Better Outcomes in Pediatric-Onset vs Adult-Onset Bipolar Disorder

Individuals with pediatric-onset bipolar disorder fare better than individuals diagnosed at a later age with the disorder, and bipolar disorder in general is associated with better outcomes than schizophrenia.

Bipolar disorder (BD) was associated with poorer outcomes than good mental health but better outcomes than schizophrenia, according to study results published in Bipolar Disorders. Furthermore, individuals with pediatric BD fared better than individuals diagnosed at a later age with the disorder.

Mathilde Frahm Laursen, MD, of the Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital and the Department of Clinical Medicine, Aalborg University, Denmark, and colleagues conducted a nationwide cohort study including patients with an incident diagnosis of BD or schizophrenia who were registered in the Danish National Patient Registry and psychiatrically healthy controls. Outcomes included duration of hospitalization, psychiatric admissions, psychiatric outpatient contacts, bone-fracture-related healthcare contacts, self-harm-related healthcare contacts, and criminal charges. Pediatric-onset BD, defined as onset between the age of 5 and 17 years, and adult-onset BD, defined as onset between the age of 18 and 39 years, were compared with individuals with schizophrenia and individuals in the control group.

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The study included 6370 patients with a diagnosis of BD; 6005 were adult-onset BD and 365 were pediatric-onset BD. Of these patients, 5515 adults with BD were matched to an equal number of adults diagnosed with schizophrenia and 349 children and adolescents with BD were matched to an equal number of children and adolescents with schizophrenia. The investigators matched all patients with BD on a 1 to 3 basis to 19,110 healthy participants.

Compared with participants with pediatric-onset schizophrenia, participants with pediatric-onset BD had 28% fewer psychiatric outpatient contacts, 56% fewer psychiatric admissions, a 70% lower incidence of acts of self-harm, a 32% lower incidence of contacts due to bone fracture, and a 14% lower rate of criminal charges. 

Comparing participants with adult-onset BD vs adult-onset schizophrenia, the investigators found similar results, with 42% fewer psychiatric outpatient contacts, 28% fewer psychiatric admissions, a 15% lower rate of acts of self-harm, a 7% lower rate of criminal charges. However, participants with adult-onset BD had a 13% higher incidence of healthcare contacts due to bone fracture. Comparing pediatric BD to matched healthy participants, the incidence rate ratio for self-harm was 2.80, whereas in adult-onset BD it was considerably higher at 16.68. The incidence rate ratio was also higher in healthcare contacts due to bone fractures and criminal charges compared with healthy individuals.

The investigators noted that these findings show that individuals with adult-onset BD do more poorly than patients with pediatric-onset BD on all measures, except the number of outpatient contacts. This is in contrast to the results of previous studies. The investigators suggested that this difference may be due to the accessibility of mental healthcare in Denmark, which may allow for earlier treatment of pediatric-onset disease, and to the direct comparison of pediatric- and adult-onset BD groups with age-matched groups with schizophrenia, thus mitigating the confounding effects of age and the differences in pediatric and adult services.

“[Providing] optimized and earlier interventions in both pediatric-onset BD and adult-onset BD will hopefully result in a better prognosis for both age groups,” investigators concluded.


Laursen MF, Valentin JB, Licht RW, Correll CU, Nielsen RE. Longitudinal outcomes in pediatric- and adult-onset bipolar patients compared to healthy and schizophrenia controls [published online May 9, 2019]. Bipolar Disord. doi:10.1111/bdi.12973