The University of Melbourne, Centre for Youth Mental Health, Parkville 3052, Australia; The University of Melbourne, Melbourne Medical School, Parkville 3052, Australia.
Orygen, Parkville 3052, Australia.
J Affect Disord. 2023 Jan 15;321:290-303. doi: 10.1016/j.jad.2022.10.019. Epub 2022 Oct 25.
Functional status could predict development of bipolar disorder (BD) or have clinical significance. The relationship between BD risk and functioning is poorly understood. We undertook a systematic review examining the global and social functioning of those at risk for BD.
We examined observational studies comparing a risk sample with healthy controls or full-threshold BD participants, using measures of global or social functioning. Risk status included family history of BD, meeting risk criteria, or having prodromal symptomatology, or premorbid functioning of persons with BD. Medline, PsycINFO, and Embase were searched. The Newcastle-Ottawa Scale for Cross-Sectional Studies was used to assess quality. Meta-analyses were performed where possible.
7215 studies were screened and 40 studies were included (8474 participants). Risk samples had poorer functioning than controls, and superior functioning to participants with BD. Meta-analysis indicated poorer global functioning among persons with familial risk compared to healthy controls (mean global functional difference: 5.92; 95 % confidence interval: 7.90, 3.95; mean premorbid functioning difference: 2.31; 95 % confidence interval: 0.70, 3.92). Studies with higher proportions of female participants had slightly poorer global functioning. High heterogeneity was attributable functional measures and potentially functionally differential subgroups within the risk samples.
Broader measures of functioning, such as neurocognition and behavioural measures, were excluded. Measures of global functioning are limited by conflating functioning and symptoms.
Functioning in the BD risk populations is intermediate to that of healthy controls and persons with BD, indicating their value in definitions of BD risk, in itself a likely heterogeneous state.
功能状态可以预测双相情感障碍（BD）的发展或具有临床意义。BD 风险与功能之间的关系尚未得到充分理解。我们进行了一项系统评价，研究了处于 BD 风险中的个体的整体和社会功能。
我们检查了比较风险样本与健康对照或全阈值 BD 参与者的观察性研究，使用了整体或社会功能的测量方法。风险状况包括双相情感障碍的家族史、符合风险标准、或有前驱症状，或双相情感障碍患者的病前功能。检索了 Medline、PsycINFO 和 Embase。使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）评估横断面研究的质量。在可能的情况下进行了荟萃分析。
筛选了 7215 项研究，纳入了 40 项研究（8474 名参与者）。风险样本的功能比对照组差，比 BD 参与者的功能好。荟萃分析表明，与健康对照组相比，具有家族风险的个体的整体功能较差（平均整体功能差异：5.92；95%置信区间：7.90，3.95；平均病前功能差异：2.31；95%置信区间：0.70，3.92）。女性参与者比例较高的研究显示出稍差的整体功能。高异质性归因于功能测量以及风险样本中潜在的功能差异亚组。
更广泛的功能测量，如神经认知和行为测量，被排除在外。整体功能的测量受到将功能和症状混为一谈的限制。
BD 风险人群的功能处于健康对照组和 BD 患者之间，表明其在 BD 风险定义中的价值，风险本身可能就是一种异质状态。
