Predictors of recurrence in bipolar disorders in Spain (PREBIS study data)

Objective: The objective of this study was to evaluate demographic, psychosocial and clinical predictors of mood recurrences in bipolar disorder (BD) euthymic outpatients followed-up for 12 months in a naturalistic setting. Methods: The study included 595 consecutive BD patients, diagnosed according to DSM-IV-TR criteria, in clinical remission at baseline. Quarterly assessments were scheduled. Clinical evaluation as well as mood and functioning psychometric evaluations were performed. We applied logistic regression analysis to determine predictors of presenting an affective recurrence, and Cox regression analysis to examine the association between individual predictors and time to affective recurrence. Results: Of the 593 patients finally included (60% women, 84.5% BD I), 141 (23.78%) had at least a recurrence during the 12 months follow-up. Time until 25% of the patients experienced a recurrence was 12 months (95% CI: 9.14-undetermined). In multivariate analysis, factors significantly related to relapse were living setting (p = 0.002) and total number of previous episodes (p = 0.01). Residents in mixed urban/rural catchment areas had 57% more risk than dwellers of cities with more than 100,000 people, and a higher number of previous episodes also increased the relapse risk. A shorter time to relapse was related to job status (p = 0.004) and to living setting (p = 0.002). Conclusion: In our sample, living in environments of less than 100,000 inhabitants and having more previous affective episodes were related to an increased relapse risk in BD, and job status and living setting were related to a shorter time to relapse. Limitations: No specific contemporary practice guidelines were used. Drug treatment and plasma levels, although measured, were not registered. (C) 2012 Elsevier B. V. All rights reserved.