Bipolar disorder in children and adolescents: diagnostic inpatient rates from 2000 to 2013 in Germany

Abstract

BackgroundDespite growing consensus on nosology and epidemiology of bipolar disorder (BD) in minors, differences remain. We contribute to this discussion by measuring long-term trends in the inpatient discharge rates of BD in minors.MethodsNationwide German inpatient discharge diagnoses of BD and other related psychiatric disorders were mapped between 2008 and 2013 using registry data from the German Federal Health Monitoring System. This was compared with previously published data, 2000–2007, to assess long-term trends in diagnosis of BD at discharge. Long-term trends (2000–2013) were also computed.ResultsDischarge diagnosis of BD increased by 18% (2.02–2.46 per 100,000) in minors. There was a significant increase of 24.1% in adolescents 15–19 years old (6.56–8.14 per 100,000). BD, at discharge, as a proportion of all psychiatric disorders, increased from 0.26% in 2008 to 0.27% in 2013. When analysing long-term trends (2000–2013), the rates for BD increased significantly as did trends for all mental disorders, except for psychotic disorders, which fell by almost 14%. Between 2000 and 2013, the rate for depression in minors increased by 730%.LimitationsThe dataset consisted of cross-sectional administrative data points with diagnoses based on clinical criteria.ConclusionsThe rate of BD as a discharge diagnosis in German minors has increased significantly, consistently exceeding the general trend for a rise in rates for mental disorders. Overall, the rate of discharge diagnosis of BD from inpatient units in Germany remains a small proportion of all psychiatric diagnoses.

The incidence, psychiatric co-morbidity and pharmacological treatment of severe mental disorders in children and adolescents

“…However, our findings are more in line with a Danish registry-based study from specialist health care, which demonstrated a 12-year cumulative incidence of 0.3% for schizophrenia-like disorder and about 0.1% for bipolar disorder by 20 years of age [4]. The current findings are also similar to incidence rates of bipolar disorder in children and adolescents found in health care settings in the UK [7] and Germany [10]. In a registry-based study from Denmark, the incidence of schizophrenia-like disorder (F20-F29) among 5–18 year olds increased significantly during the period 2000–2012 [27], demonstrating higher incidence rates of schizophrenia when outpatient contacts were included in the Danish Psychiatric Central Register [28].…”

“…In the US National Comorbidity Survey of nationally representative adolescents, 2.9% of the 13–18 year olds met diagnostic criteria for bipolar disorder type I or II [8]. This is higher than European figures, but a recent study from Germany demonstrated an 18% increase in the rate of discharge diagnosis for bipolar disorder among 0–19 year olds between 2000 and 2013 [10]. In the above mentioned registry-based study from specialist health care in Denmark, 0.1% of the population were diagnosed with bipolar disorder by the age of 20 years [4].…”

Decreasing rate of inpatient pediatric bipolar disorder diagnosis in the US between 2004 and 2010

“…While rates of BD diagnosis among youth initially increased and then decreased in the United States between the mid‐2000s and 2010, the population‐adjusted rate of youth BD diagnosis in Denmark continuously increased between 1995 and 2012 33 . BD diagnosis also increased among adolescents and adults in the national German inpatient healthcare system between 2000 and 2013 34,35 . Although there has been a slight increase in BD diagnosis internationally, the present study suggests that rates of inpatient BD diagnosis decreased in the United States, with at least one US state demonstrating a continued decrease until 2015 23 .…”

Epidemiologie psychischer Störungen bei Kindern und Jugendlichen

“…Eine anhaltende Kontroverse betrifft die Prävalenz von bipolar affektiven Störungen in Kindheit und Jugend: während in den USA sowohl bei stationären als auch bei ambulanten Patienten seit Mitte der 1990er Jahre die Zahl der Diagnose "bipolare Störung" bei Kindern und Jugendlichen explodierte, herrschten in anderen Weltgegenden Skepsis und Zurückhaltung vor [15]. Dieser Anstieg wurde vor allem durch eine konzeptuelle Änderung der Diagnosekriterien hin zum "broad phenotype" verursacht.…”