Bipolar mood episodes can show up as depression, mania, or mixed episodes that contain symptoms of both depression and mania.
Mood episodes were more likely to show up again in people who had more limited access to services because they lived in rural areas and in people who were more severely disabled by their condition.
People with these risk factors could be the target of new interventions.
"Discuss bipolar symptoms with a psychiatrist."
Researchers, led by Dr. Conseulo de Dios, of the University Hospital La Paz in Madrid Spain, conducted a study to find out what might predict relapse of bipolar mood episodes.
They enrolled 593 patients with bipolar disorder who attended outpatient treatments at clinics in Spain and who had remission from bipolar symptoms for at least two months. About 85 percent of the patients in this study had bipolar disorder type I.
The study was naturalistic, so patients could continue with any treatments or medications they chose. The researchers followed patients for one year and assessed them every three months for mood symptoms and recurrence of mood episodes.
Within the one year follow-up period, 23.7 percent of the patients had at least one mood episode.
Patients who relapsed were more likely to have severe disability at the start of the study and to have a higher number of past mood episodes.
The patients who were working were less likely to relapse.
People who lived in rural areas or small towns were 57 percent more likely to relapse. People in cities over with populations over 100,000 used more services, like seeing psychiatrists and having blood tests.
The authors note that there is often less access to specialized care in small towns and rural areas compared to larger cities. This fact may influence the overall health and relapse rates for people with bipolar disorder.
New interventions or support systems could target people with these risk factors to help lower the likelihood that bipolar symptoms relapse.
The results of this study were published online ahead of print in May in the Journal of Affective Disorders.
This study was funded by AstraZeneca. Authors in this study report financial affiliations with Pfizer, Bristol-Meyers Squibb, Eli Lilly, GlaxoSmithKline, among others.