Skip to main content Accessibility help

Psychoeducation for bipolar disorder and risk of recurrence and hospitalization – a within-individual analysis using registry data

  • Erik Joas (a1), Kristoffer Bäckman (a1), Alina Karanti (a1), Timea Sparding (a1), Francesc Colom (a2), Erik Pålsson (a1) and Mikael Landén (a1) (a3)...



The efficacy of psychoeducation for bipolar disorder has been demonstrated in clinical trials, but it is not known if the results translate into effectiveness in routine clinical practice. The aim was to determine the effectiveness of psychoeducation for bipolar disorder in a routine clinical setting.


We identified 2819 patients with at least three registrations in the Swedish Quality Assurance Register for Bipolar Disorder. Among those, 402 had not been exposed to psychoeducation at the first visit, but received psychoeducation during any of the following registrations. Using within-individual analyses, the risk of recurrence after having received psychoeducation was compared with the risk prior to psychoeducation.


In adjusted within-individuals comparisons, periods after psychoeducation was associated with decreased risks of any recurrence [odds ratio (OR) 0.57, 95% CI 0.42–0.78], (hypo-)manic or mixed episodes (OR 0.54, 95% CI 0.39–0.76), depressive episodes (OR 0.63, 95% CI 0.47–0.86), and inpatient care (OR 0.54, 95% CI 0.33–0.86) relative to periods prior to psychoeducation. There was no association with rates of involuntary sectioning or suicide attempts.


The results suggest that psychoeducation for bipolar disorder reduces the risk of mood episodes and inpatient care also when implemented in routine clinical practice.


Corresponding author

Author for correspondence: Mikael Landén, E-mail:


