Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: A Meta-Analysis and Meta-Regression Study
Open accessAbstract
Objective: Bipolar disorder is highly comorbid with anxiety disorders, however current and lifetime comorbidity patterns of each anxiety disorder and their associated features are not well studied. Here, we aimed to conduct a meta-analysis and meta-regression study of current evidence. Method: We searched PubMed to access relevant articles published until September 2015, using the keywords ‘Bipolar disorder’ or ‘Affective Psychosis’ or ‘manic depressive’ separately with ‘generalized anxiety’, ‘panic disorder’, ‘social phobia’, ‘obsessive compulsive’ and ‘anxiety’. Variables for associated features and prevalence of anxiety disorders were carefully extracted. Results: Lifetime any anxiety disorder comorbidity in BD was 40.5 %; panic disorder (PD) 18.1 %, generalized anxiety disorder (GAD) 13.3 %, social anxiety disorder (SAD) 13.5 % and obsessive compulsive disorder (OCD) 9.7 %. Current any anxiety disorder comorbidity in BD is 38.2 %; GAD is 15.2 %, PD 13.3 %, SAD 11.7 % and OCD 9.9%. When studies reporting data about comorbidities in BDI or BDII were analyzed separately, lifetime any anxiety disorder comorbidity in BDI and BDII were 38 % and 34 %, PD was 15 % and 15 %, GAD was 14 % and 16.6 %, SAD was 8 % and 13 %, OCD was 8 % and 10 %, respectively. Current any DSM anxiety disorder comorbidity in BDI or BDII were 31 % and 37 %, PD was 9 % and 13 %, GAD was 8 % and 12 %, SAD was 7 % and 11 %, and OCD was 8 % and 7 %, respectively. The percentage of manic patients and age of onset of BD tended to have a significant impact on anxiety disorders. Percentage of BD I patients significantly decreased the prevalence of panic disorder and social anxiety disorder. A higher rate of substance use disorder was associated with greater BD – SAD comorbidity. History of psychotic features significantly affected current PD and GAD. Conclusions: Anxiety disorder comorbidity is high in BD with somewhat lower rates in BDI vs BDII. Age of onset, substance use disorders, and percentage of patients in a manic episode or with psychotic features influences anxiety disorder comorbidity.
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These associations are stronger for social anxiety disorder than for any other anxiety disorder in people with bipolar disorder.
“These associations were stronger for social anxiety disorder than for any other anxiety disorder (Perroud et al. 2007; Yapici Eser et al. 2018; Kocabas et al. 2019).”
From Cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder: a case series (2024) · cites this paper as Yapici Eser et al. 2018
The Results (Meta-regression analysis; page unavailable) report an association between substance use disorder and social anxiety disorder comorbidity in people with bipolar disorder. The paper does not establish that the associations referred to in the citing sentence are stronger for social anxiety disorder than for every other anxiety disorder. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSocial anxiety disorder is associated with substance use problems in people with bipolar disorder.
“Several investigations have linked social anxiety disorder with increased rates of suicidal ideation and behaviour (Perroud et al. 2007; Kocabas et al. 2019; Amuk and Patel 2020; Masi et al. 2021), as well as with substance use problems (Yapici Eser et al. 2018) in people with bipolar disorder.”
From Cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder: a case series (2024) · cites this paper as Yapici Eser et al. 2018
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McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31544-0 · Cited by 1,047 · see citing works
Comorbidity of bipolar and anxiety disorders: An overview of trends in research
Spoorthy, M. S., Chakrabarti, S., & Grover, S. (2018) · World Journal of Psychiatry · doi:10.5498/wjp.v9.i1.7 · Cited by 125 · see citing works
Genetic contributions to bipolar disorder: current status and future directions
O’Connell, K. S., & Coombes, B. J. (2021) · Psychological Medicine · doi:10.1017/s0033291721001252 · Cited by 115 · see citing works
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The Impact of Subsyndromal Bipolar Symptoms on Patient’s Functionality and Quality of Life
Grunze, H., & Born, C. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00510 · Cited by 46 · see citing works
Pati, S., Mahapatra, P., Dwivedi, R., Athe, R., Sahoo, K. C., Samal, M., Das, R. C., & Hussain, M. A. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2020.616480 · Cited by 45 · see citing works
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Bipolar II disorder: a state‐of‐the‐art review
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Anxiety and Compulsive Sexual Behavior Disorder: A Systematic Review
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Comorbidities in Youth with Bipolar Disorder: Clinical Features and Pharmacological Management
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Ferroptosis as a potential molecular mechanism of bipolar disorder
