Cited by 51Bipolar Disorder and TreatmentAttention Deficit Hyperactivity DisorderSchizophrenia research and treatment

Attention-deficit hyperactivity disorder and anxiety disorders as precursors of bipolar disorder onset in adulthood

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Meier, Sandra M., Pavlova, Barbara, Dalsgaard, Søren, Nordentoft, Merete, Mors, Ole, Mortensen, Preben B., Uher, Rudolf·2018·The British Journal of Psychiatry

Abstract

Background: Attention-deficit hyperactivity disorder (ADHD) and anxiety disorders have been proposed as precursors of bipolar disorder, but their joint and relative roles in the development of bipolar disorder are unknown. Aims: To test the prospective relationship of ADHD and anxiety with onset of bipolar disorder. Method: We examined the relationship between ADHD, anxiety disorders and bipolar disorder in a birth cohort of 2 409 236 individuals born in Denmark between 1955 and 1991. Individuals were followed from their sixteenth birthday or from January 1995 to their first clinical contact for bipolar disorder or until December 2012. We calculated incidence rates per 10 000 person-years and tested the effects of prior diagnoses on the risk of bipolar disorder in survival models. Results: Over 37 394 865 person-years follow-up, 9250 onsets of bipolar disorder occurred. The incidence rate of bipolar disorder was 2.17 (95% CI 2.12–2.19) in individuals with no prior diagnosis of ADHD or anxiety, 23.86 (95% CI 19.98–27.75) in individuals with a prior diagnosis of ADHD only, 26.05 (95% CI 24.47–27.62) in individuals with a prior diagnosis of anxiety only and 66.16 (95% CI 44.83–87.47) in those with prior diagnoses of both ADHD and anxiety. The combination of ADHD and anxiety increased the risk of bipolar disorder 30-fold (95% CI 21.66–41.40) compared with those with no prior ADHD or anxiety. Conclusions: Early manifestations of both internalising and externalising psychopathology indicate liability to bipolar disorder. The combination of ADHD and anxiety is associated with a very high risk of bipolar disorder. Declaration of interest: None.

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  1. Larsson H, Ryden E, Boman M, Langstrom N, Lichtenstein P, Landen M. Risk of bipolar disorder and schizophrenia in relatives of people with attention-deficit hyperactivity disorder. Br J Psychiatry 2013; 203: 103-6.

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Authors
Meier, S. M., Pavlova, B., Dalsgaard, S., Nordentoft, M., Mors, O., Mortensen, P. B., & Uher, R.
Affiliations
  • Aarhus University (DK)
  • Copenhagen University Hospital (DK)
  • Aarhus University Hospital (DK)
  • Dalhousie University (CA)
Corresponding author
Uher, Rudolf
Venue
The British Journal of Psychiatry
Published
2018-06-21
Volume
213
Issue
3
Pages
555-560
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
OpenAlex
W2808787792
Cited by
51
References
35
Citations by year
2026: 10 · 2025: 6 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 8 · 2020: 5 · 2019: 8
FWCI
4.13
Type
journal article
Language
en
Open access
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
  • Scopus (Elsevier) (submittedVersion)
Funders
  • Aarhus Universitet
  • Aarhus Universitetshospital
  • Dalhousie Medical Research Foundation
  • Nova Scotia Health Research Foundation (275319, 1716 and 353892, 275319, 353892)
  • European Commission (275319)
  • Canada Research Chairs (231397)
  • Gentofte Hospital
  • Dalhousie University
  • Lundbeckfonden (R155-2014-1724, R248‐2017‐2003)
  • Novo Nordisk Fonden (NNF 16OC0022018)
  • H. Lundbeck A/S (R155-2014-1724)
  • Canadian Institutes of Health Research (142738, 124976, 148394)
  • National Center for Research Resources
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
bipolar disorder, attention deficit hyperactivity disorder, anxiety disorders, psychiatric comorbidity, risk factors, birth cohort, incidence
MeSH terms
Adolescent, Adult, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Bipolar Disorder, Denmark, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Linear Models, Young Adult

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