Risky decision-making in bipolar disorder: Evidence from a three-level meta-analysis

doi:10.3724/SP.J.1041.2025.0100

Abstract

Abstract: Bipolar disorder (BD), one of six major mental disorders in China, manifests as recurrent episodes of (hypo)mania and major depression. Recently, researchers have increasingly focused on the cognitive and behavioral characteristics of BD patients. Notably, increased risk-taking might emerge as a typical symptom of BD, supported by evidence from BD patients' daily behaviors, empirical research, and neuroimaging studies. However, contradictory findings have been reported, with some studies failing to find differences in risk preferences between BD patients and healthy controls (HCs) and a few studies even indicating increased risk aversion among BD patients. Consequently, whether and to what extent BD is associated with alterations in risk preference remain unclear. Thus, this study involved a three-level meta-analysis to examine the relationship between BD and risky decision-making, encompassing studies utilizing various measures of risky decision-making (i.e., risk attitude scales, behavioral tasks, and daily risk behaviors). Moreover, we aimed to uncover potential moderators, including sample and measurement characteristics, to better address inconsistent findings.
A systematic literature search was conducted with the Web of Science, PubMed, Scopus, PsycINFO, CNKI (China National Knowledge Infrastructure), and WFD (Wan Fang Data) databases up to April 15, 2024, to identify studies investigating risky decision-making in BD patients and HCs. We calculated the standard mean differences (Hedges' g) in risky decision-making between BD patients and HCs. We conducted a three-level random-effects meta-analysis, including heterogeneity analysis, moderation analyses for sample and measurement characteristics, and assessments of publication bias.
Across 176 effect sizes in 71 cross-sectional studies, BD patients exhibited greater risk-seeking than HCs (Hedges' g = 0.301), regardless of whether it was measured via risk attitude scales (Hedges' g = 0.624), behavioral tasks (Hedges' g = 0.252) or daily risk behaviors (Hedges' g = 0.312). Moreover, this difference was also moderated by age (β = 0.009) and mood phase, where BD patients in any mood phase preferred more risk-seeking than HCs (euthymic: Hedges' g = 0.245; (hypo)mania: Hedges' g = 0.604; major depression: Hedges' g = 0.417). For behavioral tasks, age (β = 0.012) and region were found to have significant moderating effects. Specifically, significant effect sizes were observed for samples originating from Europe (Hedges' g = 0.419) and South America (Hedges' g = 0.420). Moreover, effect sizes were significant in studies using the Iowa Gambling Task (IGT; Hedges' g = 0.396) and Cambridge Gambling Task (Hedges' g = 0.220), and effect sizes in IGT studies were larger than in those employing the Classic Risky Choice Tasks. Regarding. With respect to daily attitudes/behaviors, mood phase was identified as a significant moderator. Notably, effect sizes for (hypo)manic patients (Hedges' g = 0.747) were significantly larger than those for euthymic patients. Moreover, compared with HCs, BD patients exhibited increased risk-seeking across the health (Hedges' g = 0.308), financial (Hedges' g = 0.331), and overall attitude (Hedges' g = 0.733) domains.
This study comprehensively explored the relationship between BD and risky decision-making via various measures, revealing a consistent pattern of increased risk-seeking among BD patients. These findings suggest that increased risk-taking might be a noteworthy symptom of BD and propose potential utility for its application in clinical management and psychoeducation. Furthermore, future studies should consider factors such as mood phase and task type and try to uncover the underlying psychological mechanisms through which BD affects risky decision-making.

Key words: Bipolar disorder, risky decision-making, meta-analysis, decision task, cross-mood specificity

LU Jiaqi, LI Yusi, HE Guibing. (2025). Risky decision-making in bipolar disorder: Evidence from a three-level meta-analysis. Acta Psychologica Sinica, 57(1), 100-124.

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