The DOI matches its Crossref record; 52 of the 52 references it cites were found in a registry or an index.
Lifetime prevalence of anxiety disorders in people with bipolar disorder: a systematic review and meta-analysis
Abstract
Background Anxiety disorders are increasingly recognised as an important determinant of outcomes in patients with bipolar disorder. However, a reliable estimate of their prevalence is still missing, because the published prevalence of anxiety disorders in individuals with bipolar disorder varies widely. In this study, we aimed to quantify the lifetime prevalence of anxiety disorders in individuals with bipolar disorder and compare it with rates in people without the disorder.Methods We searched the Web of Knowledge and Medline (through the PubMed interface) for articles published in any language from the database inception dates up until June 1, 2014, using a combination of the word "bipolar" and search terms for anxiety disorders. We included studies that reported original data about the lifetime prevalence of DSM-III and DSM-IV anxiety disorders in adults with bipolar disorder that recruited participants irrespective of comorbidities and that used a validated diagnostic interview to establish the diagnoses of bipolar disorder and at least one anxiety disorder. We excluded studies that reported only the current prevalence or if we were unable to establish whether they described current or lifetime prevalence, and those with discrepancies in the data that could not be resolved by contacting the authors. We did a random-effects meta-analysis of lifetime prevalence of DSM-III and DSM-IV anxiety disorders in adults with bipolar disorder, in which we quantified the lifetime prevalence of any anxiety disorder in people with bipolar disorder. We compared this prevalence in people with bipolar I disorder versus those with bipolar II disorder, and in people with bipolar disorder versus population controls.Findings Data from 40 studies, including 14 914 individuals from North America, Europe, Australia, South America, and Asia, indicate that the lifetime prevalence of anxiety disorders in individuals with bipolar disorder is 45% (95% CI 40-51). Direct comparison in five samples with a total of 1378 individuals with bipolar disorder and 56 812 population controls without bipolar disorder indicates a three-fold increase (risk ratio [RR] 3·22 [95% CI 2·41-4·29]; p<0·0001) in the prevalence of anxiety disorders in those with bipolar disorder. 13 studies that included both individuals with bipolar I disorder (n=4270) and those with bipolar II disorder (n=1939) showed no difference in the lifetime prevalence of anxiety disorders between these subtypes (RR 1·07 [95% CI 0·96-1·20]; p=0·223). We noted significant heterogeneity among included studies that was not accounted for by reported differences in study characteristics.Interpretation People with bipolar disorder are at increased risk of anxiety disorders compared with those without bipolar disorder; nearly one in two has an anxiety disorder in their lifetime. Anxiety disorders should therefore be assessed alongside the mood symptoms in patients with bipolar disorder.Funding Capital Health Research Fund.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“20% of people with bipolar disorder have a lifetime diagnosis of social anxiety disorder (Pavlova et al. 2015)”
From Cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder: a case series (2024) · cites this paper as Pavlova et al. 2015
In the citing paper
“and comorbid diagnoses including anxiety disorders (Pavlova, Perlis, Alda, & Uher, 2015), substance use disorders (Merikangas et al., 2007) and eating disorders (Seixas et al., 2012).”
