Original Article

Recurrent Events Model Application in Determining the Risk Factors of Bipolar Disorder Recurrence

Abstract

Objective: Recurrent events data is one of the most important types of survival data whose main feature is correlation between individual’s observations. The aim of this study was to analyze the time to bipolar disorder (BD) relapse and determine the related factors using recurrent events models.

Method: In this retrospective study, records of 104 BD patients with at least one relapse who were admitted for the first time (2001-2015) in Farabi hospital of Kermanshah were gathered to identify the factors influencing the time intervals between the recurrent survivals data using the Cox model with and without frailty (shared frailty), once with frailty gamma distribution and once with log-normal distribution frailty. All calculations were performed using R and SPSS software, versions 3.0.2 and 16 and the level of significance was considered at 0.05.

Results: Among the employed models, Cox model with lognormal shared frailty showed better fit for BD recurrent survival data. According to results of Cox model with lognormal frailty, 2 factors (marital status and history of veteran) were identified to affect the time intervals between relapses.

Conclusion: Because of the better fit of the models with the frailty effect on data, the correlation between the recurrent time intervals of each subject's relapse of BD was confirmed. Also, since the risk of subsequent relapses was less in married and veteran patients, marriage and emotional care supports can be considered as effective factors in reducing the risk of subsequent relapses of this disease.

References

Pour Kamali T, Samsam Shariat S. The bipolar disorder.Cheshmandaz Amin in Applied

Psychology.2014;1(2):1-5

Goodwin FK, Jamison KR. Manic-depressive illness: bipolar disorders and recurrent depression:

Oxford University Press; 2007.

Kaplan HI, Sadock BJ. Comprehensive textbook of psychiatry:10th edn. Williams & Wilkins

Co; 2017.

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk

assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters

in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.

The lancet. 2012;380(9859):2224-60.

Kupka R, Regeer E. Bipolar mood disorders. Nederlands tijdschrift voor

geneeskunde.2007;151(41):2256-60.

Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of

disease and risk factors, 2001: systematic analysis of population health data. The Lancet.

;367(9524):1747-57.

Morris CD, Miklowitz DJ, Wisniewski SR, Giese AA, Thomas MR, Allen MH. Care satisfaction,

hope, and life functioning among adults with bipolar disorder: data from the first 1000

participants in the Systematic Treatment Enhancement Program. Comprehensive Psychiatry.

;46(2):98-104.

Sadock BJ, Sadock VA. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical

psychiatry: Lippincott Williams & Wilkins; 2011.

Sadock BJ, Sadock VA. Comprehensive textbook of psychiatry: Lippincott Williams and

Wilkens. Philadelphia 2003. 2005;2878.

Hirschfeld R, Calabrese JR, Weissman MM, Reed M, Davies MA, Frye MA, et al. Screening

for bipolar disorder in the community. The Journal of clinical psychiatry. 2003; 64(1): 53-9.

Revicki DA, Hanlon J, Martin S, Gyulai L, Ghaemi SN, Lynch F, et al. Patient-based utilities

for bipolar disorder-related health states. Journal of affective disorders. 2005; 87(2): 203-10.

Akiskal HS, Bourgeois ML, Angst J, Post R, Möller H-J, Hirschfeld R. Re-evaluating the

prevalence of and diagnostic composition within the broad clinical spectrum of bipolar

disorders. Journal of affective disorders. 2000;59:S5-S30.

Cook RJ, Lawless J. The statistical analysis of recurrent events: Springer Science & Business

Media; 2007.

Rondeau V, Commenges D, Joly P. Maximum penalized likelihood estimation in a gamma-

frailty model. Lifetime data analysis. 2003;9(2):139-53.

Kleinbaum DG, Klein M. Kaplan-Meier survival curves and the log-rank test. Survival

analysis: Springer; 2012. p. 55-96.

Mazroui Y, Mathoulin‐Pelissier S, Soubeyran P, Rondeau V. General joint frailty model for

recurrent event data with a dependent terminal event: application to follicular lymphoma data.

Statistics in medicine. 2012;31(11-12):1162-76.

Mallick M, Ravishanker N. Additive positive stable frailty models. Methodology and

Computing in Applied Probability. 2006;8(4):541-58.

Noh M, Ha ID, Lee Y. Dispersion frailty models and HGLMs. Statistics in medicine.

; 25(8):1341-54.

Klein JP, Moeschberger ML. Survival analysis: techniques for censored and truncated data:

Springer Science & Business Media; 2005.

Dagne GA, Snyder J. Bayesian Analysis of Repeated Events using Event-Dependent Frailty

Models: An Application To Behavioral Observation Data. Communications in Statistics-Theory

and Methods.2009;39(2):293-310.

Huang X, Liu L. A joint frailty model for survival and gap times between recurrent events.

Biometrics. 2007;63(2):389-97.

Rondeau V, Mathoulin-Pelissier S, Jacqmin-Gadda H, Brouste V, Soubeyran P. Joint frailty

models for recurring events and death using maximum penalized likelihood estimation:

application on cancer events. Biostatistics. 2007;8(4):708-21.

Jahangiri MF, Kheiri S, Sedehi M. Bayesian analysis of the factors affecting the interval

between blood donations using Cox's shared frailty model: A cross-sectional study on a sample

of blood donors in Iran. Journal of Health System Research. 2015;11(1):153-62

van Zaane J, van den Berg B, Draisma S, Nolen WA, van den Brink W. Screening for bipolar

disorders in patients with alcohol or substance use disorders: performance of the mood disorder

questionnaire. Drug and alcohol dependence. 2012;124(3):235-41.

Eslami-Shahrbabaki M, Fekrat A, Mazhari S. A Study of the Prevalence of Psychiatric

Disorders in Patients with Methamphetamine-Induced Psychosis. Addiction & health.

;7(1-2):37.

Chapel S, Chiu Y-Y, Hsu J, Cucchiaro J, Loebel A. Lurasidone dose response in bipolar

depression: a population dose-response analysis. Clinical therapeutics. 2016;38(1):4-15.

McElroy SL, Altshuler LL, Suppes T, Keck Jr PE, Frye MA, Denicoff KD, et al. Axis I

psychiatric comorbidity and its relationship to historical illness variables in 288 patients with

bipolar disorder. American Journal of Psychiatry. 2001;158(3):420-6.

Qureshi Zadeh M, Ranjbar Koochaksarai F, Pezeshki M. Risk factors in recurrence of bipolar mood disorder and its relationship with demographic characteristics.Tabriz University of Medical Sciences Journal. Summer 2009; 31(2): 77 - 81.

Files
IssueVol 16 No 1 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v16i1.5381
Keywords
Bipolar Disorder Cox Frailty Model Recurrence Survival Analysis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Rezaei M, Hashemi SR, Farnia V, Rahmani S. Recurrent Events Model Application in Determining the Risk Factors of Bipolar Disorder Recurrence. Iran J Psychiatry. 2021;16(1):68-75.