Comorbidity of bipolar and anxiety disorders: An overview of trends in research

Table 1 Prevalence of anxiety disorder comorbidity in bipolar disorder: Evidence from meta-analytic and systematic reviews

Details	Any anxiety disorder	Individual anxiety disorders
Meta-analytic reviews
Kowatch et al[29], 2005. 7 studies of child and adolescent BD (n = 362)	Mean prevalence of any anxiety disorder in BD 27% (range 14%-43%)
Vázquez et al[18], 2014. 46 studies of anxiety comorbidity in BD	Lifetime prevalence in epidemiological and clinical studies - mean 47% (range 24%-88%)	Mean prevalence: PD 22% (1%-40%), PHOBIAS 22% (2%-59%), GAD 20% (7%-42%), PTSD 16% (3%-39%), OCD 13% (5%-48%)
Amerio et al[30], 2015. 46 studies of comorbid BD and OCD		Pooled prevalence of OCD in BD 17.0%; pooled prevalence of BD in OCD 18.0%
Nabavi et al[11], 2015. 52 interview-based studies of outpatients and inpatients	Lifetime prevalence of any anxiety disorder in BD 43%	Lifetime prevalence of: PD 17%, GAD 14%, SAD 13%, PTSD 11%, SP PHOBIA 11%, OCD 11%, AGORA 8%
Pavlova et al[19], 2015. 40 studies (n = 14914) of community and clinical population	Lifetime prevalence of anxiety disorder in BD 45%	Lifetime prevalence of: GAD 20%, SOC PHOBIA 20%, PD 19%, PTSD 17%; no differences between BP I and BP II
Tonna et al[31], 2015. 4 studies of adolescent BD- OCD (n = 345)		Pooled prevalence of comorbid OCD in BD among adolescents 23%; greater than adults (14%)
Amerio et al[32], 2016. 14 studies of comorbid BD and OCD in BP I and BP II		Pooled prevalence of OCD in BP I 22%; pooled prevalence of BP I in OCD 4% and of BP II in OCD 13.5%
Preti et al[33], 2016. 28 studies of comorbid BD and GAD (n = 7894)		Current prevalence 12% and lifetime prevalence 15% of GAD in BD
Taskiran et al[34], 2016. 33 studies of child and adolescent BD	Prevalence of any anxiety disorder in BD 44%	Prevalence of: GAD 25%, SEP ANX 22%, OCD 17%, SOC PHOBIA 15%, PD 10%
Pavlova et al[35], 2017. 10 studies of euthymic BD (n = 2120)	Current prevalence of any anxiety disorder in BD 35%	Current prevalence of: GAD 12%, SAD 10%, SP PHOBIA 10%, OCD 7%
Yapici Eser et al[20], 2018. 135 studies of comorbid BD and anxiety disorders	Lifetime prevalence 41% and current prevalence 38% of anxiety disorder in BD; lifetime prevalence 38% in BD I and 34% in BD II; current prevalence 31% in BD I and 37% in BD II	Lifetime prevalence: PD 18%, GAD 13%, SAD 13%, OCD 10%; current prevalence: GAD 15%, PD 13%, SAD 12%, OCD 10%; prevalence PD and SAD significantly affected by proportion of BD I patients
Preti et al[36], 2018. 15 studies of comorbid BD and PD (n = 3391)		Lifetime prevalence: PD 16%; current prevalence: PD 13%; no difference between BP I and BP II
Systematic reviews
Strakowski et al[37], 1994. 4 studies of anxiety comorbidity in BD		Mean prevalence: PD 7%-16%, OCD 8%-13%
Krishnan[38], 2005. 10 studies of anxiety comorbidity in BD	Mean rate 71% (range 49%-92%)	Mean rates: SOC PHOBIA 47%, PTSD 39%, PD 11%, OCD 10%
McIntyre et al[8], 2006. 17 studies of anxiety comorbidity in BD	Lifetime rates 16%-79% in 11 studies; usually 30%50%; current prevalence 15%-56% in 8 studies	AGORA lifetime 22%-62%; current 6%-7%; SP PHOBIA lifetime 2%-67%; current 8% SOC PHOBIA lifetime 4%-47%; current 13%-19% GAD lifetime 3%-43%; current 2%-25% PTSD lifetime 7%-37%; current 4%-40% PD lifetime 2%-38%; current 8%-26% OCD lifetime 2%-31%; current 6%-8%
Tamam[9], 2007. 15 studies of anxiety comorbidity in BD	Lifetime prevalence in epidemiological and clinical studies 24%-93%	Lifetime prevalence of: SOC PHOBIA 5%-47%, PD 6%-43%, OCD 7%-39%, GAD 3%-43%, PTSD 7%-21%
Kauer-Sant'Anna et al[15], 2009. 9 studies of anxiety comorbidity in BD	Lifetime prevalence in epidemiological studies 48%-93%	SP PHOBIA 10%-67%, SOC PHOBIA 8%-47%, PTSD 7%-39%, GAD 3%-42%, PD 5%-33%
Quarantini et al[39], 2009. PTSD prevalence in BD		Lifetime rates of PTSD in BD 16%-39%
Maina et al[16], 2011. 11 studies of anxiety comorbidity in BD	Lifetime prevalence in epidemiological studies 63%-89%; in clinical samples 11%-79%	PD 4%-39%, OCD 3%-35%, GAD 3%-32%, SOC PHOBIA 2%-31%, PTSD 5%-29%
Pallanti et al[40], 2011. 10 studies of comorbid BD and OCD		Lifetime prevalence in epidemiological and clinical studies 15%-35%
Lala et al[41], 2012. 7 studies of elderly patients		PTSD 5%-11%, PD -current 22%, GAD-current 16%, OTHERS 10%-11%
Schaffer et al[10], 2012. 9 studies of anxiety comorbidity in BD	Lifetime prevalence in epidemiological studies 52%-75%	Lifetime prevalence: OCD 10%-25%, PD 14%-27%, PTSD 16%-39%
Latalova et al[22], 2013. 12 studies of anxiety comorbidity in BD	Lifetime prevalence in epidemiological studies 75%; in clinical samples 27%-56%	Lifetime prevalence: SOC PHOBIA 47%-52%, SAD 38%, SP PHOBIA 35%, GAD 30%, PTSD 24% (16%-39%), PD 20%, OCD 14% (3%-35%)
Amerio et al[42], 2014. 64 articles of comorbid BD and OCD		Lifetime prevalence of OCD in BD 11%-21% (mean BP I 15%, BP II 13%); lifetime prevalence of BD in OCD 6%-10% (mean BP I 4%, BP II 9%)
Frías et al[43], 2015. 167 studies of child and adolescent BD	Mean prevalence of any anxiety disorder in BD 54% (range 41%-80%)	GAD and SEP ANX rates higher than other disorders; OCD 36%-39%, PD 18%-23%, PTSD 8%
Sharma[44], 2017. 8 studies of post-partum BD comorbidity		Anecdotal reports of simultaneous onset of comorbid BD-OCD in the postpartum period

BD: Bipolar disorder; BP I: Bipolar disorder subtype I; BP II: Bipolar disorder subtype II; AGORA: Agoraphobia; GAD: Generalized anxiety disorder; OCD: Obsessive compulsive disorder; PD: Panic disorder; PTSD: Post-traumatic stress disorder; SAD: Social anxiety disorder; SEP ANX: Separation anxiety disorder; SOC PHOBIA: Social phobia; SP PHOBIA: Specific phobia.