Yehia, A., Beaupre, L. M., Ho, A. M., Biernacka, J. M., Frye, M. A., & Abulseoud, O. A. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03429-w · Cited by 17 · see citing works
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Comparison of Emotional Dysregulation Features in Cyclothymia and Adult ADHD
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Impact of comorbid obsessive-compulsive disorder on suicidality in patients with bipolar disorder
Salvo, G. D., Pessina, E., Aragno, E., Martini, A., Albert, U., Maina, G., & Rosso, G. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113088 · Cited by 14 · see citing works
Seeberg, I., Nielsen, I., Jørgensen, C., Eskestad, N., & Miskowiak, K. W. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.119 · Cited by 13 · see citing works
Yoldi‐Negrete, M., Morera, D., Palacios‐Cruz, L., Camarena, B., Ortega, H., Castañeda-Franco, M., Becerra‐Palars, C., Martino, D., Strejilevich, S., & Fresán, A. (2019) · The European Journal of Psychiatry · doi:10.1016/j.ejpsy.2019.06.005 · Cited by 11 · see citing works
Burgos‐Julián, F. A., Ruiz‐Íñiguez, R., Peña‐Ibáñez, F., Montero, A. C., & Santed‐Germán, M. A. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2717 · Cited by 10 · see citing works
Engelhardt, C. L., Meier, M., Keller, S., & Laireiter, A. (2024) · PLoS ONE · doi:10.1371/journal.pone.0299803 · Cited by 10 · see citing works
Huang, C., Chang, Y., Wang, T., Lee, S.-Y., Chen, S., Chen, P. S., Lane, H., Yang, Y. K., & Lu, R. (2020) · Brain and Behavior · doi:10.1002/brb3.1813 · Cited by 10 · see citing works
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Translating Molecular Psychiatry: From Biomarkers to Personalized Therapies—A Narrative Review
Capatina, T.-F., Oatu, A., Babasan, C., & Trifu, S. C. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26094285 · Cited by 9 · see citing works
Cotrena, C., Branco, L. D., Ponsoni, A., Shansis, F., & Fonseca, R. P. (2021) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2021.1981251 · Cited by 9 · see citing works
Caricasole, V., Bernardo, I. D., Varinelli, A., Galimberti, C., Zanello, R., Bosi, M. F., Ketter, T. A., Viganò, C. A., & Dell’Osso, B. M. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.07.033 · Cited by 9 · see citing works
Social cognition in bipolar I and II disorders: an updated systematic review and meta-analysis
Zhang, B., Chen, X., & Qiu, N. (2025) · BMC Psychiatry · doi:10.1186/s12888-024-06462-z · Cited by 8 · see citing works
Boisvert, M., Dugre, J. R., & Potvin, S. (2024) · Psychological Medicine · doi:10.1017/s003329172400165x · Cited by 8 · see citing works
Galimberti, C., Caricasole, V., Bosi, M. F., Viganò, C. A., Ketter, T. A., & Dell’Osso, B. M. (2019) · Early Intervention in Psychiatry · doi:10.1111/eip.12900 · Cited by 8 · see citing works
Tu, E.-N., Manley, H., Saunders, K. E. A., & Creswell, C. (2023) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2023.06.022 · Cited by 7 · see citing works
Dsm-5 Anxious Distress Specifier in Patients with Bipolar Depression
Zimmerman, M. A., Kerr, S., Balling, C. E., Kiefer, R., & Dalrymple, K. L. (2020) · Annals of Clinical Psychiatry · doi:10.1177/104012372003200216 · Cited by 7 · see citing works
Improving Psychiatry Services with Artificial Intelligence: Opportunities and Challenges
Eser, H. Y., BALLI, M., & DOĞAN, A. E. (2024) · Turkish Journal of Psychiatry · doi:10.5080/u27604 · Cited by 6 · see citing works
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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 · see citing works
Pavlova, B., Warnock-Parkes, E., Alda, M., Uher, R., & Clark, D. M. (2024) · International Journal of Bipolar Disorders · doi:10.1186/s40345-023-00321-8 · Cited by 5 · see citing works
Brancati, G. E., Cosentino, V., Barbuti, M., Weiss, F., Calderone, A., Fierabracci, P., Salvetti, G., Santini, F., & Perugi, G. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07308-z · Cited by 5 · see citing works
Ko, H., Park, D., Shin, J. H., Yu, R., Ryu, V., & Lee, W. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.951043 · Cited by 5 · see citing works
Examining Patterns of Polypharmacy in Bipolar Disorder: Findings from the REAP-BD, Korea
Kim, K., Yang, H., Na, E., Lee, H., Jang, O., Yoon, H., Oh, H. S., Ham, B., Park, S., Lin, S., et al. (2019) · Psychiatry Investigation · doi:10.30773/pi.2019.02.26.4 · Cited by 5 · see citing works
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 · see citing works
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 · see citing works
Olgiati, P., Luca, M., Luca, A., Messina, A., Souery, D., Kasper, S. F., Zohar, J., Montgomery, S., Ferentinos, P. P., Rujescu, D., et al. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121308 · Cited by 4 · see citing works
Unraveling the Mysteries of Mental Illness With Psilocybin
Sottile, R., Singh, H., Weisman, A., & Vida, T. A. (2022) · Cureus · doi:10.7759/cureus.25414 · Cited by 4 · see citing works
Cetkovich, M., Abadi, A. F., Camino, S., Bonetto, G. G., Herbst, L., Marengo, E., Torrente, F. M., Maresca, T., Bustin, J., Morra, C. A., et al. (2022) · Vertex Revista Argentina de Psiquiatría · doi:10.53680/vertex.v33i158.319 · Cited by 4 · see citing works
