OBJECTIVE: Conformational change in the last four amino acid of the albumin's N-terminus is called ischemia-modified albumin (IMA). Metabolic stress factors such as ischemia, hypoxia, acidosis or endothelial injury may cause these conformational modifications. In this study, we hypothesized that the plasma IMA level changes might help to determine the global metabolic risk in bipolar disorder (BD), unipolar depression (UD), and schizophrenia (SZ). Therefore, it was aimed to investigate metabolic risk factors affecting IMA levels in this study. Modification of the albumin molecule might be a marker of global metabolic risk in schizophrenia and mood disorders. METHOD: The study included 32 patients with BD, 32 patients with UD, 28 patients with SZ and 34 healthy individuals. For determining the IMA levels, standard amounts of cobalt ions were added to the serums, and the quantity of disengaged cobalt ions was measured by colorimetric assay. RESULTS: IMA (F = 3.04, p = 0.032) levels differed between the groups. IMA levels of the BD group were significantly higher than the healthy control group (p = 0.048). White blood cell count in the BD group (p = 0.034) and total oxidant status (TOS) in the SZ group (p < 0.001) were the determinants of IMA levels with linear regression analysis. CONCLUSION: Elevation of IMA levels may indicate a global metabolic risk, and IMA levels are elevated in the BD group in this study. Determinants of IMA levels may indicate the significant metabolic risk in patient groups. Oxidative stress (OS) was the determinant of IMA levels in the SZ, and white blood cell count was the determinant of IMA levels in the BD group. Although the IMA levels were higher in all patient groups, the statistical significance appeared only in the BD group. Elevated IMA level was due to elevated OS in the SZ group, whereas the immunity in the BD group.