title: Psychoeducation for relapse prevention in bipolar disorder: a systematic review of efficacy in randomized controlled trials.
abstract: OBJECTIVE
  Previous reviews have concluded that interventions including psychoeducation are effective in preventing relapse in bipolar disorder, but the efficacy of psychoeducation itself has not been systematically reviewed. Our aim was to evaluate the efficacy of psychoeducation for bipolar disorder in preventing relapse and other outcomes, and to identify factors that relate to clinical outcomes.
  
  
  METHODS
  We employed the systematic review of randomized controlled trials of psychoeducation in participants with bipolar disorder not in an acute illness episode, compared with treatment-as-usual, and placebo or active interventions. Pooled odds ratios (ORs) for non-relapse into any episode, mania/hypomania, and depression were calculated using an intent-to-treat (ITT) analysis, assigning dropouts to relapse, with a sensitivity analysis in which dropouts were assigned to non-relapse (optimistic ITT).
  
  
  RESULTS
  Sixteen studies were included, eight of which provided data on relapse. Although heterogeneity in the data warrants caution, psychoeducation appeared to be effective in preventing any relapse [n = 7; OR: 1.98-2.75; number needed to treat (NNT): 5-7, depending on the method of analysis] and manic/hypomanic relapse (n = 8; OR: 1.68-2.52; NNT: 6-8), but not depressive relapse. Group, but not individually, delivered interventions were effective against both poles of relapse; the duration of follow-up and hours of therapy explained some of the heterogeneity. Psychoeducation improved medication adherence and short-term knowledge about medication. No consistent effects on mood symptoms, quality of life, or functioning were found.
  
  
  CONCLUSIONS
  Group psychoeducation appears to be effective in preventing relapse in bipolar disorder, with less evidence for individually delivered interventions. Better understanding of mediating mechanisms is needed to optimize efficacy and personalize treatment.
authors.affiliation: Specialist Service for Affective Disorders, Manchester Mental Health and Social Care Trust, Manchester, UK.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bond
authors.affiliation: Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Anderson
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D055118:Medication Adherence; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D016896:Treatment Outcome
keywords: bipolar disorder; meta-analysis; psychoeducation; relapse prevention; systematic review