Keramatian Kamyar, Pinto Jairo V, Tsang Vivian W L, Chakrabarty Trisha, Yatham Lakshmi N
Department of Psychiatry, University of British Columbia, Vancouver, Canada.
University Hospital, Federal University of Santa Catarina, Florianópolis, Brazil.
Br J Psychiatry. 2025 May 8:1-11. doi: 10.1192/bjp.2025.63.
The duration of undiagnosed or untreated bipolar disorder (DUBD) has become a focus of research interest. However, its relationship with clinical characteristics and outcomes remains poorly understood.
The objective of this systematic review and meta-analysis was to examine DUBD and explore its relationships with clinical characteristics and outcomes in bipolar disorder.
We conducted a systematic search of the literature to identify studies reporting on DUBD and its relationships with clinical characteristics and outcomes including frequency of relapse into mood episodes, severity and persistence of mood symptoms, functional and cognitive measures, suicidality, hospital admission rate, and comorbidities such as substance use disorders.
Thirty articles met inclusion criteria for the systematic review, and 23 studies were included in the three different sets of meta-analyses. The pooled mean DUBD across all studies was 9.10 years. Early onset, depression as the polarity of the first mood episode, lifetime suicide attempts, comorbid anxiety and alcohol use disorders, and family history of bipolar disorder were associated with significantly longer DUBD, whereas diagnosis of bipolar I disorder and lifetime psychotic symptoms were associated with shorter DUBD. Studies that investigated outcomes subsequent to the diagnosis of bipolar disorder yielded conflicting results.
DUBD may be associated with certain adverse outcomes. This association indicates the importance of adopting a more comprehensive approach to assessing mood disorders, with an emphasis on prioritising early screening for bipolar disorder. The significant heterogeneity among included studies suggests a need for improved methodological rigour in future research.
未诊断或未治疗的双相情感障碍（DUBD）的病程已成为研究关注的焦点。然而，其与临床特征及预后的关系仍知之甚少。
本系统评价和荟萃分析的目的是研究DUBD，并探讨其与双相情感障碍临床特征及预后的关系。
我们对文献进行了系统检索，以确定报告DUBD及其与临床特征和预后关系的研究，这些预后包括情绪发作复发频率、情绪症状的严重程度和持续时间、功能和认知指标、自杀倾向、住院率以及物质使用障碍等共病情况。
30篇文章符合系统评价的纳入标准，23项研究纳入了三组不同的荟萃分析。所有研究中DUBD的合并平均病程为9.10年。早发、首次情绪发作极性为抑郁、有过自杀未遂史、共病焦虑和酒精使用障碍以及双相情感障碍家族史与DUBD显著延长相关，而双相I型障碍诊断和有过终生精神病性症状与较短的DUBD相关。对双相情感障碍诊断后预后的研究结果相互矛盾。
DUBD可能与某些不良预后相关。这种关联表明采用更全面的方法评估情绪障碍的重要性，重点是优先进行双相情感障碍的早期筛查。纳入研究之间存在显著异质性，提示未来研究需要提高方法学的严谨性。
