Creativity and transition to bipolar disorder: a prospective analysis from the early-bipolife study

Bipolar disorders (BD) are severe mental illnesses with recurrent depressive and (hypo-)manic episodes and a chronic course. While anecdotal and cross-sectional studies suggest a link between BD and creativity, longitudinal evidence is limited. This study investigates the role of creativity in individuals with varying risk for developing BD, using data from the multicenter, prospective Early-BipoLife study. N = 1,255 individuals aged 15-35 years were assessed and followed for over two years. Of these, N = 1,105 were included in the analyses; 150 were excluded due to missing creativity questionnaires. Creativity was measured with the Barron-Welsh Art Scale (BWAS) and the Creative Achievement Questionnaire (CAQ); BD risk was assessed with the EPIbipolar. Analyses included comparisons of mean creativity scores across BD risk groups and logistic regressions testing prospective associations between continuous creativity scores and transition to manifest BD. To enhance clinical applicability, group comparisons and odds ratios (ORs) were also calculated, providing estimates of relative risk across subgroups defined by BD risk status and creativity level.

At baseline (BL), participants at high BD risk scored significantly higher on the CAQ than those at low risk, while no differences were observed for BWAS scores. During FU, 25 of 1,105 individuals transitioned to manifest BD. Logistic regression analyses did not reveal significant associations between creativity and transitions. However, group comparisons indicated elevated transition likelihood in individuals with high BD risk, with the highest ORs in those combining high BD risk and high creativity (BWAS: OR = 7.05, 95% CI: 1.94-25.56; CAQ: OR = 5.57, 95% CI: 1.88-16.54) compared to low-risk individuals with low creativity.

High BD risk was associated with higher CAQ scores at BL, suggesting heightened creativity may precede transition. Prospective analyses over two years did not confirm this association, likely due to the small number of transitions. Nonetheless, cross-sectional differences and group comparisons suggest that individuals with both high BD risk and high creativity, particularly real-world accomplishments captured by the CAQ, may show an increased likelihood of transition. These preliminary findings warrant replication in larger, longer-term studies. Importantly, creativity should not be pathologized but considered both as a resource and as a potential modifier of risk trajectories.