Individualising the risk of recurrence for women with bipolar disorder in the perinatal period

Casanova Dias, Marisa 2025. Individualising the risk of recurrence for women with bipolar disorder in the perinatal period. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Bipolar Disorder (BD) affects approximately 3-5% of the population, and while it is well-established that women with BD face a high risk of recurrence during the perinatal period—particularly postpartum, current prediction remains imprecise. This thesis investigates the risk and predictors of perinatal recurrence in women with bipolar disorder (BD), aiming to improve the understanding of clinical, psychological, and pharmacological factors that contribute to postpartum relapse. This work addresses a significant gap in knowledge about modifiable predictors and their implications for prevention and clinical care. It begins with a systematic review and meta-analysis of recurrence rates in women with BD, finding a pooled recurrence rate of 32%, with marked heterogeneity across studies. Few studies adequately reported the impact of prophylactic pharmacotherapy, and there was limited disaggregation by episode subtype. Subsequent chapters explore specific domains of postpartum recurrence risk, based on a prospective cohort of pregnant women with BD, and complemented by detailed analysis of psychological, clinical, and treatmentrelated predictors in other samples. Borderline personality traits were found to be associated with recurrence, highlighting the potential relevance of dimensional personality factors in perinatal outcomes. Higher levels were associated with non-psychotic postpartum depression and were inversely associated with postpartum psychosis. The BISMArC and prospective cohort analysis examined the role of prophylactic medication at delivery and its interaction with bipolar subtype. Overall, medication was not significantly associated with reduced recurrence, though lithium showed a potential protective effect in exploratory analyses. Importantly, clinical predictors such as psychotic symptoms in past episodes remained strongly associated with recurrence risk. This body of work highlights the complex and multifactorial nature of recurrence in BD. It underscores the need for tailored, subtype-specific risk analysis, longitudinal research designs, and better integration of clinical and psychological markers. The findings support a personalised approach to prevention and treatment in perinatal mental health care.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Medicine
Date of First Compliant Deposit:	14 May 2026
Last Modified:	18 May 2026 09:03
URI:	https://orca.cardiff.ac.uk/id/eprint/187004

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