Rates and associations of relapse over 5 years of 2649 people with bipolar disorder: a retrospective UK cohort study

• Published in: International Journal of Bipolar Disorders 2023-06, Vol.11 (1), p.23-23, Article 23
• Main Authors: Hett, Danielle, Morales-Muñoz, Isabel, Durdurak, Buse Beril, Carlish, Max, Marwaha, Steven
• Format: Article
• Language: English
• Subjects: Behavioral Therapy; Bipolar disorder; Clinical Psychology; Cohort analysis; Comorbidity; Epidemiology; Health services; Medicine; Medicine & Public Health; Mental health care; Naturalistic; Neurology; Psychiatry; Psychopharmacology; Psychosis; Psychotherapy; Relapse; Self destructive behavior
• ISSN: 2194-7511; 2194-7511
• DOI: 10.1186/s40345-023-00302-x

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 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 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