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

• Published in: Psychological medicine 2017-04, Vol.47 (6), p.1107-1115
• Main Authors: Pavlova, B., Perlis, R. H., Mantere, O., Sellgren, C. M., Isometsä, E., Mitchell, P. B., Alda, M., Uher, R.
• Format: Article
• Language: English
• Subjects: Agoraphobia; Anxiety; Anxiety Disorders - epidemiology; Bipolar disorder; Bipolar Disorder - epidemiology; Comorbidity; Confidence intervals; Humans; Medical diagnosis; Medicin och hälsovetenskap; Mood; Obsessive compulsive disorder; Original Articles; Panic attacks; Population studies; Post traumatic stress disorder; Prevalence; Social anxiety; Systematic review; Traumatic stress
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291716003135

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. 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. 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. 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.