A Lifetime Prevalence of Comorbidity Between Bipolar Affective Disorder and Anxiety Disorders: A Meta-analysis of 52 Interview-based Studies of Psychiatric Population

Bipolar affective disorder has a high rate of comorbidity with a multitude of psychiatric disorders and medical conditions. Among all the potential comorbidities, co-existing anxiety disorders stand out due to their high prevalence. To determine the lifetime prevalence of comorbid anxiety disorders in bipolar affective disorder under the care of psychiatric services through systematic review and meta-analysis. Random effects meta-analyses were used to calculate the lifetime prevalence of comorbid generalised anxiety disorder, panic disorder, social anxiety disorder, specific phobia, agoraphobia, obsessive compulsive disorder and posttraumatic stress disorder in bipolar affective disorder. 52 studies were included in the meta-analysis. The rate of lifetime comorbidity was as follows: panic disorder 16.8% (95% CI 13.7–20.1), generalised anxiety disorder 14.4% (95% CI 10.8–18.3), social anxiety disorder13.3% (95% CI 10.1–16.9), post-traumatic stress disorder 10.8% (95% CI 7.3–14.9), specific phobia 10.8% (95% CI 8.2–13.7), obsessive compulsive disorder 10.7% (95% CI 8.7–13.0) and agoraphobia 7.8% (95% CI 5.2–11.0). The lifetime prevalence of any anxiety disorders in bipolar disorder was 42.7%. Our results suggest a high rate of lifetime concurrent anxiety disorders in bipolar disorder. The diagnostic issues at the interface are particularly difficult because of the substantial symptom overlap. The treatment of co-existing conditions has clinically remained challenging. •There is a high comorbidity between bipolar disorder and anxiety disorders.•Panic disorder is the most common comorbid anxiety disorder in bipolar disorder.•The presence of comorbid anxiety disorders may adversely affect the overall outcome in bipolar disorder. Bipolar affective disorders are among the most disabling psychiatric conditions with relatively high rates of morbidity and mortality. A substantial proportion of patients with these conditions also suffer from other co-existing psychiatric disorders, particularly anxiety disorders, which may adversely affect their overall outcome and prognosis. Previous studies have indicated the presence of a high level of heterogeneity regarding the prevalence of comorbidity. This meta-analysis is an attempt to estimate the prevalence of comorbidity between these two conditions by summarising the findings of primary studies. We hope that this review will populate and generate research hypotheses, as well as assist clinicians alike.