Accuracy of Machine Learning Models in Predicting Clinical Outcomes in Bipolar Disorder: A Systematic Review

Bipolar disorder (BD) is one of the leading causes of disability worldwide, causing significant functional impairments in those affected. The heterogeneous course of BD renders the prediction of clinical progress and outcomes challenging, but it can be potentially enhanced with the use of artificial intelligence methods. In this systematic review, we aimed to examine the extant literature regarding the predictive accuracy of clinical functioning, illness affective state, relapse, and relevant predictors amongst patients with BD, using artificial intelligence methods.

The study was guided by PRISMA and the Cochrane Handbook for Systematic Reviews. Six electronic databases were systematically searched from inception for relevant studies until July 2025 and relevant data were summarised in tables. The protocol of the review was registered on Prospero, ID: CRD42024590343.

Forty articles were included in this review. The area under the curve (AUC) values for clinical functioning, illness affective state, and relapse prediction were 0.59-0.72 (poor to acceptable), 0.57-0.97 (poor to outstanding), and 0.45-0.98 (poor to outstanding), respectively. Supervised, tree-based algorithms performed the best. Predictive factors included sociodemographic, clinical and psychological factors and wearable data, as well as speech and video recordings.

Existing studies showed the potential of machine learning methods in the prediction of clinical progress and outcomes of BD (specifically functional status, affective state, and relapse) based on relevant collected variables. Longitudinal studies can further clarify and validate the associated predictive factors for earlier identification of those at risk of poorer prognosis to enhance management of BD.