Bipolar disorder epidemiology and demographics: Difference between revisions

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{{Bipolar disorder}}
{{Bipolar disorder}}
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==Overview==
==Overview==
The estimated lifetime prevalence of bipolar disorder among adults worldwide is 1 to 3 percent, and the lifetime prevalence of bipolar I and bipolar II disorder was 2.8 percent. The mean age of onset for bipolar I disorder is 18 years and for bipolar II disorder 20 years. The one-year prevalence of bipolar I disorder in people aged 65 years and older is approximately 0.4 percent and the lifetime rate is 0.8 percent. These rates were less than rates in younger individuals.
==Epidemiology and demographics==
==Epidemiology and demographics==
Clinical depression and bipolar disorder are classified as separate illnesses. Some researchers increasingly view them as part of an overlapping spectrum that also includes anxiety and psychosis. The lifetime prevalence of cyclothymic disorder is 0.4-1%. The rate appears equal in men or women, though women more often seek treatment.
According to Hagop Akiskal, [[M.D.]], at the one end of the spectrum is bipolar type [[schizoaffective disorder]], and at the other end is [[unipolar depression]] (recurrent or not recurrent), with the anxiety disorders present across the spectrum. Also included in this view is [[premenstrual dysphoric disorder]], [[postpartum depression]], and [[postpartum psychosis]]. This view helps to explain why many people who have the illness do not have first-degree relatives with clear-cut "bipolar disorder", but who have family members with a history of these other disorders.
In a 2003 study, Hagop Akiskal M.D. and Lew Judd M.D. re-examined data from the landmark [[Epidemiologic]] Catchment Area study from two decades before.<ref name=Judd_and_Akiskal_2003>{{cite journal | first = Lewis L. | last = Judd | coauthors = Hagop S. Akiskal | month = January | year = 2003 | title = The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases | journal = Journal of Affective Disorders | volume = 73|issue = 1-2 | pages = 123-131 | id = {{DOI|10.1016/S0165-0327(02)00332-4}}|url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=12507745&dopt=ExternalLink}}</ref> The original study found that 0.8 percent of the population surveyed had experienced a [[manic episode]] at least once (the diagnostic threshold for [[bipolar I]]) and 0.5 a [[hypomanic]] episode (the diagnostic threshold for bipolar II).
By tabulating survey responses to include sub-threshold diagnostic criteria, such as one or two symptoms over a short time-period, the authors arrived at an additional 5.1 percent of the population, adding up to a total of 6.4 percent of the entire population who can be thought of as having a bipolar spectrum disorder. This and similar recent studies have been interpreted by some prominent bipolar disorders researchers as evidence for a much higher [[prevalence]] of bipolar conditions in the general population than previously thought.
However these re-analyses should be interpreted cautiously because of substantive as well as methodological study limitations. Indeed, prevalence studies of bipolar disorder are carried out by lay interviewers (that is, not by expert [[clinician]]s/psychiatrists who are more costly to employ) who follow fully structured/fixed interview schemes; responses to single items from such interviews may suffer limited validity.
Furthermore, a well-known statistical problem arises when ascertaining disorders and conditions with a relatively low population prevalence or base-rate, such as bipolar disorder: even assuming that lay interviews diagnoses are highly accurate in terms of [[Sensitivity (tests)|sensitivity]] and [[Specificity (tests)|specificity]] and their corresponding area under the [[ROC curve]] (that is, [[AUC]], or area under the [[receiver operating characteristic]] curve), a condition with a relatively low prevalence or base-rate is bound to yield high [[Type I and type II errors|false positive]] rates, which exceed [[Type I and type II errors|false negative]] rates; in such a circumstance a limited [[positive predictive value]], PPV, yields high [[false positive]] rates even in presence of a specificity which is very close to 100%.<ref name=Baldessarini1993>{{cite journal | first = Ross J. |last = Baldessarini | coauthors = Finklestein S., Arana G. W.| month = May | year = 1983 | title =
The predictive power of diagnostic tests and the effect of prevalence of illness | journal = Archives of General Psychiatry | volume = 40 | issue = 5 | pages = 569-573 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=6838334&dopt=ExternalLink}}</ref>
To simplify, it can be said that a very small error applied over a very large number of individuals (that is, those who are *not affected* by the condition in the general population during their lifetime; for example, over 95%) produces a relevant, non-negligible number of subjects who are incorrectly classified as having the condition or any other condition which is the object of a survey study: these subjects are the so-called false positives; such reasoning applies to the 'false positive' but not the 'false negative' problem where we have an error applied over a relatively very small number of individuals to begin with (that is, those who are *affected* by the condition in the general population; for example, less than 5%).
Hence, a very high percentage of subjects who seem to have a history of bipolar disorder at the interview are false positives for such a medical condition and apparently never suffered a fully [[clinical]] [[syndrome]] (that is, bipolar disorder type I): the population prevalence of bipolar disorder type I, which includes at least a lifetime manic episode, continues to be estimated at 1%.<ref name=Soldani2005>{{cite journal | first = Federico | last = Soldani | coauthors = Sullivan P. F. Pedersen N. L. | month = Apr | year = 2005 | title = Mania in the Swedish Twin Registry: criterion validity and prevalence | journal = Australian and New Zealand of Psychiatry | volume = 39 | issue = 4 | pages = 235-243 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=15777359&dopt=ExternalLink}}</ref>  "Mild-to-severe versions of bipolar disorder afflict nearly 4 percent of adults at some time in their lives."<ref>Bipolar Surprise, Science News, [[March 31]] [[2007]], vol. 171, #13, p.196</ref>
A different but related problem in evaluating the public health significance of psychiatric conditions has been highlighted by Robert Spitzer of Columbia University: fulfillment of [[diagnostic criteria]] and the resulting [[diagnosis]] do not necessarily imply need for treatment.<ref name=Spitzer1998>{{cite journal | first = Robert | last = Spitzer | month = Feb | year = 1998 | title = Diagnosis and need for treatment are not the same | journal = Archives of General Psychiatry | volume = 55 | issue = 2 | pages = 120 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=9477924&dopt=ExternalLink}}</ref> As a consequence, subjects who experience bipolar symptoms but not a full-blown, impairing bipolar syndrome should not be automatically considered as patients in need of treatment.


