The prevalence, clinical impact, and therapeutic considerations of trauma in adults with bipolar disorder: A systematic review

Background: Exposure to severe stressful life events (e.g., physical, sexual, emotional abuse and/or physical or emotional neglect) is common among adults with bipolar disorder (BD) and is associated with poor prognosis and clinical outcomes. This systematic review aims to evaluate the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD. Methods: A systematic review of primary research was conducted using Embase, PsycInfo, MEDLINE, and PubMed databases from inception to January 2025, following PRISMA criteria. Sixteen human studies evaluating the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD were included. Results: Prevalence rates of trauma in adults with BD have been variably estimated at approximately 40–60%. Childhood physical maltreatment is highly associated with comorbidities (e.g., metabolic disorders) and symptom severity in adults with BD. Childhood emotional maltreatment is associated with an earlier age of onset, greater illness severity, comorbidity and suicidality in BD. The moderating effects of trauma on treatment response across disparate modalities of treatment are not adequately characterized in persons with BD. Conclusions: Trauma, especially childhood trauma, is prevalent and has a severe negative clinical impact on the presentation, progression, treatment, and outcomes of adults with BD. The research strategic priority is to characterize the biosignature of trauma in BD, the impact of trauma on treatment outcomes, and to empirically evaluate integrated models of care in persons with BD with a history of trauma.