From What are People's Experiences of a Novel Cognitive Behavioural Therapy for Bipolar Disorders? A Qualitative Investigation with Participants on the TEAMS Trial. (2017) · cites this paper as Pavlova, Perlis, Alda, & Uher, 2015
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.005 · Cited by 19,575
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.617 · Cited by 12,052
Diagnostic and Statistical Manual of Mental Disorders(DSM)
Leong, F. T. L. (2008) · Sage eBooks · doi:10.4135/9781412963978.n182 · Cited by 10,861
Yatham, L. N., & Malhi, G. S. (2011) · Oxford University Press eBooks · doi:10.1093/med/9780199562305.001.0001 · Cited by 3,515
Merikangas, K. R., Akiskal, H. S., Angst, J., Greenberg, P. E., Hirschfeld, R. M. A., Petukhova, M., & Kessler, R. C. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.5.543 · Cited by 2,399
Cited by
Sorted by citations
Items 101–153 of 153
Properties of common anxiety scales among patients with bipolar disorder
Seon, Q., Hum, S., Tuineag, M., Pavlová, B., Beaulieu, S., & Mantere, O. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.139 · Cited by 5
Bipolar Disorder: Comorbidity with Other Mental Disorders
Васильева, С. Н., Simutkin, G. G., Schastnyy, E. D., Лебедева, Е. В., & Bokhan, N. A. (2021) · Psikhiatriya · doi:10.30629/2618-6667-2021-19-3-15-21 · Cited by 6
Berkol, T. D., & Aytaç, H. M. (2021) · Eurasian Journal of Medicine · doi:10.5152/eurasianjmed.2021.20270 · Cited by 5
Dsm-5 Anxious Distress Specifier in Patients with Bipolar Depression
Zimmerman, M., Kerr, S., Balling, C. E., Kiefer, R., & Dalrymple, K. L. (2020) · Annals of Clinical Psychiatry · doi:10.1177/104012372003200304 · Cited by 5
Elkington, S., Brown, M. C., Wright, K. A., Regan, J. L., Pattarnaraskouwski, K., Steel, C., Hales, S. A., Holmes, E. A., & Morant, N. J. (2024) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12538 · Cited by 4
Tarchi, L., Bugini, S., Dani, C., Cassioli, E., Rossi, E., Lucarelli, S., Ricca, V., Caini, S., & Castellini, G. (2024) · CNS Drugs · doi:10.1007/s40263-024-01125-9 · Cited by 9
Recognizing the Extent of Overlap Between Bipolar Disorder and Anxiety Disorders
Ketter, T. A. (2015) · EBioMedicine · doi:10.1016/j.ebiom.2015.09.022 · Cited by 4
Scott, J. L., Vorspan, F., Loftus, J., Bellivier, F., & Étain, B. (2021) · International Journal of Bipolar Disorders · doi:10.1186/s40345-021-00234-4 · Cited by 4
[Binding of ribosomal RNAs with ribosomal proteins covalently bound to polymer carriers].
Spiridonova, V. A., Djenge, L., & Bogdanov, A. A. (1975) · PubMed · Cited by 4
Skelton, M., Mitchell, B. L., Assary, E., Li, D., Morneau‐Vaillancourt, G., Murphy, A. E., ter Kuile, A., Wang, R., Adams, M. J., Byrne, E. M., et al. (2026) · Nature Human Behaviour · doi:10.1038/s41562-026-02476-7 · Cited by 4
Wang, Y., Liu, J., Zhang, R., Luo, G., & Sun, D. (2025) · Journal of Neural Transmission · doi:10.1007/s00702-024-02876-x · Cited by 3
Takaesu, Y., Shiroma, A., Nosaka, T., & Maruyama, H. (2025) · Neuropsychopharmacology Reports · doi:10.1002/npr2.70012 · Cited by 3
Rate of OCD and sub-threshold OCD in bipolar disorder patients with first depressive episode
Braverman, L., Fuchs, C., Weizman, A., & Poyurovsky, M. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.114010 · Cited by 3
Nunnink, M., Ballester, L., Vilagut, G., Alayo, I., Mortier, P., Almenara, J., Cebrià, A. I., Gabilondo, A., Gili, M., Lagares, C., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120058 · Cited by 4
Herrera, M. (2018) · Springer eBooks · doi:10.1007/978-3-319-74391-2_2 · Cited by 3
