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. Author manuscript; available in PMC: 2020 Sep 1.
Published in final edited form as: Bipolar Disord. 2019 May 15;21(6):483–502. doi: 10.1111/bdi.12785

Table 3:

Risk of recurrence, mood polarity, and strength association (when possible) of each assessed factor


Demographic Factors

Sex
Author Adult/Child Study Risk of recurrence
Birmaher et al., 2006 Child more mood episodes in female sex (t = 1.99, p= 0.05)
Jairam et al., 2004 Child no statistically significant difference (ND)
Srinath et al., 1998 Child no statistically significant difference (ND)
Strober et al., 1995 Child no statistically significant difference (ND)
Wozniak et al., 2013 Child more depressive episodes in males (M= 10.7, SD= 23.3 vs. M= 10.2, SD= 16.8, t=7.2, p<0.001)

Age at onset
Author Adult/Child Study Risk of recurrence
Baldessarini et al., 2012 Adult more mood episodes in earlier onset group (F=3.92, p=0.02)
Bashir et al., 1987 Child no statistically significant difference (ND)
Birmaher et al., 2014 Child less mood episodes in later onset of mood symptoms group (χ2= 25.57, p= 0.001)
Bromet et al., 2005 Adult shorter time to relapse in earlier onset group (HR=0.51; 95% CI=0.31–0.84, p˂ 0.01)
Carlson et al., 1977 Adult no statistically significant difference (0.38 vs. 0.42 mean episode frequency/year)
Carlson et al., 2000 Adult more manic and mixed episodes in earlier onset group (64.7% vs. 12.5% and 26.1% vs. 3.3% OR=10.23; 95% CI=1.13–92.37) and less depressive episodes in earlier onset group (17.6% vs. 62.5)
Coryell et al., 2013 Adult more depressive episodes in earlier onset group (M= 39.9, SD= 32.3 vs. M= 35.1, SD= 31.3, p= 0.015)
Jairam et al., 2004 Child no statistically significant difference (ND)
Karthick et al., 2015 Adult no statistically significant difference (ND)
Leverich et al., 2007 Adult more mood episodes in earlier onset group (20 episodes before entry study: 50 childhood, 105 adolescents and 30 adulthood. Number episodes in first year follow-up: M= 5.4, SD= 3.72 childhood; M= 4.1, SD= 3.43 adolescents; M= 2.8, SD= 3.34 adult)
Lish et al., 1994 Adult more mood episodes in earlier onset group (51% vs 34%, χ2 = 9.3, p= 0.002)
Perlis et al., 2004 Adult more mood episodes in earlier onset group (χ2 = 13.82, p= 0.001)
Perlis et al., 2009 Adult earliest recurrence in childhood onset group (log-rank χ2 = 14.98, p= 0.0001) and adolescent onset group (χ2 = 6.87, p= 0.01) vs. adult onset. Risk not found between child- and adolescent-onset groups (χ2 = 1.79, p= 0.18). Median days to recurrence were 308, 418, and 542 for the child-, adolescent- , and adult-onset age groups, respectively
Post et al., 2010 Adult more mood episodes in earlier onset group (effect size not reported)
Schurhoff et al., 2000 Adult risk not found (M= 0.25, SD= 0.05 vs. M= 0.23, SD= 0.07 mania/year and M= 0.33, SD= 0.06 vs. M= 0.45, SD= 0.31 depression/year)
Srinath et al., 1998 Child no statistically significant difference (ND)
Suppes et al., 2001 Adult more mood episodes in earlier onset group (64 vs. 57, p= 0.0002 in depression and 53 vs. 46, p= 0.005 in mania).
Winokur et al., 1989 Adult more mood episodes in earlier onset group (42% polyepisodic group and 25% oligoepisodic group, p= 0.005)
Yatham et al., 2009 Adult more mood episodes in earlier onset group (small increase in survival time HR (β = 1.119; p= 0.02) with later age of onset)
Clinical Factors

