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Meta-Analysis
. 2021 Jul 8;47(4):959-974.
doi: 10.1093/schbul/sbaa197.

Environmental Risk Factors in Bipolar Disorder and Psychotic Depression: A Systematic Review and Meta-Analysis of Prospective Studies

Victoria Rodriguez  1 , Luis Alameda  1   2   3 , Giulia Trotta  1 , Edoardo Spinazzola  1 , Paolo Marino  1 , Sandra L Matheson  4   5 , Kristin R Laurens  1   6 , Robin M Murray  1 , Evangelos Vassos  7
Affiliations
Meta-Analysis

Environmental Risk Factors in Bipolar Disorder and Psychotic Depression: A Systematic Review and Meta-Analysis of Prospective Studies

Victoria Rodriguez et al. Schizophr Bull. .

Abstract

Objective: The aim of this systematic review and meta-analysis was to study the association between specific environmental risk factors (ERF) and later development of Bipolar disorder and Psychotic depression.

Methods: A systematic search of prospective studies was conducted in MEDLINE, EMBASE and PsycINFO databases, and supplemented by hand searching, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number: CRD42018092253). Selected ERF included: pre-/peri-natal factors-paternal age at birth, maternal infection, obstetric complications, perinatal stress; early childhood factors-urbanicity at birth, childhood infection, childhood adversity; later life factors-substance misuse, ethnic minority and migration, urbanicity later in life, stressful life events, and traumatic head injury. Pooled effect sizes of the association between these ERF and affective psychoses were calculated from systematically selected studies. When studies examining each ERF were insufficient for meta-analysis, results were presented narratively.

Results: Forty-six studies were included for quantitative analyses among selected ERF for affective psychosis, with significant association found for paternal age >40 years (OR 1.17, 95%CI 1.12-1.23), early (OR 1.52, 95%CI 1.07-2.17) and late (OR 1.32, 95%CI 1.05-1.67) gestational age, childhood adversity (OR 1.33, 95%CI 1.18-1.50), substance misuse (OR 2.87, 95%CI 1.63-5.50), and being from an ethnic minority (OR 1.99, 95%CI 1.39-2.84).

Conclusions: These results suggest some shared environmental load between non-affective and affective psychosis, implying generalized risks for psychosis rather than for specific diagnostic categories. Nonetheless, published studies for some ERF in the affective psychoses are scarce, and further longitudinal studies are needed.

Keywords: affective psychosis; bipolar disorder; environmental risk factors; meta-analysis; psychotic depression.

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Figures

Fig. 1.
Fig. 1.
Flow diagram of database search by November 2019.
Fig. 2.
Fig. 2.
Forest plots of the associations between environmental risk factors and affective psychosis grouped by (A) Peri-/prenatal factors; (B) early childhood factors; and (C) later life factors.
Fig. 2.
Fig. 2.
Forest plots of the associations between environmental risk factors and affective psychosis grouped by (A) Peri-/prenatal factors; (B) early childhood factors; and (C) later life factors.
Fig. 3.
Fig. 3.
Differential effect of environmental risk factors across the life-span in non-affective (NAP) and affective psychoses (AP). This graph represents the differential effect for NAP and AP of the different environmental risk factors (ERF) across the life-span based on retrieved literature review for NAP and our systematic review and meta-analyses for AP. It spatially represents the strength and level of evidence of association of different ERF with both NAP and AP. We indicate with a dashed line the ERF for which questionable evidence for NAP is available.
See this image and copyright information in PMC

References

    1. World Health Organization & World Bank. WHO | World Report on Disability.World Health Organization; 2011. https://www.who.int/disabilities/world_report/2011/report/en/. Accessed July 23, 2019.
    1. Perälä J, Suvisaari J, Saarni SI, et al. . Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry. 2007;64(1):19–28. - PubMed
    1. Merikangas KR, Jin R, He JP, et al. . Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011;68(3):241–251. - PMC - PubMed
    1. Moreira ALR, Van Meter A, Genzlinger J, Youngstrom EA. Review and meta-analysis of epidemiologic studies of adult bipolar disorder. J Clin Psychiatry. 2017;78(9):e1259–e1269. - PubMed
    1. Jääskeläinen E, Juola T, Korpela H, et al. . Epidemiology of psychotic depression - systematic review and meta-analysis. Psychol Med. 2018;48(6):905–918. - PubMed

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