Intervention trials for adults with bipolar disorder in low-income and lower-middle-income countries: A systematic review

Background: The treatment gap for bipolar disorder is aggravated by economic inequality. Around half of the world's population live in a low-or lower-middle-income country, where research on treatment is scarce. Hence, this review aims to determine the number and types of intervention studies conducted on adults with bipolar disorder in low-income and lower-middle-income countries and analyze the effect of these interventions on symptom severity, medical adherence, and quality of life. Methods: A systematic review was conducted in June and November 2021 using eight databases. Controlled intervention trials on adults with bipolar disorder on data from low-income and lower-middle-income countries at time of publication were included. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials or The Risk Of Bias In Non-randomized Studies of Interventions assessment tool. Results: Twenty-one studies met the inclusion criteria. These were divided into four subtypes based on the intervention; pharmacotherapy (=12), psychosocial (=7), electroconvulsive therapy (=1), and traditional medicine (=1). Three studies were from low-income countries. A high risk of bias characterized the studies; only four studies reported the procedures used for randomization. Most studies, however, identified a beneficial effect on symptom severity, and in addition, medical adherence could be improved with psychosocial interventions. Limitations: Heterogeneity across studies prevented any meaningful pooling of data to meta-analyses. Conclusion: Data for treatment interventions contextualized to the local setting for bipolar disorder remains sparse, particularly from low-resource settings. Further studies are urgently needed to target the treatment gap for bipolar disorder.

Automated summary

The treatment gap for bipolar disorder is exacerbated by economic inequality. Research on treatment in low-income and lower-middle-income countries is limited. Existing studies show that interventions such as pharmacotherapy, psychosocial interventions, and traditional medicine have a beneficial effect on symptom severity and medical adherence. However, there is a high risk of bias and heterogeneity in the studies, highlighting the need for further research to address the treatment gap.