Bipolar disorder (BD) is associated with impairments in facial emotion recognition (FER), affecting social functioning and quality of life. Understanding FER deficits in BD is crucial for tailoring interventions and improving treatment outcomes. This systematic review and meta-analysis aims to evaluate FER differences among individuals with BD, unaffected first-degree relatives (FDRs), and healthy controls (HCs), exploring predictors related to patient and study characteristics.

We systematically searched PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO databases from inception to March 28, 2024. Random-effects meta-analyses were conducted to explore differences in accuracy and reaction time during FER identification and discrimination tasks.

A total of 100 studies were included, comprising 4920 individuals with BD (females = 56%, mean age = 34.1 ± 9.1), 676 FDRs (females = 55%, mean age = 36.1 ± 12), and 4909 HCs (females = 53.2%, mean age = 32.5 ± 9.5). Compared to HCs, adults with BD exhibited significantly lower accuracy (SMD = −0.47; 95% CIs = −0.56, −0.38) and higher reaction time (SMD = 0.57; 95%CIs = 0.33, 0.81) during facial emotion identification tasks. During facial emotion discrimination tasks, adults with BD had significantly lower accuracy than HCs (SMD = −0.59; 95%CIs = −0.78, −0.4), but similar speed. No significant differences were observed between BD and FDRs. Meta-regressions identified several predictors of FER performance, including manic symptom severity, stimulus duration, and presence of practice before task.

FER deficits appear to be a core feature of BD and require specialized, systematic assessment. Identifying these deficits may help guide interventions aimed at improving affective cognition and social outcomes in individuals with BD.

Among the clinical features of bipolar disorder (BD), sleep disturbances are highly prevalent and persist across all phases of the illness, from onset to acute and inter-episodic periods. Substantial evidence suggests that sleep disturbances may function as proximal triggers for suicidal behavior, independent of other underlying psychiatric conditions. Although suicide is a major clinical concern in BD, the interplay between sleep disturbances and suicidality remains incompletely understood.

We conducted a systematic review and meta-analysis (SRMA) following the PRISMA guidelines. We performed a comprehensive search across PubMed, PsycINFO, and SCOPUS, including all studies reporting an association between sleep disturbances and suicidal behavior in BD. A total of 16 reports, comprising 14 cross-sectional studies and two longitudinal studies, were included in this SRMA.

Among individuals with BD, sleep disturbances were associated with increased odds of lifetime suicidal behaviors (OR = 1.51, 95% CI = 1.23, 1.86), and a history of suicide attempts was associated with significantly elevated odds of experiencing sleep disturbances (OR = 1.37, 95% CI = 1.21, 1.55). In addition, poor sleep quality as measured by the Pittsburgh Sleep Quality Index positively correlated with suicidality (r = 0.24, 95% CI = 0.10, 0.36).

These results highlight the link between sleep disturbances and suicidal tendencies in individuals with BD. Prompt recognition and treatment of sleep disturbances could be crucial for averting or reducing suicidal behaviors in this population.