Debate: No bipolar disorder in prepubertal children at high familial risk

Hillegers, Manon H. J.

doi:10.1111/camh.12313

Cited by 3 publications

(2 citation statements)

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“…[R]ates of mania/bipolar I disorder are lower in both places than referenced by Van Meter, et al Van Meter and colleagues responded to our reanalysis, which prompted a nine-article debate section in CAMH (Carlson and Dubicka 2019;Duffy 2019;Goldstein et al 2019;Hazell 2019;Hillegers 2019;Pan et al 2019;Parry et al 2019a;Stringaris 2019;Van Meter et al 2019b). Duffy, lead researcher for the longitudinal Canadian high-risk offspring study, summarised research data and concluded (Duffy 2019):…”

Section: Prior Re-examination Of First Meta-analysis Of 'Pbd' Communi...mentioning

confidence: 89%

‘Pediatric Bipolar Disorder’ rates are still lower than claimed: a re-examination of eight epidemiological surveys used by an updated meta-analysis

Parry

Allison

Bastiampillai

2021

Int J Bipolar Disord

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Background ‘Pediatric bipolar disorder’ (PBD) is a controversial diagnosis with varying rates of clinical diagnosis. A highly cited meta-analysis (Van Meter et al. 2011) of a dozen epidemiological surveys suggested a global community prevalence of PBD of 1.8%. This was updated to 3.9% with eight additional surveys (Van Meter et al. 2019a). In terms of the Cochrane Handbook for Systematic Reviews of Interventions, the heterogenous community surveys were arguably unsuitable for statistical meta-analysis and warranted a narrative analysis. A narrative analysis (Parry et al. 2018) of the original 12 surveys concluded rates of PBD were substantially lower than 1.8% and led to a nine-article debate on the validity, arguable overdiagnosis and iatrogenic aspects of the PBD diagnosis (e.g. Carlson and Dubicka Child Adolesc Mental Health 21:86–87, 2019). This article extends the narrative analysis to include the eight newer community surveys. Methods A narrative analysis of the methodologies and the prevalence rates reported by the epidemiological surveys. Results Across all twenty surveys there was significant variation in methodologies and reported prevalence rates. Of the eight newer surveys, five (two Brazilian, one English, one Turkish, one United States) provided information of pre-adolescent prevalence rates of bipolar spectrum disorder. These pre-adolescent rates were zero or close to zero. Rates of adolescent hypomania and mania were higher, but follow-up data in two studies suggested hypomania might sometimes achieve prolonged remission or not lead to adult bipolar disorder. Limitations Methods in the original surveys vary and criteria used for various bipolar diagnoses were not always fully described. This limitation applies to a narrative analysis but also to a statistical meta-analysis. Conclusion Bipolar disorder is very rare in childhood and rare in adolescence. PBD as a diagnostic construct fails to correlate with adult bipolar disorder and the term should be abandoned. Hypomanic syndromes in adolescence may not always progress to adult bipolar disorder. Early diagnosis of bipolar disorder is important, but over-diagnosis risks adverse iatrogenic consequences.

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