Recent studies have indicated that at least 50% of adult sufferers report manifestation of symptoms before the age of 17. Moreover, there is a growing consensus that bipolar disorder originates in childhood. In young children the illness is now referred to as [[pediatric]] bipolar disorder. Today about 0.5% of children under 18 are believed to have the condition. For children, the main concern is that bipolar disorder needs to be diagnosed correctly and treated properly because it can look like unipolar depression, [[ADHD]] or [[conduct disorder]]. Young children, [[adolescent]]s and [[adult]]s each express the condition differently according to child and adolescent bipolar disorders expert [http://www.bipolarchild.com/articles.html Demitri Papolos M.D.] and the[http://www.bpkids.org Child and Adolescent Bipolar Foundation]. There is, however, controversy about this last point<ref>{{cite web|title=Bipolar Disorder in Children and Adolescents: a Caution|url=http://www.psycheducation.org/depression/SoboOnKids.htm|accessdate= |format= |work=|publisher=psycheducation.org}}</ref>
*The estimated lifetime prevalence of bipolar disorder among adults worldwide is 1 to 3 percent<ref name="pmid248062112">{{cite journal| author=Pedersen CB, Mors O, Bertelsen A, Waltoft BL, Agerbo E, McGrath JJ | display-authors=etal| title=A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. | journal=JAMA Psychiatry | year= 2014 | volume= 71 | issue= 5 | pages= 573-81 | pmid=24806211 | doi=10.1001/jamapsychiatry.2014.16 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24806211  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25239247 Review in: Evid Based Ment Health. 2015 Feb;18(1):12]</ref>, and the lifetime prevalence of bipolar I and bipolar II disorder was 2.8 percent<ref name="pmid21199968">{{cite journal| author=Kessler RC, Ormel J, Petukhova M, McLaughlin KA, Green JG, Russo LJ | display-authors=etal| title=Development of lifetime comorbidity in the World Health Organization world mental health surveys. | journal=Arch Gen Psychiatry | year= 2011 | volume= 68 | issue= 1 | pages= 90-100 | pmid=21199968 | doi=10.1001/archgenpsychiatry.2010.180 | pmc=3057480 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21199968  }}</ref>
*The mean age of onset for bipolar I disorder is 18 years and for bipolar II disorder 20 years<ref name="pmid21383262">{{cite journal| author=Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA | display-authors=etal| title=Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. | journal=Arch Gen Psychiatry | year= 2011 | volume= 68 | issue= 3 | pages= 241-51 | pmid=21383262 | doi=10.1001/archgenpsychiatry.2011.12 | pmc=3486639 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21383262  }}</ref>. The ratio of men to women who develop bipolar disorder is approximately 1:1.
*In the United States, the estimated lifetime prevalence of bipolar I disorder was 1 percent, and bipolar II disorder 1.1 percent. The mean age of onset for bipolar I and bipolar II disorder was 18 and 20 years.<ref name="pmid17485606">{{cite journal| author=Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M | display-authors=etal| title=Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. | journal=Arch Gen Psychiatry | year= 2007 | volume= 64 | issue= 5 | pages= 543-52 | pmid=17485606 | doi=10.1001/archpsyc.64.5.543 | pmc=1931566 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17485606  }}</ref>
