Bipolar Disorder Recognized Earlier, but Mortality Remains High

Megan Brooks

May 21, 2015

TORONTO ― Bipolar disorder is being detected at younger ages, but this has not led to a drop in mortality, new research shows.

"Unfortunately, our study cannot say why bipolar is being diagnosed earlier, but we have several theories. One is increased awareness about bipolar disorder among clinicians," Clara Reece Medici, fifth-year medical student, Psychiatric Research Academy, Aarhus University, in Denmark, told Medscape Medical News.

"Despite younger age at diagnosis, we haven't really been able to alter mortality rates," she noted.

A large observational study from Sweden published in 2014 showed that the age at diagnosis of bipolar has decreased.

"We wanted to see if this is true in Denmark too," Medici told Medscape Medical News here at the American Psychiatric Association (APA) 2015 Annual Meeting, where she presented her research.

Unnatural Causes

Using the Danish Psychiatric Central Research Register and Danish Register of Causes of Death, the study team analyzed patients with a first-ever diagnosis of bipolar disorder according to ICD-10 criteria between 1995 and 2012.

They identified 15,334 incident cases of bipolar disorder in the study period. The mean age of patients at time of diagnosis fell from 54.5 years in 1995 to 42.4 years in 2012, "which is quite significant," Medici said.

"But this hasn't reduced the high mortality rate," she noted. The mean standardized mortality ratio was 1.7 (95% confidence interval [CI], 1.2 - 2.1); the rate remained stable throughout the study period.

"The majority of patients die from natural causes, but accidents and suicide account for a larger part of deaths in bipolar patients compared with the general population," Medici noted.

For example, 9.0% of bipolar patients died from suicide vs an expected 5.1%; for accidents, the figures were 5.2% and 4.0%, respectively. Accidents, suicide, or violence/homicide accounted for 19.1% of deaths in men with bipolar disorder and in 11.8% of women with the disorder. Most unnatural deaths occurred within the first 5 years after diagnosis.

"Measures taken to lower mortality in patients with bipolar disorder should focus on both physical and mental illness," the investigators note.

Progress, Challenges

Commenting on the findings for Medscape Medical News, Maria A. Oquendo, MD, professor of psychiatry, New York–Presbyterian/Columbia University Medical Center, in New York City, and president-elect of the APA, who starts her term in May 2016, said, "Greater awareness is clearly making a difference, but...we still have work to do." Nevertheless, the decreasing age at diagnosis shows "progress."

"One thing is to recognize the disorder early. Another is to get symptoms into remission. In order to decrease morbidity and mortality, effective treatment is key. Still, early identification is an essential first step. That men with bipolar disorder have higher mortality from unnatural causes than women with bipolar disorder is consistent with what is observed in the general population," said Dr Oquendo.

"Clinically," she added, this study "alerts us to the risk not only of suicide in this group but also of accidental deaths."

The authors report no relevant financial relationships.

American Psychiatric Association (APA) 2015 Annual Meeting. Presented May 17, 2015.


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