample people with BD at baseline. Relapse was defined as either hospitalisation, or a referral to acute mental health crisis services, between June 2014 and June 2019. We calculated the 5-year rate of relapse and examined the sociodemographic and clinical factors that were independently associated with relapse status and the number of relapses, over the 5-year period.
RESULTS
RESULTS
Of 2649 patients diagnosed with BD and receiving care from secondary mental health services, 25.5% (n = 676) experienced at least one relapse over 5 years. Of the 676 people who relapsed, 60.9% experienced one relapse, with the remainder experiencing multiple relapses. 7.2% of the baseline sample had died during the 5-year follow-up. Significant factors associated with experiencing any relapse, after adjustment for relevant covariates, were history of self-harm/suicidality (OR 2.17, CI 1.15-4.10, p = 0.02), comorbidity (OR 2.59, CI 1.35-4.97, p = 0.004) and psychotic symptoms (OR 3.66, CI 1.89-7.08, p < 0.001). Factors associated with the number of relapses over 5 years, after adjustment for covariates, were self-harm/suicidality (β = 0.69, CI 0.21-1.17, p = 0.005), history of trauma (β = 0.51, CI = 0.07-0.95, p = 0.03), psychotic symptoms (β = 1.05, CI 0.55-1.56, p < 0.001), comorbidity (β = 0.52, CI 0.07-1.03, p = 0.047) and ethnicity (β = - 0.44, CI - 0.87 to - 0.003, p = 0.048).
CONCLUSIONS
CONCLUSIONS
Around 1 in 4 people with BD in a large sample of people with BD receiving secondary mental health services in the UK relapsed over a 5-year period. Interventions targeting the impacts of trauma, suicidality, presence of psychotic symptoms and comorbidity could help to prevent relapse in people with BD and should be considered in relapse prevention plans.
Identifiants
pubmed: 37391627
doi: 10.1186/s40345-023-00302-x
pii: 10.1186/s40345-023-00302-x
pmc: PMC10313572
doi:
Types de publication
Journal Article
Langues
eng
Pagination
23Informations de copyright
© 2023. The Author(s).
Références
Bipolar Disord. 2009 Aug;11(5):453-73
pubmed: 19624385
Psychiatry Res. 2018 Dec;270:749-754
pubmed: 30551320
J Affect Disord. 2018 Jan 1;225:123-128
pubmed: 28826088
Int Clin Psychopharmacol. 2017 May;32(3):115-120
pubmed: 28207568
Acta Psychiatr Scand. 2016 Apr;133(4):324-34
pubmed: 26475572
Am J Psychiatry. 2006 Feb;163(2):217-24
pubmed: 16449474
Lancet Psychiatry. 2016 Apr;3(4):342-9
pubmed: 26873185
Int J Bipolar Disord. 2022 Dec 18;10(1):31
pubmed: 36528859
Bipolar Disord. 2021 Sep;23(6):584-594
pubmed: 33638252
BJPsych Open. 2022 Jul 11;8(4):e130
pubmed: 35815760
Neurosci Biobehav Rev. 2021 May;124:100-123
pubmed: 33515607
Br J Psychiatry. 2017 Sep;211(3):175-181
pubmed: 28684403
Eur Neuropsychopharmacol. 2015 Oct;25(10):1501-12
pubmed: 26238969
J Clin Psychiatry. 2011 Sep;72(9):1250-6
pubmed: 21672501
Psychol Med. 2013 Dec;43(12):2593-602
pubmed: 23510515
J Affect Disord. 2012 Feb;136(3):733-9
pubmed: 22036802
J Affect Disord. 2021 Dec 1;295:681-687
pubmed: 34509784
Psychol Med. 1989 Feb;19(1):129-41
pubmed: 2727202
J Affect Disord. 2012 Dec 20;143(1-3):160-5
pubmed: 22925351
Am J Psychiatry. 2003 May;160(5):999-1001
pubmed: 12727708
J Affect Disord. 2021 Feb 1;280(Pt A):250-257
pubmed: 33220561
Psychol Med. 2022 Sep 30;:1-14
pubmed: 36177878
Am J Psychiatry. 2004 Dec;161(12):2222-9
pubmed: 15569893
Compr Psychiatry. 2017 Jul;76:169-176
pubmed: 28531646
J Affect Disord. 2022 Jan 15;297:176-188
pubmed: 34699850
Int J Bipolar Disord. 2016 Dec;4(1):2
pubmed: 26763504
J Clin Psychiatry. 2015 Sep;76(9):1241-8
pubmed: 25845021
Bipolar Disord. 2012 Feb;14(1):19-30
pubmed: 22329469
Nat Rev Dis Primers. 2018 Mar 08;4:18008
pubmed: 29516993
Biol Psychiatry. 2003 Jun 1;53(11):1028-42
pubmed: 12788248
Schizophr Bull. 2021 Apr 29;47(3):864-874
pubmed: 33459778
Bipolar Disord. 2019 May;21(3):270-275
pubmed: 30051555
Pharmacoeconomics. 2010;28(7):555-66
pubmed: 20405969
Pilot Feasibility Stud. 2020 Nov 7;6(1):170
pubmed: 33292713