Comorbidity
Author Adult/Child Study Comorbidity
type 		Risk of recurrence
Birmaher et al., 2006 Child Psychosis more mood episodes in psychotic group (t = 2.78 [p= .006])
Bromet et al., 2005 Adult ANX more mood episodes in ADHD group (M= 6.0, SD= 3.5 vs. M= 3.9, SD= 3.2, p˂ 0.0001)
Coryell et al., 2013 Adult ANX more mood episodes in SUD group (OR = 1.57; 95% CI, 0.96–2.58; p= 0.07)
DelBello et al., 2007 Child SUD (alcohol) more mood episodes in SUD group (HR= 4.3, 95% CI= 3.3 to 5.3, p= 0.005)
Hua et al., 2011 Child Psychosis more mood episodes in psychotic group (63.39±126.33 vs. 19.92±34.48)
Jairam et al., 2004 Child Psychosis no statistically significant difference (ND)
Kovacs et al., 1995 Child DBD no statistically significant difference. No more mood episodes in DBD groups (4.8 (1–12) vs. 6.9 (1–17))
Post et al., 2014a Adult ANX more mood episodes in ANX group (OR = 1.36; 95% CI, 0.82–2.27; p= 0.23)
SUD more mood episodes in psychotic group (63.39±126.33 vs. 19.92±34.48)
Ratheesh et al., 2011 Child ANX more mood episodes in ANX group (3 (1–4) vs. 2 (1–14))
Ryden et al., 2009 Adult ADHD more depressive episodes in ANX group (effect size not reported)
Sala et al., 2012 Child ANX less follow-up time spent euthymic (OR = 0.97; 95% CI, 0.96–0.99; p= 0.0004)
Sala et al., 2014 Child ANX ↑ risk any mood recurrences (76% vs. 56.4%, χ2= 15.12, p= 0.0001) and depression recurrences specifically (64.9% vs. 49.4%, F= 5.33, p= 0.02)
Serra et al., 2017 Adult ANX more time in mood episodes in ANX group (%) (5.49±8.94 vs 3.12±6.17, p= 0.04)
more time in depressive episodes in ANX group (%) (26.0±22.9 vs. 17.9±22.9, p= 0.009).
Srinath et al., 1998 Child Psychosis no statistically significant difference (ND)
Strober et al., 1995 Child Psychosis no statistically significant difference (ND)
Tamam et al., 2008 Adult ADHD more mixed episodes in ADHD group (M= 5.6, SD= 9.2 vs. M= 0.81, SD= 3.4, p˂ 0.001)

Yen et al., 2016		 Child ANX 1 point ↑ ANX PSR= ↑ risk depressive recurrence 43% (HR= 1.43, 95% CI [1.24–1.65]
1 point ↑ ANX PSR= ↑ risk mania recurrence 43% (HR= 1.43, 95% CI [1.16–1.75]
ADHD 1 point ↑ ADHD PSR= ↑ risk depressive recurrence 53% (HR= 1.53, 95% CI [1.25–1.85])
1 point ↑ ADHD PSR= ↑ risk mania recurrence 72% (HR= 1.72, 95% CI [1.21–2.44]
DBD 1 point ↑ DBD PSR= ↑ risk depressive recurrence 22% (HR= 1.22, 95% CI [1.04–1.44])
1 point ↑ DBD PSR= ↑ risk mania recurrence 67% (HR= 1.67, 95% CI [1.29–2.16]
SUD 1 point ↑ SUD PSR= ↑ risk depressive recurrence 21% (HR= 1.21, 95% CI [1.01–1.44])
1 point ↑ SUD PSR= ↑ risk mania recurrence 46% (HR= 1.46, 95% CI [1.09–1.96]

Subsyndromal mood symptoms
Author Adult/Child Study Risk of recurrence
Birmaher et al., 2014 Child less mood episodes in fewer subsyndromal episodes group (χ2= 10.36, p= 0.02)
Jairam et al., 2004 Child no statistically significant difference (ND)
Wozniak et al., 2011 Child Persistent BD-I group had significantly higher one-year prevalence of major depressive disorder compared to the Non-Persistent BD-I group (effect size not reported)

