Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication

Abstract

Context: There is growing recognition that bipolar disorder (BPD) has a spectrum of expression that is substantially more common than the 1% BP-I prevalence traditionally found in population surveys.Objective: To estimate the prevalence, correlates, and treatment patterns of bipolar spectrum disorder in the US population.Design: Direct interviews.Setting: Households in the continental United States.Participants: A nationally representative sample of 9282 English-speaking adults (aged Ն18 years).Main Outcome Measures: Version 3.0 of the World Health Organization's Composite International Diagnostic Interview, a fully structured lay-administered diagnostic interview, was used to assess DSM-IV lifetime and 12-month Axis I disorders. Subthreshold BPD was defined as recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania. Indicators of clinical severity included age at onset, chronicity, symptom severity, role impairment, comorbidity, and treatment.Results: Lifetime (and 12-month) prevalence estimates are 1.0% (0.6%) for BP-I, 1.1% (0.8%) for BP-II, and 2.4% (1.4%) for subthreshold BPD. Most respondents with threshold and subthreshold BPD had lifetime comorbidity with other Axis I disorders, particularly anxiety disorders. Clinical severity and role impairment are greater for threshold than for subthreshold BPD and for BP-II than for BP-I episodes of major depression, but subthreshold cases still have moderate to severe clinical severity and role impairment. Although most people with BPD receive lifetime professional treatment for emotional problems, use of antimanic medication is uncommon, especially in general medical settings.Conclusions: This study presents the first prevalence estimates of the BPD spectrum in a probability sample of the United States. Subthreshold BPD is common, clinically significant, and underdetected in treatment settings. Inappropriate treatment of BPD is a serious problem in the US population. Explicit criteria are needed to define subthreshold BPD for future clinical and research purposes. Psychiatry. 2007;64:543-552 Arch Gen

Bipolar Disorder Center for Pennsylvanians: Implementing an Effectiveness Trial to Improve Treatment for At-Risk Patients

“…In our study, 61% of the participants were female, similar to several other recently published large studies, which found rates from 55% to 70% (19,22–26). The BDCP participants’ mean age at onset of bipolar disorder was 20.8 years, which matches nationwide epidemiologic studies, such as the Epidemiologic Catchment Area study, the National Comorbidity Survey replication, and other studies, all of which found a mean age at onset between 19.8 and 22.9 years (22,24,25,27–29). …”

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…As described in Section 6, patients diagnosed with BD very commonly have one or more comorbid psychiatric diagnoses, with SUDs, impulse control disorders, anxiety disorders, and personality disorders (especially cluster B disorders) particularly common 45. The presence of comorbidity increases the complexity of the illness and can make an accurate diagnosis even more difficult.…”

“…The most common comorbid conditions are substance use disorder, anxiety disorder, personality disorder, and impulse control disorder (such as ADHD, ODD, and CD) 45. Comorbidity impacts the course of BDs by increasing the likelihood of treatment resistance and suicide risk, and also by increasing the time spent with impairing symptoms 34, 50, 669, 670…”

Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses

“…BD typically begins in adolescence or early adulthood and can have life‐long adverse effects on the patient's mental and physical health, educational and occupational functioning, and interpersonal relationships (Valente & Kennedy, 2010). Although not as common as major depressive disorder (MDD), the lifetime prevalence of BD in the United States is substantial (estimated at approximately 4%), with similar rates regardless of race, ethnicity, and gender (Ketter, 2010; Merikangas et al., 2007). Long‐term outcomes are persistently suboptimal (Geddes & Miklowitz, 2013).…”