Umbrella Review and Evidence Map of Systematic Reviews and Meta-Analyses Risk Factors for Early-Onset Bipolar Disorder
Abstract
Objective: To synthesize systematic-review evidence on risk factors for early-onset bipolar disorder (EOBD), appraise methodological quality, assess factor-specific certainty, and map the evidence base.
Method: We conducted a PRISMA-compliant, PROSPERO-registered umbrella review of English-language systematic reviews and meta-analyses indexed in MEDLINE, PsycINFO, Embase, and the Cochrane Library before April 2026. EOBD was defined as bipolar disorder (BD) with a mean age at onset below 25 years in relevant primary studies. Review methods were appraised with AMSTAR-2; certainty for each risk-factor association was evaluated using an adapted GRADE framework. Findings were synthesized narratively and mapped by risk-factor type.
Results: Fifty-three reviews, including 20 meta-analyses, contributed evidence across 17 risk-factor categories. Family history of BD and ADHD diagnosis had moderate-certainty evidence. Parental age, depressive disorders, and sleep or circadian disturbances had low-certainty evidence; the remaining categories had very-low-certainty evidence. No factor reached high certainty. AMSTAR-2 ratings were predominantly low: 2 reviews were high, 16 moderate, 30 low, and 5 critically low. The evidence was uneven, geographically concentrated in Western populations, and partly dependent on recurring high-risk cohorts.
Conclusions: EOBD risk appears developmental, probabilistic, and multivariable. Family history of BD and ADHD diagnosis provide the strongest risk enrichment but are neither deterministic nor diagnostically specific. Future research should prioritize prospective, externally validated multivariable models; clinical application may favor staged longitudinal assessment rather than diagnosis or treatment based on any single marker. Policies could support tiered early-detection pathways, timely specialist access, and continuity across child and adult services without promoting risk-based labeling.
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BibTeX
@misc{smith2026umbrella,
title = {{Umbrella Review and Evidence Map of Systematic Reviews and Meta-Analyses Risk Factors for Early-Onset Bipolar Disorder}},
author = {Logan Thomas Smith and Cristian Alcaino and Kayla L. Baresich and Olivia C. Bishop and Mackenzie A. Maddox and Victoria Murphy and Robin Nusslock and Eric A. Youngstrom and Lauren Alloy},
howpublished = {PsyArXiv},
year = {2026},
month = sep,
doi = {10.31234/osf.io/fmpj6_v1},
url = {https://osf.io/preprints/psyarxiv/fmpj6_v1/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Umbrella Review and Evidence Map of Systematic Reviews and Meta-Analyses Risk Factors for Early-Onset Bipolar Disorder
AU - Logan Thomas Smith
AU - Cristian Alcaino
AU - Kayla L. Baresich
AU - Olivia C. Bishop
AU - Mackenzie A. Maddox
AU - Victoria Murphy
AU - Robin Nusslock
AU - Eric A. Youngstrom
AU - Lauren Alloy
PY - 2026
DA - 2026/09/11
PB - PsyArXiv
DO - 10.31234/osf.io/fmpj6_v1
UR - https://osf.io/preprints/psyarxiv/fmpj6_v1/
AB - Objective: To synthesize systematic-review evidence on risk factors for early-onset bipolar disorder (EOBD), appraise methodological quality, assess factor-specific certainty, and map the evidence base. Method: We conducted a PRISMA-compliant, PROSPERO-registered umbrella review of English-language systematic reviews and meta-analyses indexed in MEDLINE, PsycINFO, Embase, and the Cochrane Library before April 2026. EOBD was defined as bipolar disorder (BD) with a mean age at onset below 25 years in relevant primary studies. Review methods were appraised with AMSTAR-2; certainty for each risk-factor association was evaluated using an adapted GRADE framework. Findings were synthesized narratively and mapped by risk-factor type. Results: Fifty-three reviews, including 20 meta-analyses, contributed evidence across 17 risk-factor categories. Family history of BD and ADHD diagnosis had moderate-certainty evidence. Parental age, depressive disorders, and sleep or circadian disturbances had low-certainty evidence; the remaining categories had very-low-certainty evidence. No factor reached high certainty. AMSTAR-2 ratings were predominantly low: 2 reviews were high, 16 moderate, 30 low, and 5 critically low. The evidence was uneven, geographically concentrated in Western populations, and partly dependent on recurring high-risk cohorts. Conclusions: EOBD risk appears developmental, probabilistic, and multivariable. Family history of BD and ADHD diagnosis provide the strongest risk enrichment but are neither deterministic nor diagnostically specific. Future research should prioritize prospective, externally validated multivariable models; clinical application may favor staged longitudinal assessment rather than diagnosis or treatment based on any single marker. Policies could support tiered early-detection pathways, timely specialist access, and continuity across child and adult services without promoting risk-based labeling.
ER -