Unit 7 epidemiology bipolar disorder

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Unit 7 epidemiology bipolar disorder

  1. 1. The Epidemiology of Bipolar Disorder
  2. 2. Lifetime Prevalence of Bipolar Disorder by Age Source: Kessler RC et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593-602. <ul><li>Based on the National Comorbidity Survey Replication (NCS-R) – the most recent nationally representative survey </li></ul><ul><li>Earlier studies (NCS; Epidemiologic Catchment Area [ECA]) found slightly lower lifetime prevalence rates (~1%) </li></ul><ul><li>Population-based studies in 10 different countries have found consistent lifetime prevalence rates of bipolar disorder (0.3 to 1.5%) </li></ul>Total (%) 18-29 (%) 30-44 (%) 45-59 (%) 60+ Bipolar I-II disorders 3.9 5.9 4.5 3.5 1.0
  3. 3. Twelve-Month Prevalence of Bipolar Disorder by Severity Source: Kessler RC et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593-602. Total (%) Serious (% of all cases) Moderate (% of all cases) Mild (% of all cases) Bipolar I-II disorders 2.6 82.9 17.1 0.0
  4. 4. Incidence and Age of Onset (AOO) <ul><li>Average age of onset: 25 years old </li></ul><ul><li>Range: 12 to 65+ </li></ul><ul><ul><li>First-episode mania cases in the elderly may be associated with comorbid cerebrovascular disorder </li></ul></ul>Source: National Institute of Mental Health. Source: Tohen M, Angst J. Epidemiology of Bipolar Disorder. In: Textbook in Psychiatric Epidemiology , MT Tsuang and M Tohen, eds. (2 nd edition). Wiley-Liss, 2002: New York.
  5. 5. Annual Incidence <ul><li>Data from the U.S. are limited </li></ul><ul><li>Scandinavian countries: </li></ul><ul><ul><li>9.2 to 15.2 per 100,000 men </li></ul></ul><ul><ul><li>7.4 to 32.5 per 100,000 women </li></ul></ul><ul><li>England and Denmark: </li></ul><ul><ul><li>2.6 per 100,000 individuals </li></ul></ul><ul><li>Ireland: </li></ul><ul><ul><li>4.5 per 100,000 </li></ul></ul>Sources: National Institute of Mental Health
  6. 6. Bipolar II <ul><li>Bipolar II has been less studied than Bipolar I </li></ul><ul><li>Lifetime prevalence estimates of 0.2% to 0.9% may underestimate bipolar II, because hypomania is not always recognized </li></ul>
  7. 7. Comorbid Conditions <ul><li>Substance abuse (~60.7% prevalence among those with Bipolar I in the ECA study) </li></ul><ul><li>Anxiety disorders </li></ul>Source: Tohen M, Angst J. Epidemiology of Bipolar Disorder. In: Textbook in Psychiatric Epidemiology , MT Tsuang and M Tohen, eds. (2 nd edition). Wiley-Liss, 2002: New York.
  8. 8. Risk Factors (1) <ul><li>More common in urban than rural populations </li></ul><ul><li>Higher prevalence in institutionalized (prisons, nursing homes) and homeless </li></ul><ul><li>No apparent gender difference </li></ul><ul><li>Association of bipolar disorder with class status is unclear </li></ul><ul><ul><li>Some studies suggest higher prevalence in higher socioeconomic classes, but may be due to assessment bias – those with lower socioeconomic status may be more likely classified as schizophrenic or psychotic </li></ul></ul><ul><ul><li>ECA program found higher rates in those with less education </li></ul></ul>Source: Tohen M, Angst J. Epidemiology of Bipolar Disorder. In: Textbook in Psychiatric Epidemiology , MT Tsuang and M Tohen, eds. (2 nd edition). Wiley-Liss, 2002: New York.
  9. 9. Risk Factors (2) <ul><li>Race </li></ul><ul><ul><li>ECA program and other studies found no differences by race </li></ul></ul><ul><li>Marital status </li></ul><ul><ul><li>Those cohabiting, divorced, or never married more likely to suffer from bipolar disorder than married individuals </li></ul></ul><ul><li>Family history of bipolar disease </li></ul>Source: Tohen M, Angst J. Epidemiology of Bipolar Disorder. In: Textbook in Psychiatric Epidemiology , MT Tsuang and M Tohen, eds. (2 nd edition). Wiley-Liss, 2002: New York.
  10. 10. Age, Sex, and Ethnicity <ul><li>The Epidemiologic Catchment Area (ECA) Program – the first study in the U.S. that obtained prevalence rates for bipolar disorder using structured diagnostic instruments – found that lifetime prevalence varied by age group, but not by sex or ethnic group </li></ul>Source: Tohen M, Angst J. Epidemiology of Bipolar Disorder. In: Textbook in Psychiatric Epidemiology , MT Tsuang and M Tohen, eds. (2 nd edition). Wiley-Liss, 2002: New York.

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