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

Context: There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods. Objectives: To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative. Design, Setting, and Participants: Crosssectional, face-to-face, household surveys of 61 392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview. Main Outcome Measures: Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment. Results: The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 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 25.2% reported contact with the mental health system. Conclusions: Despite cross-site variation in the prevalence rates of BPS, 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 BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.

Bristol-Myers Squibb

Eli Lilly and Co

GlaxoSmithKline

Johnson and Johnson Pharmaceuticals

Ortho-McNeil Pharmaceutical

Pfizer

Sanofi-Aventis

National Institute of Mental Health (NIH)[R01MH070884]

National Institute of Mental Health (NIH)[U01-MH60220]

John D. and Catherine T. MacArthur Foundation

Pfizer Foundation

US Public Health Service[R13-MH066849]

US Public Health Service[R01-MH069864]

US Public Health Service[R01 DA016558]

Fogarty International Center (FIRCA/NIH)[FIRCA R03-TW006481]

Pan American Health Organization (PAHO)

Eli Lilly and Co Foundation

FAPESP State of Sao Paulo Research Foundation[03/00204-3]

Ministry of Health

National Center for Public Health Protection

Shenzhen Bureau of Health

Shenzhen Bureau of Science, Technology, and Information

Ministry of Social Protection

WHO World Health Organization (India)

Japan Ministry of Health, Labour and Welfare[H13-SHOGAI-023]

Japan Ministry of Health, Labour and Welfare[H14-TOKUBETSU-026]

Japan Ministry of Health, Labour and Welfare[H16-KOKORO-013]

Lebanese Ministry of Public Health

WHO World Health Organization (Lebanon)

Fogarty International (FIRCA/NIH)

Janssen Cilag

Roche

Novartis

National Institute of Psychiatry Ramon de la Fuente[4280]

National Council on Science and Technology[CONACyT-G30544-H]

New Zealand Ministry of Health

Alcohol Advisory Council

Health Research Council

Ministry of Public Health (formerly the Ministry of Health)

Robert Wood Johnson Foundation[044708]

John W. Alden Trust