Delay in Diagnosis of Bipolar Disorder Linked With Sex, Suicide Attempts, Age at Onset

Age at onset and age when seeking professional help have been found to be linked with delays in diagnosis of bipolar disorder, Canadian researchers discovered in a study published in the Journal of Affective Disorders. The investigators also found a longer period until diagnosis of bipolar I disorder compared with bipolar II disorder.

Delays in diagnosis of bipolar disorder can lead to social, psychiatric, and other health challenges, and early interventions can lead to psychosocial improvements.  Therefore, the investigators sought to identify factors involved in delays using data from the Health Outcomes and Patient Evaluations in Bipolar Disorder (HOPE-BD) multicentre study of The Canadian Network for Bipolar Disorder (CAN-BD).

The researchers selected a sample of patients who participated in the HOPE-BD study, which included patients in Ontario, Quebec, and British Columbia who were at least 15 years of age. Patients included in the sample (n=319, mean age 42 years, 60.2% female) had been diagnosed with bipolar I disorder I (n=192) or bipolar II disorder (n=127) according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and knew the duration of their undiagnosed bipolar disorder.

The median age at onset of bipolar disorder was 23 years, and the median age at diagnosis of bipolar disorder was 35 years. The median duration of undiagnosed bipolar disorder was 8 years. In their first episode, the majority of patients experienced depression (53.6%), which was linked with longer duration in which bipolar disorder went undiagnosed (P <.0001).

Onset of bipolar disorder before the age of 18 years was linked with longer duration of undiagnosed bipolar disorder  (P <.0001), and women were more likely to have longer duration of undiagnosed bipolar disorder compared with men (P =.0013).

Delays in diagnosis tended to be longer for bipolar II disorder and when there was an absence of lifetime psychotic symptoms (P <.0001). Lifetime suicide attempts (P =.0045) and comorbid anxiety disorders (P =.0324) were associated with longer duration of undiagnosed bipolar disorder.

“Clinical factors such as lifetime suicide attempts and comorbid anxiety disorders were associated with a longer diagnostic delay, whereas the presence of lifetime psychotic symptoms and psychiatric hospitalizations were associated with a shorter delay,” the researchers said. “These findings highlight the need for implementation of strategies for early identification and interventions in BD.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. This research was supported by Janssen-Ortho, Canada. Please see the original reference for a full list of disclosures.

Reference

Keramatian K, Pinto JV, Schaffer A, et al. Clinical and demographic factors associated with delayed diagnosis of bipolar disorder: data from Health Outcomes and Patient Evaluations in Bipolar Disorder (HOPE-BD) study. J Affect Disord. Published online October 1, 2021. doi:10.1016/j.jad.2021.09.094