*Bipolar disorder is the 18<sup>th</sup> leading cause of disability in the United States.<ref name="pmid23842577">{{cite journal| author=Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D | display-authors=etal| title=The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. | journal=JAMA | year= 2013 | volume= 310 | issue= 6 | pages= 591-608 | pmid=23842577 | doi=10.1001/jama.2013.13805 | pmc=5436627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23842577  }}</ref>
*Individuals with manic or hypomanic episodes, psychosocial functioning is severely impaired in 70 percent; in 90 percent of the affected individuals functioning is severely impaired during episodes of major depression.<ref name="pmid17485606" />
*The one-year prevalence of bipolar I disorder in people aged 65 years and older is approximately 0.4 percent and the lifetime rate is 0.8 percent. These rates were less than rates in younger individuals.<ref name="pmid27814503">Blanco C, Compton WM, Saha TD, Goldstein BI, Ruan WJ, Huang B | display-authors=etal (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=27814503 Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III.] ''J Psychiatr Res'' 84 ():310-317. [http://dx.doi.org/10.1016/j.jpsychires.2016.10.003 DOI:10.1016/j.jpsychires.2016.10.003] PMID: [https://pubmed.gov/27814503 27814503]</ref>
*Geriatric bipolar patients are predominantly female; 69 percent of late-life bipolar patients were women.<ref name="pmid19581570">{{cite journal| author=Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS | display-authors=etal| title=Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. | journal=Arch Gen Psychiatry | year= 2009 | volume= 66 | issue= 7 | pages= 785-95 | pmid=19581570 | doi=10.1001/archgenpsychiatry.2009.36 | pmc=2810067 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19581570  }}</ref>
*The prevalence of bipolar spectrum disorders in children and adolescents is approximately 2 percent.<ref name="pmid21672501">{{cite journal| author=Van Meter AR, Moreira AL, Youngstrom EA| title=Meta-analysis of epidemiologic studies of pediatric bipolar disorder. | journal=J Clin Psychiatry | year= 2011 | volume= 72 | issue= 9 | pages= 1250-6 | pmid=21672501 | doi=10.4088/JCP.10m06290 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21672501  }}</ref> However it is not well established because several factors make the diagnosis of bipolar disorder in pediatric complex and controversial.<ref name="pmid26388529">{{cite journal| author=Grande I, Berk M, Birmaher B, Vieta E| title=Bipolar disorder. | journal=Lancet | year= 2016 | volume= 387 | issue= 10027 | pages= 1561-1572 | pmid=26388529 | doi=10.1016/S0140-6736(15)00241-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26388529  }}</ref>
*Pediatric bipolar disorder is characterized by high rates of comorbidity.<ref name="pmid21672501" />
*Community studies suggest that the prevalence of bipolar disorder may be greater among adolescents (age 13 to 18 years) than children (age ≤12 years)<ref name="pmid216725013">{{cite journal| author=Van Meter AR, Moreira AL, Youngstrom EA| title=Meta-analysis of epidemiologic studies of pediatric bipolar disorder. | journal=J Clin Psychiatry | year= 2011 | volume= 72 | issue= 9 | pages= 1250-6 | pmid=21672501 | doi=10.4088/JCP.10m06290 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21672501  }}</ref><ref name="pmid24305108">{{cite journal| author=Douglas J, Scott J| title=A systematic review of gender-specific rates of unipolar and bipolar disorders in community studies of pre-pubertal children. | journal=Bipolar Disord | year= 2014 | volume= 16 | issue= 1 | pages= 5-15 | pmid=24305108 | doi=10.1111/bdi.12155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24305108  }}</ref>


