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Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative
Open accessAbstract
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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“While the prevalence rates for each subtype varied across the nine countries studied, subthreshold BD was the most common at 1.4% (0.8%), followed by BDI at 0.6% (0.4%) and BDII at 0.4% (0.3%).6”
From Canadian Network for Mood and Anxiety Treatments ( CANMAT ) and International Society for Bipolar Disorders ( ISBD ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [6]
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“Worldwide, approximately 43% of patients with BD report suicidal ideation, 21% a plan, and 16% a suicide attempt within the past year.6”
From Canadian Network for Mood and Anxiety Treatments ( CANMAT ) and International Society for Bipolar Disorders ( ISBD ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [6]
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“The World Mental Health Survey Initiative reported total lifetime (and 12‐month) prevalence estimates of 2.4% (1.5%) across BDI, BDII and subthreshold BD subtypes.”
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In the citing paper
“Worldwide, approximately 43% of patients with BD report suicidal ideation, 21% a plan, and 16% a suicide attempt within the past year.6”
From Canadian Network for Mood and Anxiety Treatments ( CANMAT ) and International Society for Bipolar Disorders ( ISBD ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Worldwide, approximately 43% of patients with BD report suicidal ideation, 21% a plan, and 16% a suicide attempt within the past year.6”
From Canadian Network for Mood and Anxiety Treatments ( CANMAT ) and International Society for Bipolar Disorders ( ISBD ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [6]
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In the citing paper
“bipolar depression is considerably more persistent than non-bipolar depression,5”
From The Costs of Depression (2012) · cites this paper as [5]
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Metadata
- 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
- 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)
- 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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