Effective Factors on the Recurrence of Bipolar Mood Disorder I in an Iranian Population Sample Using the Frailty Model with Bayesian Approach

Objective: Bipolar I disorder is one of the most frequent mental disorders characterized by manic or mixed +/- depressive episodes. Drug treatment has been proved to diminish next episodes, but many other factors are important for exacerbating the conditions. This study aimed to investigate the effective factors on the time and number of episodes in these patients by applying the shared frailty model. Method : In this retrospective longitudinal study, the information of 606 patients with bipolar I disorder, admitted for the first time in Ibn-e-Sina psychiatric hospital in Mashhad from the beginning of 2007 until the end of 2009 were used. These patients were followed up until the end of 2018 for readmission. The Cox model with gamma frailty and Bayesian approach were used to determine the effective factors of frequent recurrences. Results: History of head trauma, substance abuse, and legal conflict had a positive impact on recurrences, while age had a negative effect on recurrences and the risk of recurrence was higher in younger people (P < 0.05). The variance estimation of frailty effect was 0.97 that indicates a correlation between the recurrence intervals of bipolar I patients, owing to a heterogeneity among patients. Conclusion: Based on the results, a higher risk of recurrence of bipolar I disorder was found in younger patients and those with a history of head trauma, substance abuse, and legal conflicts. Further investigations are required to account for the genetic factor and psychosocial exposure during critical periods applying this model.