Morejón, A. J. V., Jackson, C., Vázquez-Morejón, R., & Pérez, J. (2022) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465822000248 · Cited by 2
Diagnosis, Clinical Features, Differential Diagnosis, and Psychiatric Comorbidities
Vasconcelos-Moreno, M. P., Pinto, J. V., Hasse-Sousa, M., Melo, I. M. D. S., Saviatto, N. G., Lucas, P. K., Baldez, D. P., Passos, I. C., & Kapczinski, F. P. (2025) · Springer eBooks · doi:10.1007/978-3-031-85519-1_6 · Cited by 4
Hao, Y., Yao, W., & Zou, S. (2025) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2025.12894 · Cited by 2
Takaesu, Y., Shiroma, A., & Nosaka, T. (2025) · Neuropsychopharmacology Reports · doi:10.1002/npr2.70036 · Cited by 1
Holborn, T., Schifano, F., Smith, E., & Deluca, P. (2025) · Psychoactives · doi:10.3390/psychoactives4030028 · Cited by 4
Terrien, S., & Besche‐Richard, C. (2018) · Dunod eBooks · doi:10.3917/dunod.besce.2018.01.0053 · Cited by 2
Li, G., Zhang, B., Long, M., & Ma, J. (2023) · Neuroreport · doi:10.1097/wnr.0000000000001896 · Cited by 2
Clinical dynamics of affective episodes in bipolar disorder
Osipova, N. N., Beglyankin, N. I., Roganov, D. A., Klyachin, V. A., & Bardenshteyn, L. M. (2022) · Russian Medicine · doi:10.17816/medjrf108906 · Cited by 1
Local brain abnormalities in emotional disorders: Evidence from resting state fMRI studies
Jia, X., Li, M.-T., Wang, C., Antwi, C. O., Darko, A. P., Zhang, B., & Ren, J. (2024) · Wiley Interdisciplinary Reviews Cognitive Science · doi:10.1002/wcs.1694 · Cited by 1
Melson, A. J., Wetherall, K., O’Neill, K., Maxwell, M., Calveley, E., McCoy, M., & O’Connor, R. C. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12469-3 · Cited by 3
Saxena, A., Saxena, S., Saxena, Y., Jain, A., Goyal, P., Kumar, A., Mishra, S., & Kumar, S. S. (2025) · Journal for Research in Applied Sciences and Biotechnology · doi:10.55544/jrasb.4.5.1 · Cited by 1
Kessing, L. V. (2025) · Danish Medical Journal · doi:10.61409/a07250539 · Cited by 1
Genome-wide genetic overlap between fear-based disorders and generalised anxiety disorder
ter Kuile, A., Mitchell, B. L., Lee, S. H., Morneau‐Vaillancourt, G., Skelton, M., Coleman, J. R. I., Davies, H. L., Mundy, J., Peel, A. J., Hübel, C., et al. (2026) · Molecular Psychiatry · doi:10.1038/s41380-026-03677-2 · Cited by 1
Ansari, M. I., Sperry, S. D., Leontieva, L., & Megna, J. L. (2023) · Cureus · doi:10.7759/cureus.49626 · Cited by 1
Salient 40 Hz sounds probe affective aversion and neural excitabilityPreprint
Schneefeld, F., Doelling, K. B., Marchesotti, S., Schwartz, S., Iglói, K., Giraud, A., & Arnal, L. H. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.02.26.482077 · Cited by 1
Developmental Considerations in Bipolar Disorder
Goetz, M., Mohaplová, M., Šebela, A., & Novák, T. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-815310-9.00002-2
Berardis, D. D., Fornaro, M., Orsolini, L., Vellante, F., Carano, A., Valchera, A., Tomasetti, C., Martinotti, G., & Di Giannantonio, M. (2018) · Bipolar Disorder Open Access · doi:10.4172/2472-1077.1000123
Zhang, Y., Ren, R., Lei, F., Zhou, J., Zhang, J., Wing, Y. K., Sanford, L. D., & Tang, X. (2019) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2019.04.002
Comparison of Religious Teaching with Muscle Relaxation Methods on Anxiety Patients
Ghasbe, F. A., Khodadadi‐Hassankiadeh, N., Yousefzadeh-Chabok, S., Reihanian, A., & Shirkouhi, S. G. (2019) · Caspian Journal of Neurological Sciences · doi:10.32598/cjns.5.17.73
