Culturally adapted psychoeducation for bipolar disorder: a multicentre, assessor-masked, randomised controlled trial
In brief
12 adapted sessions lowered bipolar recurrence hazard by 46% in Pakistan
In a trial of 303 adults with bipolar disorder in remission, 12 weekly culturally adapted sessions plus routine care prolonged time to a mood episode recurrence over 48 weeks compared with routine care alone. Participants also showed gains in recovery, medication adherence, and depressive symptoms; whether the benefits extend to other settings remains to be seen.
- Journal
- EClinicalMedicine (Q1)
- Published
- 24 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- M Ishrat Husain, Muqaddas Asif, Ameer B Khoso, Madeha Umer, Suleman Shakoor, Tayyeba Kiran, et al.
- PMID
- 42964307
- DOI
- 10.1016/j.eclinm.2026.104271
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 1 November 2026): Randomized bipolar psychoeducation trial on recurrence prevention
- Picked for Family Practice (top studies of the week, 1 November 2026): Randomized trial supports maintenance care for community patients with bipolar
Abstract
BACKGROUND: Adjunctive psychoeducation can reduce recurrence of mood episodes in bipolar disorder (BD), but evidence from low-resource settings is scarce. We evaluated whether culturally adapted psychoeducation (CaPE) plus treatment-as-usual (TAU) prolongs time to recurrence in adults with BD in remission in Pakistan, a lower-middle-income country. METHODS: In this multi-centre, assessor-masked randomised controlled trial, adults with remitted bipolar I or II disorder at seven urban centres in Pakistan were randomly assigned to CaPE plus TAU or TAU alone. CaPE comprised 12 weekly individual sessions delivered by master's-level psychologists. The primary outcome was time to recurrence of any mood episode over 48 weeks, assessed with the Longitudinal Interval Follow-up Evaluation. Secondary outcomes included recurrence of depressive and manic/hypomanic episodes and clinical and quality-of-life measures. The trial is registered with ClinicalTrials.gov (NCT05223959). FINDINGS: Between June 2022 and March 2025, 303 participants were randomly assigned (148 TAU, 155 CaPE plus TAU); 12-month data were available for 284 of 303 (93.7%). Over 48 weeks, CaPE prolonged time to recurrence of any mood episode versus TAU (adjusted hazard ratio 0.54, 95% CI 0.42-0.69; p < 0.001). At 12 months, CaPE improved recovery (measured with the Bipolar Recovery Questionnaire, on which higher scores indicate greater recovery; adjusted difference 144.8, 95% CI 51.5-238.1; p = 0.002), knowledge and attitudes (78.2, 22.6-133.8; p = 0.006), medication adherence (-0.4, -0.8 to -0.1; p = 0.013), and depressive symptoms (-5.3, -7.8 to -2.7; p < 0.0001). All adjusted estimates account for age, sex assigned at birth, marital status, weeks since diagnosis, and weeks in treatment. INTERPRETATION: Individual culturally adapted psychoeducation added to routine care reduced recurrence risk and improved clinical outcomes in Pakistani adults with BD, and could optimise maintenance treatment in Pakistan and other low-resource settings. FUNDING: Canadian Institutes of Health Research.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.