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In our study, we aimed to perform a systematic search of environmental risk factors for BD. In addition, we assessed possible hints of bias in this literature, and identified risk factors supported by high epidemiological credibility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched the Pubmed\/MEDLINE, EMBASE and PsycInfo databases up to 7 October 2016 to identify systematic reviews and meta\u2010analyses of observational studies that assessed associations between putative environmental risk factors and BD. For each meta\u2010analysis, we estimated its summary effect size by means of both random\u2010 and fixed\u2010effects models, 95% confidence intervals (CIs), the 95% prediction interval, and heterogeneity. Evidence of small\u2010study effects and excess of significance bias was also assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixteen publications met the inclusion criteria (seven meta\u2010analyses and nine qualitative systematic reviews). Fifty\u2010one unique environmental risk factors for BD were evaluated. Six meta\u2010analyses investigated associations with a risk factor for BD. Only irritable bowel syndrome (IBS) emerged as a risk factor for BD supported by convincing evidence (<jats:italic>k<\/jats:italic>=6; odds ratio [OR]=2.48; 95% CI=2.35\u22122.61; <jats:italic>P<\/jats:italic>&lt;.001), and childhood adversity was supported by highly suggestive evidence. Asthma and obesity were risk factors for BD supported by suggestive evidence, and seropositivity to <jats:italic>Toxoplasma gondii<\/jats:italic> and a history of head injury were supported by weak evidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Notwithstanding that several environmental risk factors for BD were identified, few meta\u2010analyses of observational studies were available. Therefore, further well\u2010designed and adequately powered studies are necessary to map the environmental risk factors for BD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12490","type":"journal-article","created":{"date-parts":[[2017,5,4]],"date-time":"2017-05-04T04:22:51Z","timestamp":1493871771000},"page":"84-96","source":"Crossref","is-referenced-by-count":134,"title":["Systematic assessment of environmental risk factors for bipolar disorder: an umbrella review of systematic reviews and meta\u2010analyses"],"prefix":"10.1111","volume":"19","author":[{"given":"Beatrice","family":"Bortolato","sequence":"first","affiliation":[{"name":"Institute for clinical Research and Education in Medicine I.R.E.M.  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