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Meta-Analysis
. 2025 Mar 5;68(1):e45.
doi: 10.1192/j.eurpsy.2025.27.

Sex differences in psychosocial functioning and neurocognition in bipolar disorder: a systematic review and meta-analysis

Maria Serra-Navarro  1   2 , Derek Clougher  1   2   3 , Vincenzo Oliva  1   2 , Clàudia Valenzuela-Pascual  1   2 , Michele De Prisco  1   2 , María Florencia Forte  1   2 , Marina Garriga  1   2 , Brisa Solé  1   2 , Jose Sánchez-Moreno  1   2   3 , Norma Verdolini  4 , Giulia Menculini  5 , Alfonso Tortorella  5 , Miquel Bernardo  6 , J Antoni Ramos-Quiroga  7   8   9 , Anabel Martinez-Aran  1   2 , Eduard Vieta  1   2 , Silvia Amoretti  7   8 , Carla Torrent  1   2
Affiliations
Meta-Analysis

Sex differences in psychosocial functioning and neurocognition in bipolar disorder: a systematic review and meta-analysis

Maria Serra-Navarro et al. Eur Psychiatry. .

Abstract

Introduction: Impairment in both psychosocial functioning and neurocognition (NC) performance is present in bipolar disorder (BD) yet the role of sex differences in these deficits remains unclear. The present systematic review and meta-analysis examined whether males and females with BD demonstrate differences in psychosocial functioning and NC performance.

Methods: The Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases were systematically searched from inception until November 20, 2023.

Results: Twenty studies published between 2005 and 2023 with a total sample size of 2286 patients with BD were included. A random effects meta-analysis revealed a statistically significant result with a small effect (SMD = 0.313) for sex differences in verbal learning and memory as well as visual learning and memory (SMD = 0.263). Females outperformed males in both domains. No significant sex differences were observed for any other NC outcome or psychosocial functioning. High heterogeneity and differences in assessment scales used should be considered when interpreting these findings, given their potential impact on results.

Conclusions: Future research should adopt a more homogenous, standardized approach using longitudinal designs to gain a clearer insight into sex differences in this population. This approach so may increase the use of preventative therapeutic options to address the difficult clinical challenge of reaching cognitive and functional recovery.

Keywords: bipolar disorder; meta-analysis; neurocognition; psychosocial functioning; sex.

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Conflict of interest statement

Eduard Vieta has received grants and served as a consultant, advisor, or CME speaker for the following entities: AB-Biotics, AbbVie, Adamed, Alcediag, Angelini, Biogen, Beckley-Psytech, Biohaven, Boehringer-Ingelheim, Celon Pharma, Compass, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, HMNC, Idorsia, Johnson & Johnson, Lundbeck, Luye Pharma, Medincell, Merck, Newron, Novartis, Orion Corporation, Organon, Otsuka, Roche, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, Teva, and Viatris, outside the submitted work. Marina Garriga has received honoraria/travel support from Ferrer, Janssen-Cilag, and Lundbeck, with no financial or other relationship relevant to the subject of this article. J. Antoni Ramos-Quiroga was on the speakers’ bureau and/or acted as consultant for Biogen, Idorsia, Casen-Recordati, Janssen-Cilag, Novartis, Takeda, Bial, Sincrolab, Neuraxpharm, Novartis, BMS, Medice, Rubió, Uriach, Technofarma and Raffo in the last 3 years. He also received travel awards [air tickets + hotel] for taking part in psychiatric meetings from Idorsia, Janssen-Cilag, Rubió, Takeda, Bial and Medice. The Department of Psychiatry chaired by him received unrestricted educational and research support from the following companies in the last 3 years: Exeltis, Idorsia, Janssen-Cilag, Neuraxpharm, Oryzon, Roche, Probitas and Rubió. Miquel Bernardo has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory board of ABBiotics, Adamed, Angelini, Casen Recordati, Janssen-Cilag, Menarini, Rovi and Takeda. Silvia Amoretti has been a consultant to and/or has received honoraria/grants from Otsuka-Lundbeck, with no financial or other relationship relevant to the subject of this article. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1.
Figure 1.
PRISMA flowchart, 2020 edition, adapted. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.
Figure 2.
Figure 2.
Differences in neurocognition and functioning between females (right) and males (left). Point size is proportional to the number of patients included in that specific comparison.
See this image and copyright information in PMC

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