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Original Article
March 7, 2011

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

Author Affiliations

Author Affiliations: National Institute of Mental Health, Bethesda, Maryland (Drs Merikangas and He); Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (Mr Jin, Dr Kessler, and Ms Sampson); Department of Psychiatry; The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong (Dr Lee) and Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen (Dr Hu), People's Republic of China; Section of Psychiatric Epidemiology (Drs Viana and Andrade) and Laboratory of Medical Investigation 23 (Dr Andrade), Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil; St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Institute for Development, Research, Advocacy and Applied Care, Medical Institute for Neuropsychological Disorders, Beirut, Lebanon (Dr Karam); Department of Psychiatry, University of Medicine and Pharmacy “Carol Davila,” Bucharest, Romania (Dr Ladea); National Institute of Psychiatry, Mexico City, Mexico (Dr Medina-Mora); Health Center, Keio University, Yokohama, Japan (Dr Ono); Colegio Mayor de Cundinamarca University, Bogota, Colombia (Dr Posada-Villa); Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India (Dr Sagar); Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand (Dr Wells); and National Center of Public Health Protection, Directorate Mental Health, Sofia, Bulgaria (Dr Zarkov).

Arch Gen Psychiatry. 2011;68(3):241-251. doi:10.1001/archgenpsychiatry.2011.12

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  Cross-sectional, 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.