Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative

Abstract

Context There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methodology. Objective To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder in the WHO World Mental Health survey (WMH) initiative. Design Cross-sectional face-to-face household surveys Participants 61,392 community adults in 11 countries in the Americas, Europe, and Asia Main Outcome Measure DSM-IV disorders, severity, and treatment assessed with the World Mental Health version of the WHO Composite International Diagnostic Interview (WMH CIDI 3.0), a fully-structured lay-administered psychiatric diagnostic interview. Results The aggregate lifetime prevalence of BP-I disorder was 0.6%, BP-II was 0.4%, subthreshold BP was 1.4%, and Bipolar Spectrum (BPS) was 2.4%. Twelve-month prevalence of BP-I disorder was 0.4%, BP-II was 0.3%, subthreshold BP was 0.8%, and BPS was 1.5%. Severity of both manic and depressive symptoms, and suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across bipolar subtypes. Symptom severity was greater for depressive than manic episodes, with approximately 75% of respondents with depression and 50% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least one other disorder, with anxiety disorders, particularly panic attacks, being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries where only 25% reported contact with the mental health system. Conclusions Despite cross-site variation in the prevalence rates of bipolar spectrum disorder, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior and comorbidity across each diagnostic category provide evidence for the validity of the concept of a bipolar spectrum. BPS treatment needs are often unmet, particularly in low-income countries.

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

“…The World Mental Health Survey Initiative reported total lifetime (and 12‐month) prevalence estimates of 2.4% (1.5%) across BDI, BDII and subthreshold BD subtypes. While the prevalence rates for each subtype varied across the nine countries studied, subthreshold BD was the most common at 1.4% (0.8%), followed by BDI at 0.6% (0.4%) and BDII at 0.4% (0.3%) 6. While Canada was not included in this study, similar results were reported from the Canadian Community Health Survey‐Mental Health, which found the lifetime prevalence of BDI was 0.87% and that of BDII was 0.67% 7…”

“…The fatality of suicide attempts is also higher in BD than in the general population 48, 49. Worldwide, approximately 43% of patients with BD report suicidal ideation, 21% a plan, and 16% a suicide attempt within the past year 6. Men are at a higher risk of death by suicide, with an estimated rate of 0.366 per 100 person years, compared to 0.217 for women 47…”

Efficacy, safety and tolerability of aripiprazole in bipolar disorder: An updated systematic review and meta-analysis of randomized controlled trials

“…Bipolar disorder (BD) affects approximately 2.4% of the general population (Merikangas et al, 2011) and is easily misdiagnosed or under-diagnosed (Angst, 2006). BD is associated with a greatly impaired quality of life, increased physical health burden (Vancampfort et al, 2016;Vancampfort et al, 2015) and disability (Hirschfeld et al, 2003;Yatham et al, 2004).…”

Test performance of the Cantonese Chinese Mood Disorder Questionnaire for detecting bipolar spectrum disorder in the community of Hong Kong

“…A recent cross-national community epidemiological study confirmed that it is a common and valid illness entity across 11 countries (Merikangas et al, 2011). Although BSD has been uncommonly studied in community settings (Benazzi, 2007;Lee et al, 2009), its early age of onset, high prevalence, typically late recognition and impairing nature (Merikangas et al, 2011) have prompted recent interest in early detection in both clinical and community settings. The underrecognition of BSD (Akiskal et al, 2000) may be improved by enhancing the reliability and validity of screening instruments (Young & MacPherson, 2011).…”