A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder
Ratheesh, A, Davey, C, Hetrick, S, Alvarez-Jimenez, M, Voutier, C, Bechdolf, A, McGorry, PD, Scott, J, Berk, Michael and Cotton, SM 2017, A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder, Acta psychiatrica Scandinavica, vol. 135, no. 4, pp. 273-284, doi: 10.1111/acps.12686.
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A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder
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. 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. 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). Participants with the identified risk factors merit closer observation and may benefit from prevention efforts, especially if outcomes broader than BD are considered.
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