Nagata, T. (2019) · Anxiety Disorder Research · doi:10.14389/jsad.11.1_24
Suicidal behaviour and bipolar disorder
Vinberg, M., & Nordentoft, M. (2021) · doi:10.1093/med/9780198834441.003.0035
Birkenæs, A. V. J. (2020) · NORA - Norwegian Open Research Archives
Digital phenotyping of complex psychological responses to the COVID-19 pandemicPreprint
Hull, T. D., Levine, J., Bantilan, N., Desai, A. N., & Majumder, M. S. (2020) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/qtrpf
Sperry, S. H., Stromberg, A. R., Murphy, V., Lasagna, C. A., Menkes, M. W., McInnis, M. G., Yocum, A. K., & Tso, I. F. (2023) · doi:10.31234/osf.io/9tnjr
Managing anxiety disorders in bipolar patients
Bourin, M. (2023) · Archives of Depression and Anxiety · doi:10.17352/2455-5460.000078
Solerdelcoll, M., Baeza, I., & Sugranyes, G. (2024) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2024.01.001
Making Sense of the Senseless: How to Gather and Organize Pertinent Information
Goldberg, J. F., & Stahl, S. M. (2024) · Cambridge University Press eBooks · doi:10.1017/9781009181549.003
The Emergence of Mania After Initiating Escitalopram for Anxiety Disorder
Surineni, K., Armstrong, A. G., Wallace, S., & Schrader, N. (2024) · Cureus · doi:10.7759/cureus.63441
Working with Anxiety Disorders in Bipolar Disorder
Provencher, M. D., Garceau, L., & Jones, S. H. (2024) · Springer eBooks · doi:10.1007/978-3-031-63349-2_19
Richardson, T. H., Wright, K. A., Strawbridge, R., Wheatley, J., & Chong, Y. (2025) · Mental Health Science · doi:10.1002/mhs2.70016
Troubles anxieux et troubles bipolaires
Godier, É., Dejean, D., Ifrah, G., & Gohier, B. (2023) · Elsevier eBooks · doi:10.1016/b978-2-294-77180-4.00031-7
Steel, C., Wright, K., Goodwin, G., Simon, J., Morant, N. J., Taylor, R., Brown, M. C., Jennings, S., Hales, S. A., & Holmes, E. A. (2020) · Figshare · doi:10.6084/m9.figshare.12486929
Jensen, R., Pedersen, S., Almer, G. M., Wagner, C., & Vinberg, M. (2026) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2026.2629872
The anxious bipolar phenotype: clinical complexity and treatment response
Singh, B., Ho, A. M., Coombes, B. J., Romo‐Nava, F., Barboza, A. B. C., Gardea‐Resendez, M., Bond, D. J., Prieto, M. L., Veldić, M., Pendegraft, R., et al. (2026) · International Journal of Bipolar Disorders · doi:10.1186/s40345-026-00415-z · Cited by 1
Shelepin, K. Y., Shelepin, E. Y., Андреевна, С. К., Zubko, V. M., & Chausov, A. (2026) · Психиатрия психотерапия и клиническая психология · doi:10.34883/pi.2026.17.1.014
Yin, M., Zhang, H., Pei, H., Zhou, R., Lu, W., Wu, B., Xu, T., Wu, Y., Du, X., & Peng, D. (2026) · ALPHA PSYCHIATRY · doi:10.31083/ap52059
Metadata
- Authors
- Pavlova, B., Perlis, R. H., Alda, M., & Uher, R.
- Affiliations
- Massachusetts General Hospital (US)
- Dalhousie University (CA)
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 2
- Issue
- 8
- Pages
- 710-717
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W1931775200
- Cited by
- 153
- References
- 52
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 15 · 2023: 16 · 2022: 8 · 2021: 13 · 2020: 22 · 2019: 12 · 2018: 17 · 2017: 16 · 2016: 10 · 2015: 3
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- bipolar disorder, anxiety disorders, lifetime prevalence, comorbidities, bipolar I disorder, bipolar II disorder, psychiatric comorbidity, relative risk, mental health service utilization, quality of life, social functioning
- MeSH terms
- Adult, Anxiety Disorders, Bipolar Disorder, Female, Humans, Male, Risk, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