Hide All
Allison, PD (2006) Fixed effects regression methods in SAS (Paper 184–31). In Proceedings of the 31st Annual SAS users group international conference, SAS Institute Inc., Cary, NC, pp. 120.
Askland, D and Ahmad Sadik, N (2016) Patientutbildning för personer med bipolär sjukdom: Upplägg och innehåll av utbildningar inom psykiatrisk öppenvård [Psychoeducation for individuals with bipolar disorders: Design and content of education in specialized psychiatric care] University West. Degree Project for Postgraduate Programme in Specialist Nursing in Psychiatry. (Accessed 31 January 2017).
Bond, K and Anderson, IM (2015) Psychoeducation for relapse prevention in bipolar disorder: a systematic review of efficacy in randomized controlled trials. Bipolar Disorders 17, 349362.
Cakir, S, Bensusan, R, Akca, ZK and Yazici, O (2009) Does a psychoeducational approach reach targeted patients with bipolar disorder? Journal of Affective Disorders 119, 190193.
Candini, V, Buizza, C, Ferrari, C, Caldera, MT, Ermentini, R, Ghilardi, A, Nobili, G, Pioli, R, Sabaudo, M and Sacchetti, E (2013) Is structured group psychoeducation for bipolar patients effective in ordinary mental health services? A controlled trial in Italy. Journal of Affective Disorders 151, 149155.
Colom, F, Vieta, E, Martinez-Aran, A, Reinares, M, Goikolea, JM, Benabarre, A, Torrent, C, Comes, M, Corbella, B, Parramon, G and Corominas, J (2003 a) A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Archives of General Psychiatry 60, 402407.
Colom, F, Vieta, E, Reinares, M, Martinez-Aran, A, Torrent, C, Goikolea, JM and Gasto, C (2003 b) Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement. Journal of Clinical Psychiatry 64, 11011105.
Colom, F, Vieta, E, Sánchez-Moreno, J, Martínez-Arán, A, Reinares, M, Goikolea, J and Scott, J (2005) Stabilizing the stabilizer: group psychoeducation enhances the stability of serum lithium levels. Bipolar Disorders 7, 3236.
Colom, F, Vieta, E, Sanchez-Moreno, J, Goikolea, JM, Popova, E, Bonnin, CM and Scott, J (2009) Psychoeducation for bipolar II disorder: an exploratory, 5-year outcome subanalysis. Journal of Affective Disorders 112, 3035.
de Barros Pellegrinelli, K, de, OCLF, Silval, KI, Dias, VV, Roso, MC, Bandeira, M, Colom, F and Moreno, RA (2013) Efficacy of psychoeducation on symptomatic and functional recovery in bipolar disorder. Acta Psychiatrica Scandinavica 127, 153158.
Eker, F and Harkin, S (2012) Effectiveness of six-week psychoeducation program on adherence of patients with bipolar affective disorder. Journal of Affective Disorders 138, 409416.
Goodwin, GM, Haddad, PM, Ferrier, IN, Aronson, JK, Barnes, T, Cipriani, A, Coghill, DR, Fazel, S, Geddes, JR, Grunze, H, Holmes, EA, Howes, O, Hudson, S, Hunt, N, Jones, I, Macmillan, IC, McAllister-Williams, H, Miklowitz, DR, Morriss, R, Munafo, M, Paton, C, Saharkian, BJ, Saunders, K, Sinclair, J, Taylor, D, Vieta, E and Young, AH (2016) Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 30, 495553.
Halekoh, U, Højsgaard, S and Yan, J (2006) The R package geepack for generalized estimating equations. Journal of Statistical Software 15, 111.
Joas, E, Karanti, A, Song, J, Goodwin, GM, Lichtenstein, P and Landén, M (2017) Pharmacological treatment and risk of psychiatric hospital admission in bipolar disorder. British Journal of Psychiatry 210, 197202.
Karanti, A, Bobeck, C, Osterman, M, Kardell, M, Tidemalm, D, Runeson, B, Lichtenstein, P and Landén, M (2015) Gender differences in the treatment of patients with bipolar disorder: a study of 7354 patients. Journal of Affective Disorders 174, 303309.
Karanti, A, Kardell, M, Lundberg, U and Landén, M (2016) Changes in mood stabilizer prescription patterns in bipolar disorder. Journal of Affective Disorders 195, 5056.
Michalak, EE, Yatham, LN, Wan, D and Lam, RW (2005) Perceived quality of life in patients with bipolar disorder. Does group psychoeducation have an impact. The Canadian Journal of Psychiatry 50, 95100.
Morriss, R, Lobban, F, Riste, L, Davies, L, Holland, F, Long, R, Lykomitrou, G, Peters, S, Roberts, C, Robinson, H and Jones, S (2016) Clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder (PARADES): a pragmatic, multicentre, observer-blind, randomised controlled superiority trial. The Lancet Psychiatry 3, 10291038.
Pallaskorpi, S, Suominen, K, Ketokivi, M, Mantere, O, Arvilommi, P, Valtonen, H, Leppamaki, S and Isometsa, E (2015) Five-year outcome of bipolar I and II disorders: findings of the Jorvi Bipolar Study. Bipolar Disorders 17, 363374.
Parikh, SV, Zaretsky, A, Beaulieu, S, Yatham, LN, Young, LT, Patelis-Siotis, I, Macqueen, GM, Levitt, A, Arenovich, T, Cervantes, P, Velyvis, V, Kennedy, SH and Streiner, DL (2012) A randomized controlled trial of psychoeducation or cognitive-behavioral therapy in bipolar disorder: a Canadian Network for Mood and Anxiety treatments (CANMAT) study [CME]. Journal of Clinical Psychiatry 73, 803810.
Pedersen, G, Hagtvet, KA and Karterud, S (2007) Generalizability studies of the Global Assessment of Functioning–Split version. Comprehensive Psychiatry 48, 8894.
Perry, A, Tarrier, N, Morriss, R, McCarthy, E and Limb, K (1999) Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. British Medical Journal (Clinical Research Edition) 318, 149153.
Scott, J, Colom, F, Popova, E, Benabarre, A, Cruz, N, Valenti, M, Goikolea, JM, Sanchez-Moreno, J, Asenjo, MA and Vieta, E (2009) Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis. Journal of Clinical Psychiatry 70, 378386.
Tidemalm, D, Johnson, L, Hulterstrom, A, Omerov, S and Wistedt, AA (2007) Shorter length of stay following education about affective disease. Patients and relatives received tools to control the disease according to a questionnaire study. Läkartidningen 104, 31953197.
Viktorin, A, Lichtenstein, P, Thase, ME, Larsson, H, Lundholm, C, Magnusson, PK and Landén, M (2014). The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer. American Journal of Psychiatry 171, 10671073.
Viktorin, A, Rydén, E, Thase, ME, Chang, Z, Lundholm, C, D'Onofrio, BM, Almqvist, C, Magnusson, PKE, Lichtenstein, P and Larsson, H (2017) The risk of treatment-emergent Mania With Methylphenidate in Bipolar disorder. American Journal of Psychiatry 174, 341348.
Yatham, LN, Kennedy, SH, Schaffer, A, Parikh, SV, Beaulieu, S, O'Donovan, C, MacQueen, G, McIntyre, RS, Sharma, V, Ravindran, A, Young, LT, Young, AH, Alda, M, Milev, R, Vieta, E, Calabrese, JR, Berk, M, Ha, K and Kapczinski, F (2009) Canadian network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disorders 11, 225255.


Type Description Title
Supplementary materials

Joas et al. supplementary material
Joas et al. supplementary material 1

 Word (45 KB)
45 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed