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. 2022 Aug 15:311:256-266.
doi: 10.1016/j.jad.2022.05.097. Epub 2022 May 20.

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

C J Arnbjerg  1 , N U Rurangwa  2 , E Musoni-Rwililiza  3 , D Gishoma  2 , J Carlsson  4 , P Kallestrup  5
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Free article

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

C J Arnbjerg et al. J Affect Disord. .
Free article

Abstract

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.

Trial registration: PROSPERO: CRD42020170953.

Keywords: Bipolar disorder; Global mental health; Intervention trials; Low-income countries; Low-resource setting; Lower-middle-income countries.

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