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A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder

Lookup NU author(s): Emeritus Professor Jan Scott


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© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Objective: Some people with major depressive disorder (MDD) may be at a pre-onset stage for bipolar disorder (BD), where early identification or prevention efforts may be feasible. We aimed to identify rates and characteristics predictive of transition to BD in prospective follow-up studies of people with MDD. Methods: Using a systematic search strategy, we identified studies with a diagnostic ascertainment of MDD and BD of an adequate standard, and where the minimum length of follow-up was 6 months. We examined the incidence and point prevalence of BD and the pooled odds ratios (OR) for baseline predictors. Results: From 5554 unique publications, 56 were included. Nearly a quarter of adults (22.5%) and adolescents with MDD followed up for a mean length of 12–18 years developed BD, with the greatest risk of transition being in the first 5 years. The meta-analysis identified that transition from MDD to BD was predicted by family history of BD (OR = 2.89, 95% CI: 2.01–4.14, N = 7), earlier age of onset of depression (g = −0.33, SE = 0.05, N = 6) and presence of psychotic symptoms (OR = 4.76, 95% CI: 1.79–12.66, N = 5). Conclusions: Participants with the identified risk factors merit closer observation and may benefit from prevention efforts, especially if outcomes broader than BD are considered.

Publication metadata

Author(s): Ratheesh A, Davey C, Hetrick S, Alvarez-Jimenez M, Voutier C, Bechdolf A, McGorry PD, Scott J, Berk M, Cotton SM

Publication type: Article

Publication status: Published

Journal: Acta Psychiatrica Scandinavica

Year: 2017

Volume: 135

Issue: 4

Pages: 273-284

Print publication date: 01/04/2017

Online publication date: 18/01/2017

Acceptance date: 23/11/2016

ISSN (print): 0001-690X

ISSN (electronic): 1600-0447

Publisher: Blackwell Publishing Ltd


DOI: 10.1111/acps.12686


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