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Original research
Prevalences of comorbid anxiety disorder and daily smartphone-based self-reported anxiety in patients with newly diagnosed bipolar disorder
  1. Sharleny Stanislaus1,
  2. Klara Coello1,
  3. Hanne Lie Kjærstad1,
  4. Kimie Stefanie Ormstrup Sletved1,
  5. Ida Seeberg1,
  6. Mads Frost2,
  7. Jakob Eyvind Bardram3,
  8. Rasmus Nejst Jensen4,
  9. Maj Vinberg4,5,
  10. Maria Faurholt-Jepsen1,
  11. Lars Vedel Kessing1,5
  1. 1 Psychiatric Center Copenhagen, Rigshospitalet, Region Hovedstadens Psykiatri, Kobenhavn, Hovedstaden, Denmark
  2. 2 Monsenso, Monsenso Aps, Copenhagen, Denmark
  3. 3 Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
  4. 4 Psychiatric Centre North Zealand, Region Hovedstadens Psykiatri, Hilleroed, Hovedstaden, Denmark
  5. 5 Faculty of Health Sciences, University of Copenhagen, Kobenhavn, Denmark
  1. Correspondence to Dr Sharleny Stanislaus, Psychiatric Center Copenhagen, Rigshospitalet, Region Hovedstadens Psykiatri, 2100 Kobenhavn, Hovedstaden, Denmark; sharleny.stanislaus.01{at}


Background Around 40% of patients with bipolar disorder (BD) additionally have anxiety disorder. The prevalence of anxiety in patients with newly diagnosed BD and their first-degree relatives (UR) has not been investigated.


To investigate (1) the prevalence of a comorbid anxiety diagnosis in patients with newly diagnosed BD and their UR, (2) sociodemographic and clinical differences between patients with and without a comorbid anxiety diagnosis and (3) the association between smartphone-based patient-reported anxiety and observer-based ratings of anxiety and functioning, respectively.

Methods We recruited 372 patients with BD and 116 of their UR. Daily smartphone-based data were provided from 125 patients. SCAN was used to assess comorbid anxiety diagnoses.

Findings In patients with BD, the prevalence of a comorbid anxiety disorder was 11.3% (N=42) and 10.3% and 5.9% in partial and full remission, respectively. In UR, the prevalence was 6.9%. Patients with a comorbid anxiety disorder had longer illness duration (p=0.016) and higher number of affective episodes (p=0.011). Smartphone-based patient-reported anxiety symptoms were associated with ratings of anxiety and impaired functioning (p<0.001).

Limitations The SCAN interviews to diagnose comorbid anxiety disorder were carried out regardless of the participants’ mood state.

Clinical implications

The lower prevalence of anxiety in newly diagnosed BD than in later stages of BD indicates that anxiety increases with progression of BD. Comorbid anxiety seems associated with poorer clinical outcomes and functioning and smartphones are clinically useful for monitoring anxiety symptoms.

Trial registration number Registry (NCT02888262).

  • anxiety disorders
  • depression & mood disorders
  • adult psychiatry

Data availability statement

No data are available. The study is ongoing; therefore, the research data are not shared.

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Data availability statement

No data are available. The study is ongoing; therefore, the research data are not shared.

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  • Contributors LVK, RNJ and MF-J conceived the study. LVK and JEB obtained the required funding for the study and wrote the study protocol. LVK, MF-J, MV, JEB and MF were involved in optimising the study protocol. SS, KC, KSOS, HLK, IS and MV have been responsible for the recruitment of participants and have carried out the assessment and data collection. MF and SS have been responsible for data processing. Data analyses were done by SS and supervised by MF-J and LVK. Interpretation of the data has been done by SS under the supervision of LVK and MF-J. All authors have read, contributed to and approved the final version of the manuscript.

  • Funding The study was funded by grants from the Mental Health Services, Capital Region of Denmark, the Danish Council for Independent Research, Medical Sciences (DFF–4183–00570), Weimans Fund, Markedmodningsfonden (the market development fund, 2015-310), Gangstedfonden (A29594), Helsefonden (16-B-0063), Innovation Fund Denmark (the Innovation Fund, Denmark, 5164-00001B), Copenhagen Center for Health Technology, EU H2020 ITN (EU project 722561), Augustinusfonden (16-0083) and Lundbeck Foundation (R215-2015-4121).

  • Competing interests HLK, KSOS, IS, RNJ and MF-J declare no competing interests. LVK, SS and KC have within recent 3 years been a consultant for Lundbeck. MV has within the last 3 years been a consultant for Lundbeck, Sunovion and Janssen. JEB and MF are cofounders and shareholders of Monsenso A/S.

  • Provenance and peer review Not commissioned; externally peer reviewed.