A Comparison of American and English Hospital Discharge Rates for Pediatric Bipolar Disorder, 2000 to 2010

Abstract

Objective Controversy exists over the diagnosis and prevalence of pediatric bipolar disorder (PBD). Although several small surveys suggest that the rate of the PBD diagnosis in clinical settings is higher in the United States than in other countries, no comprehensive cross-national comparisons of clinical practice have been performed. Here, we used longitudinal national datasets from 2000 to 2010 to compare US and English hospital discharge rates for PBD in patients aged 1 to 19 years. Method We used the English National Health Service (NHS) Hospital Episode Statistics (HES) dataset and the United States National Hospital Discharge Survey (NHDS) to compare US and English discharge rates for PBD (bipolar I disorder [BP-I], bipolar II disorder [BP-II], bipolar disorder not otherwise specified [BP-NOS], and cyclothymia). We also conducted cross-national comparisons for all other psychiatric diagnoses in youth and for adults with bipolar disorder (BD). Results There was a 72.1-fold difference in discharge rates for PBD in youth between the United States and England (United States, 100.9 per 100,000 population, 95% confidence interval = 98.1–103.8, versus England, 1.4 per 100,000 population, 95% CI = 1.4–1.5). After controlling for cross-national differences in length of stay, discharge rates for PBD remained 12.5 times higher in the United States than in England. For all other child psychiatric diagnoses, the discharge rate was 3.9-fold higher, and for adults with BD 7.2-fold higher, in the United States than in England. Conclusion The disparity between US and English discharge rates for PBD is markedly greater than the disparity for child psychiatric discharge rates overall and for adult rates of BD. This suggests that the difference in discharge rates for PBD may be due to differing diagnostic practices for PBD in the United States versus in England.

Conversion from depression to bipolar disorder in a cohort of young people in England, 1999–2011: A national record linkage study

“…In line with this, recent work (James et al, 2014) found the rates of admission for BP to be very low in the England until after age 19, consistent with a possible under-diagnosis or late diagnosis. Further limitations of this study include the fact that diagnoses were not standardised, relying instead upon routine clinical assessments and recording at each hospital.…”

Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study

“…2010). The latter is supported by the already increasing use of psychotropic medication in CYP in the United States (Olfson et al 2002) Europe (Steinhausen & Bisgaard, 2014) and the UK (Middleton et al 2001; Rani et al 2008; Lockhart & Guthrie, 2011; John et al 2015) but may be more of an issue for the United States due to differing diagnostic practices (James et al 2014). Nonetheless mental health and well-being are of increasing public health importance worldwide, with depression estimated to be the leading cause of disease burden by 2030 (WHO, 2004).…”

Categorical and dimensional psychopathology in Dutch and US offspring of parents with bipolar disorder: A preliminary cross-national comparison

“…Whereas prevalence of BD-I and -II in youth in the general population is not different between US and non-US countries (Van Meter et al, 2011), clinical studies have shown an increase in the “administrative” prevalence of outpatient visits and hospital admission rates of BD in youth in the United States (US) as compared to most other countries (Holtmann et al, 2010; James et al, 2014; Kozloff et al, 2010; Soutullo et al, 2005). Comparisons between US and European adult patients with BD have also shown higher prevalence, younger age of onset, more severe illnesses, and increased parental history of BD in the US (Bellivier et al, 2011; Post et al, 2008, 2014a, 2014b).…”

“…parental- or offspring characteristics), methodological (e.g. recruitment method, assessment instruments, information source, age at assessment) or cultural factors and differences (Carlson and Klein, 2014; Duffy et al, 2011; James et al, 2014; Merikangas et al, 2011; Soutullo et al, 2005). Thus far, cross-national variability in psychopathology among bipolar offspring has not been well studied.…”