‘Paediatric bipolar disorder’ rates are lower than claimed – a reexamination of the epidemiological surveys used by a meta‐analysis

Abstract

'Paediatric bipolar disorder' rates are lower than claimed -a reexamination of the epidemiological surveys used by a meta-analysis 2011, 72, 1250) claimed that the prevalence of PBD was similar to adults at 1.8% with no difference between the United States and other countries. This conclusion has been highly cited. Methods: The heterogeneous nature of the original 12 epidemiological surveys warrants a qualitative analysis, rather than statistical meta-analysis as performed by Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250. Thus, the meta-analysis and each of the 12 studies (six from the United States; six from other countries) were reexamined. Results: Most of the 12 surveys predated the emergence of the PBD hypothesis. The 12 surveys were mainly of adolescents and at times young adults with few prepubertal children. Prevalence rates in the 12 studies suggest a lower rate of bipolar disorder, especially in non-US samples. For example, the Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250 meta-analysis chose a rate of 2.8% by summation of adolescent and parent responses in a Dutch survey, however the rate fell to 0% if requiring concordance of adolescent and parent responses. Indeed, it could be argued that four of the non-US studies show 0% rates of PBD. Conclusions: Rates of PBD were generally substantially lower than 1.8%, particularly in non-US surveys, and if both parent and adolescent reports were required to meet the diagnostic threshold they fell to close to zero. The reanalysis suggests that bipolar disorder is rare before the expected age of onset in later adolescence. Key Practitioner Message• A highly cited meta-analysis of the epidemiological studies covering 'ages 7 to 21-years-old' concluded that PBD was equally prevalent in the United States and elsewhere at 1.8%, suggesting PBD may be underdiagnosed and undermedicated outside the United States.• Our reexamination of the original 12 community epidemiological surveys reveals few studies included children, heterogeneous methodology unsuited to statistical meta-analysis, and lower rates of bipolar disorder especially outside the United States.

Debate: Dimensions of mania in youth: possibly bipolar, probably risk indicators, certainly impairing

“…They have used the same semistructured interview to assess a range of manic symptoms, which diminished the effects of disparate methodological aspects outlined by Parry et al. (). We will comment on the evidence for reliability and validity of manic dimensions in youth and whether those dimensions are clinically valid constructs for the child psychiatry literature.…”

Debate Editorial: Very early onset bipolar disorder – international differences in prevalence, practice or language?

“…He calls it the Geller–Wozniak syndrome (GWS) after the two researchers who, as outlined by Parry et al. () started the controversy. Hazell's intention is not to trivialize the condition, but to state that GWS is not traditional manic depression and the age group in question is not actually adolescence, where there is less controversy about frequency of occurrence.…”

Debate: Pediatric bipolar disorder – the elephant in the room

“…The latest exchange has to do with the re‐examination by Parry et al. (Parry, Allison, & Bastiampillai, ) of a published meta‐analysis conducted by Van Meter et al. (Van‐Meter, Moreira, & Youngstrom, ) which estimated a prevalence rate of pediatric bipolar disorder of about 1.8% worldwide.…”