Bipolar disorder manifests in late life as well. Some individuals with "hyperthymic" temperament (or "hypomanic" personality style) who experience depression in later life appear to have a form of bipolar disorder. Much more needs to be elucidated about late-life bipolar disorder.


Approximately 50% of children in the U.S. child welfare system who have [[reactive attachment disorder]] also have comorbid [[Bipolar I]] disorder according to research by John Alston, MD.
<br />


==References==
==References==

Latest revision as of 16:17, 22 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]

Overview

The estimated lifetime prevalence of bipolar disorder among adults worldwide is 1 to 3 percent, and the lifetime prevalence of bipolar I and bipolar II disorder was 2.8 percent. The mean age of onset for bipolar I disorder is 18 years and for bipolar II disorder 20 years. The one-year prevalence of bipolar I disorder in people aged 65 years and older is approximately 0.4 percent and the lifetime rate is 0.8 percent. These rates were less than rates in younger individuals.

Epidemiology and demographics

  • The estimated lifetime prevalence of bipolar disorder among adults worldwide is 1 to 3 percent[1], and the lifetime prevalence of bipolar I and bipolar II disorder was 2.8 percent[2]
  • The mean age of onset for bipolar I disorder is 18 years and for bipolar II disorder 20 years[3]. The ratio of men to women who develop bipolar disorder is approximately 1:1.
  • In the United States, the estimated lifetime prevalence of bipolar I disorder was 1 percent, and bipolar II disorder 1.1 percent. The mean age of onset for bipolar I and bipolar II disorder was 18 and 20 years.[4]
  • Bipolar disorder is the 18th leading cause of disability in the United States.[5]
  • Individuals with manic or hypomanic episodes, psychosocial functioning is severely impaired in 70 percent; in 90 percent of the affected individuals functioning is severely impaired during episodes of major depression.[4]
  • The one-year prevalence of bipolar I disorder in people aged 65 years and older is approximately 0.4 percent and the lifetime rate is 0.8 percent. These rates were less than rates in younger individuals.[6]
  • Geriatric bipolar patients are predominantly female; 69 percent of late-life bipolar patients were women.[7]
  • The prevalence of bipolar spectrum disorders in children and adolescents is approximately 2 percent.[8] However it is not well established because several factors make the diagnosis of bipolar disorder in pediatric complex and controversial.[9]
  • Pediatric bipolar disorder is characterized by high rates of comorbidity.[8]
  • Community studies suggest that the prevalence of bipolar disorder may be greater among adolescents (age 13 to 18 years) than children (age ≤12 years)[10][11]



References

  1. ↑ Pedersen CB, Mors O, Bertelsen A, Waltoft BL, Agerbo E, McGrath JJ; et al. (2014). "A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders". JAMA Psychiatry. 71 (5): 573–81. doi:10.1001/jamapsychiatry.2014.16. PMID 24806211. Review in: Evid Based Ment Health. 2015 Feb;18(1):12
  2. ↑ Kessler RC, Ormel J, Petukhova M, McLaughlin KA, Green JG, Russo LJ; et al. (2011). "Development of lifetime comorbidity in the World Health Organization world mental health surveys". Arch Gen Psychiatry. 68 (1): 90–100. doi:10.1001/archgenpsychiatry.2010.180. PMC 3057480. PMID 21199968.
  3. ↑ Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA; et al. (2011). "Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative". Arch Gen Psychiatry. 68 (3): 241–51. doi:10.1001/archgenpsychiatry.2011.12. PMC 3486639. PMID 21383262.
  4. ↑ 4.0 4.1 Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M; et al. (2007). "Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication". Arch Gen Psychiatry. 64 (5): 543–52. doi:10.1001/archpsyc.64.5.543. PMC 1931566. PMID 17485606.
  5. ↑ Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D; et al. (2013). "The state of US health, 1990-2010: burden of diseases, injuries, and risk factors". JAMA. 310 (6): 591–608. doi:10.1001/jama.2013.13805. PMC 5436627. PMID 23842577.
  6. ↑ Blanco C, Compton WM, Saha TD, Goldstein BI, Ruan WJ, Huang B | display-authors=etal (2017) Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III. J Psychiatr Res 84 ():310-317. DOI:10.1016/j.jpsychires.2016.10.003 PMID: 27814503
  7. ↑ Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS; et al. (2009). "Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys". Arch Gen Psychiatry. 66 (7): 785–95. doi:10.1001/archgenpsychiatry.2009.36. PMC 2810067. PMID 19581570.
  8. ↑ 8.0 8.1 Van Meter AR, Moreira AL, Youngstrom EA (2011). "Meta-analysis of epidemiologic studies of pediatric bipolar disorder". J Clin Psychiatry. 72 (9): 1250–6. doi:10.4088/JCP.10m06290. PMID 21672501.
  9. ↑ Grande I, Berk M, Birmaher B, Vieta E (2016). "Bipolar disorder". Lancet. 387 (10027): 1561–1572. doi:10.1016/S0140-6736(15)00241-X. PMID 26388529.
  10. ↑ Van Meter AR, Moreira AL, Youngstrom EA (2011). "Meta-analysis of epidemiologic studies of pediatric bipolar disorder". J Clin Psychiatry. 72 (9): 1250–6. doi:10.4088/JCP.10m06290. PMID 21672501.
  11. ↑ Douglas J, Scott J (2014). "A systematic review of gender-specific rates of unipolar and bipolar disorders in community studies of pre-pubertal children". Bipolar Disord. 16 (1): 5–15. doi:10.1111/bdi.12155. PMID 24305108.

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