[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 · see citing works
Zhang, Z., & Das, S. (2024) · Discover Mental Health · doi:10.1007/s44192-024-00070-9 · Cited by 3 · see citing works
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 · see citing works
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 · see citing works
Conceptualization of comorbid anxiety and depressive disorders and approaches to their managing
Malygin, Y. V., Orlova, A. S., & Vl, M. (2022) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202212206148 · Cited by 3 · see citing works
Chen, S.-P., Yang, S., Hu, K.-C., Satyanarayanan, S. K., & Su, K. (2024) · Healthcare · doi:10.3390/healthcare12040490 · Cited by 3 · see citing works
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 3 · see citing works
Diagnostic Criteria and Epidemiology of Bipolar Disorders
Morton, E. E., & Murray, G. (2024) · Springer eBooks · doi:10.1007/978-3-031-63349-2_2 · Cited by 2 · see citing works
Inoue, T., Masuda, T., Sano, F., & Maruyama, H. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.05.008 · Cited by 2 · see citing works
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Onset of bipolar disorder by COVID-19: The roles of endogenous ouabain and the Na,K-ATPase
de Jesus, L. C., Gonçalves-de-Albuquerque, C. F., & Burth, P. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.08.035 · Cited by 2 · see citing works
Svee, K. T., Morken, G., Hansen, T. I., & Engum, A. (2025) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.70031 · Cited by 2 · see citing works
Anxiety Disorders in General Practice
Дзяк, Л. А., & Tsurkalenko, O. S. (2018) · Family Medicine · doi:10.30841/2307-5112.4.2018.160701 · Cited by 2 · see citing works
Heterogeneity analysis provides evidence for a genetically homogeneous subtype of bipolar-disorder
McGrouther, C. C., Rangan, A. V., Florio, A. D., Elman, J. A., Schork, N. J., & Kelsoe, J. R. (2025) · PLoS ONE · doi:10.1371/journal.pone.0314288 · Cited by 2 · see citing works
Choi, K. (2022) · Psychiatry Investigation · doi:10.30773/pi.2022.0113 · Cited by 2 · see citing works
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 · see citing works
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 · see citing works
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Anxiety comorbidity in older adults with bipolar disorders: Overlooked and underappreciated
Aftab, A., & Sajatovic, M. (2019) · Bipolar Disorders · doi:10.1111/bdi.12741
Sharma, R. (2020) · Scientific Reports · doi:10.1038/s41598-020-76605-1
SINDROME DE BURNOUT EN PERSONAL DE ENFERMERIA DE UN HOSPITAL RECONVERTIDO A COVID-19
Juárez, C. L., González, S. H., & Chávez, S. M. (2021) · doi:10.22533/at.ed.70321221124
The Literal Review of Panic Disorder and Comorbidity
Wu, T., & Yang, Y. (2021) · Advances in Social Science, Education and Humanities Research/Advances in social science, education and humanities research · doi:10.2991/assehr.k.211220.373
Managing anxiety disorders in bipolar patients
Bourin, M. (2023) · Archives of Depression and Anxiety · doi:10.17352/2455-5460.000078
Treatment Over the Lifespan in Bipolar Disorder
Reif, A., Popović, D., & RYBAKOWSKI, J. K. (2023) · Frontiers research topics · doi:10.3389/978-2-8325-3212-6
Tüm Hekimler İçin Poliklinik Koşullarında Hayati Psikiyatrik Bilgi ve Beceriler
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Muhammad, Y. A. (2026) · Frontiers in Integrative Neuroscience · doi:10.3389/fnint.2026.1775109
Investigation of polygenic risk scores and subphenotypes in social anxiety disorder
Sindermann, L., Röhrig, A., David, F. S., Schmidt, B., Domschke, K., Nieratschker, V., Dannlowski, U., Leehr, E. J., Leibing, E., Nöthen, M. M., et al. (2026) · Translational Psychiatry · doi:10.1038/s41398-026-04155-7
Gomez, R., & Houghton, S. D. (2026) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs.20260012
The role of intolerance of uncertainty in bipolar disorder
Maratchi, L., Richardson, T. H., & Morriss, J. (2026) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.70115
Sim, J. R. Q., & Zainal, N. H. (2026) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2026.108353
Wei, Y., Shi, Z., & Shen, Y. (2026) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2026.2751476
- Authors
- Yapici Eser, H., Kacar, A. S., Kilciksiz, C. M., Yalçinay-Inan, M., & Ongur, D.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2018-06-27
- Volume
- 9
- Pages
- 229-229
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC6030835
- OpenAlex
- W2809991248
- Cited by
- 83
- References
- 168
- Citations by year
- 2026: 12 · 2025: 11 · 2024: 14 · 2023: 4 · 2022: 8 · 2021: 9 · 2020: 15 · 2019: 7 · 2018: 2
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Collections portal (Koç University) (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi
- 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 disorder comorbidity, generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, age of onset, substance use disorders, psychotic features, manic episodes, lifetime prevalence, current prevalence, DSM-IV-TR diagnostic criteria, ICD-10 diagnostic criteria, psychiatric comorbidity
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