One-Year Treatment Outcomes of African-American and Hispanic Patients With Bipolar I or II Disorder in STEP-BD

Abstract

Objective Few studies have compared treatment outcomes of African-American, Hispanic, and non-Hispanic white patients with bipolar disorder. The U.S. Systematic Treatment Enhancement Program for Bipolar Disorder compared one-year outcomes for bipolar I or II disorder from each of these racial-ethnic groups. Methods African Americans (N=155) were retrospectively compared with a matched group of non-Hispanic whites (N=729), and Hispanics (N=152) were compared with a separate matched group of non-Hispanic whites (N=822). Response and recovery outcomes were examined. Survival analysis was used to compare time to treatment response for depression (Montgomery-Asberg Depression Rating Scale) and mania (Young Mania Rating Scale) as well as global assessment of functioning (Global Assessment of Functioning). Results For manic and depressive symptoms, time to response and proportion of responders were similar across groups. Over the study year the proportion of days well was similar across groups. A smaller proportion of African Americans met criteria for improved global functioning. Depression response among African Americans with psychotic symptoms was slower than the response among African Americans without psychotic symptoms and among non-Hispanic whites with or without psychotic symptoms. No differences between Hispanics and non-Hispanic whites in response times and recovery were observed. Conclusions Results are consistent with U.S. clinical trials for other psychiatric disorders, which have reported similar outcomes for ratings of primary symptoms. Baseline psychotic symptoms are likely a significant contributor when African Americans with bipolar disorder are slow to recover. These results may be less generalizable to uninsured patients.

Higher prevalence of bipolar I disorder among Asian and Latino compared to Caucasian patients receiving treatment

“…In spite of these limitations, our finding of a higher prevalence of bipolar I disorder in Asian and Latino compared to Caucasian patients receiving treatment, possibly due to minorities with milder forms of bipolar disorder not seeking care or receiving inappropriate diagnosis indicates a need for additional prospective, longitudinal studies that monitor treatment and function over‐time (Gonzalez, et al, 2010) and assess diversity within subgroups. Further efforts in clinical and public health settings are needed to decrease stigma and barriers to health care access and facilitate Asians, Latinos, and other minorities with bipolar disorders receiving timely and accurate diagnoses, culturally sensitive treatment, and optimal care utilization.…”

Racial disparities in bipolar disorder treatment and research: a call to action

“…The investigators did note that symptom reports, during the clinical assessment, from some African‐Americans may have been misattributed to psychopathology instead of sociocultural background. For example, the authors proposed that a persecutory delusion classified as a psychotic symptom may have been more accurate to view as an anxiety symptom when sociocultural context was considered . This misattribution could fuel unsuitable treatment recommendations (i.e.…”

Aging, Genetic Variations, and Ethnopharmacology

“…For ethnically diverse older adults, the results are even less optimal. African Americans show poorer outcomes on multiple measures (Gonsalez et al, 2010) as do other non-White groups. Although these outcomes are complicated by psychosocial adversity and comorbidities, genetic differences play a role and poorer outcomes are not inevitable (Murphy & McMahon, 2013).…”