Cited by 2,627Bipolar Disorder and TreatmentPersonality Disorders and PsychopathologyMental Health Treatment and Access

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

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Merikangas, Kathleen R., Jin, Robert, He, Jian-Ping, Kessler, Ronald C., Lee, Sing, Sampson, Nancy A., Viana, Maria Carmen, Andrade, Laura Helena, Hu, Chiyi, Karam, Elie G., Ladea, Maria, Medina-Mora, Maria Elena, Ono, Yutaka, Posada-Villa, Jose, Sagar, Rajesh, Wells, J. Elisabeth, Zarkov, Zahari·2011·Archives of General Psychiatry

DOI 10.1001/archgenpsychiatry.2011.12PMC PMC3486639

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Abstract

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.

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Authors: Merikangas, K. R., Jin, R., He, J.-P., Kessler, R. C., Lee, S., Sampson, N. A., Viana, M. C., Andrade, L. H., Hu, C., Karam, E. G., Ladea, M., Medina-Mora, M. E., Ono, Y., Posada-Villa, J., Sagar, R., Wells, J. E., & Zarkov, Z.
Affiliations: National Institute of Mental Health (US)
Harvard University (US)
Chinese University of Hong Kong (HK)
Universidade de São Paulo (BR)
Shenzhen KangNing Hospital (CN)
University of Balamand (LB)
Carol Davila University of Medicine and Pharmacy (RO)
Keio University (JP)
All India Institute of Medical Sciences (IN)
ORCID: Merikangas, Kathleen R.
Kessler, Ronald C.
Sampson, Nancy A.
Andrade, Laura Helena
Karam, Elie G.
Ono, Yutaka
Sagar, Rajesh
Zarkov, Zahari
Venue: Archives of General Psychiatry
Publisher: American Medical Association (AMA)
Published: 2011-03-07
Volume: 68
Issue: 3
Pages: 241
ISSN: 0003-990X (ISSN-L)
DOI: 10.1001/archgenpsychiatry.2011.12
PMC: PMC3486639
OpenAlex: W1984344128
Cited by: 2,627
References: 41
Citations by year: 2026: 135 · 2025: 212 · 2024: 191 · 2023: 190 · 2022: 232 · 2021: 231 · 2020: 210 · 2019: 219 · 2018: 173 · 2017: 179 · 2016: 162 · 2015: 142 · 2014: 126 · 2013: 111 · 2012: 80
FWCI: 76.17
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Archives of General Psychiatry (publishedVersion)
PubMed (publishedVersion)
Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
National Institute of Mental Health (R13-MH-066849, R01‐MH070884, U01-MH-60220, U01MH060220, R01‐MH069864)
National Institute on Drug Abuse (K05DA015799, R01DA016558)
Fogarty International Center (R03TW006481)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: bipolar spectrum disorders, bipolar I disorder, bipolar II disorder, prevalence, comorbidities, anxiety disorders, panic attacks, suicidal behavior, symptom severity, role impairment, mental health service utilization, treatment needs, low-income countries, cross-national comparison
MeSH terms: Adolescent, Adult, Bipolar Disorder, Cross-Sectional Studies, Cross-Cultural Comparison, Depressive Disorder, Major, Major Depressive Disorder, Female, Health Surveys, Humans, Male, Mental Health Services, Middle Aged, Sex Factors, Socioeconomic Factors, Suicide, Attempted, Utilization Review, World Health Organization, Comorbidity, Age of Onset, Young Adult

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

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