Bipolar subtype
Author Adult/Child Study Risk of recurrence
Birmaher et al., 2006 Child BD-I group was 1.7 times (95% CI, 1.06–2.67) and BD-II group was 2.7 times (95% CI, 1.35–5.31) more likely to have a recurrence than those with BD-NOS
Birmaher et al., 2009 Child higher rates of mood episodes in BD-I group (65.2%) and BD-II (81.0%) compared to BD-NOS group (53.7%). Recurrence was associated with BD-I and BD-II (vs. BD-NOS, HR:1.37, 95% CI:1.01–1.88)
Hirneth et al., 2015 Child higher rates of previous mood episodes in BD-I group (45.8% vs. 7.7% BD-II, Fisher’s exact test, p= 0.027; and 19.6% BD-NOS, Fisher’s exact test, p= 0.027)
Lewinsohn et al., 2000 Child ↑ risk mood episode in symptomatic group (27.3% vs. 2.1%; OR=17.3; 95% CI=1.6–189.6)
Environmental Factors
Low SES
Author Adult/Child Study Risk of recurrence
Birmaher et al., 2006 Child with every unit of decrease in SES 20% higher likelihood of recurrence (95% CI, 0.67–0.95)
Birmaher et al., 2014 Child less mood episodes (χ2= 7.17, p= 0.07) in higher SES group

Post et al., 2014a		 Adult more mood episodes in poor social support group (OR= 1.18; 95% CI, 0.71–1.97; p= 0.53) and more mood episodes in employment difficulties group (OR= 1.32; 95% CI, 0.79–2.21; p= 0.3)
Stressors
Author Adult/Child Study Stressor type Risk of recurrence
Birmaher et al., 2014 Child Sexual abuse less mood episodes (χ2= 8.16, p= 0.04) in less sexual abused group
Bromet et al., 2005 Adult Child abuse shorter time to relapse in child abused group (effect size not reported)
Erten et al., 2014 Adult Child abuse more depressive episodes (t= −2.38, p= 0.019) and total episodes (t= −2.25, p= 0.026) in negative live event group
Etain et al., 2013 Adult Emotional abuse more number of depressive episodes in emotional abused group (7.07±6.96 vs. 4.72±5.44, r2 = 0.03, P = .002) just in females (no in males)
Garno et al., 2005 Adult Child abuse more depressive episodes in child abused group (M= 30.4, SD= 50.4 vs. M= 12.0, SD= 24.3, p= 0.026)
Geller et al., 2008 Child Low maternal warmth more mood episodes in low maternal warmth group (HR= 2.9 (95% CI, 1.5–5.4)
Gilman et al., 2015 Adult Child abuse more mood episodes in negative live event group (abuse and maltreatment; OR=1.55 and 1.60, respectively)
Larsson et al., 2013 Adult Emotional abuse more incidence of (hypo)manic episodes (df = 8.3, p < 0.001) in emotional abused group
Li et al., 2014 Adult Child abuse no statistically significant difference (r= −0.012, p ˃ .05)
McIntyre et al., 2008 Adult Child abuse no statistically significant difference (ND)
Nolen et al., 2004 Adult Child abuse more mood episodes in child abused group (r= 0.23, p ˂ .05)

Post et al., 2014a		 Adult Child abuse more mood episodes in negative live event group (OR= 1.11; 95% CI, 0.63–1.96; p= 0.71)
Wals et al., 2005 Child Stressful life events no statistically significant difference (OR=2.1, CI=0.2–21.9, p=0.521)
Family history of bipolar disorder
Author Adult/Child Study Risk of recurrence
Birmaher et al., 2014 Child less mood episodes in less family history of bipolarity group (χ2= 13.02, p= 0.005)
Jairam et al., 2004 Child no statistically significant difference (ND)
Srinath et al., 1998 Child no statistically significant difference (ND)
Strober et al., 1995 Child no statistically significant difference (ND)

ANX: anxiety; ADHD: attention deficit hyperactivity disorder; DBD: disruptive behavioral disorders; SUD: substance use disorders; SES: socio-economic status; BD-I: bipolar disorder I; BD-II: bipolar disorder II; BD-NOS: bipolar disorder not otherwise specified; mood episode: mood polarity not specified; ND: numerical data not reported; PSR: psychiatric status rating; HR: hazard ratio; CI: coefficient interval; OR: odds ratio; M: median; SD: standard deviation.