By Dr Ananya Mandal, MD
Bipolar disorder is a psychiatric disorder that swings between depression and mania. It strikes early and can cause lifelong disability. Reports show that it is chronically undertreated in many low-income countries.
A government commissioned survey of more than 61,000 patients suggests 2.4 percent of the world’s population may have some form of the disease, which is marked by unexplained shifts in mood, energy and activity that can affect relationships and job performance.
Kathleen Merikangas of the National Institute of Mental Health in Bethesda, Maryland and colleagues wrote in the Archives of General Psychiatry, “It’s very important that we understand the scope and magnitude of this disorder so that we can plan appropriate treatments, facilitate recognition of diseases, and identify people at risk so we can bring them into treatment…Bipolar disorder is responsible for the loss of more disability-adjusted life-years than all forms of cancer or major neurologic conditions such as epilepsy and Alzheimer’s disease, primarily because of its early onset and chronicity across the life span.” The team conducted surveys of adults in the United States, Mexico, Brazil, Colombia, Bulgaria, Romania, China, India, Japan, Lebanon and New Zealand. The United States has the highest lifetime rate of bipolar disorder at 4.4%, and India the lowest, with 0.1%. Japan had a lifetime prevalence of 0.7%. Colombia, a lower-income nation, also deviated from the trend with a relatively high prevalence of 2.6%.
Results showed that less than half of those with bipolar disorder or manic-depressive psychosis received mental health treatment during their lifetimes. In low-income countries, only 25.2 percent of bipolar patients said they had any contact with the mental health system. Three fourths of those with bipolar disorder also met the diagnostic criteria for at least one other disorder, with anxiety disorders being the most common concomitant illness. Over 50% people said their symptoms started in adolescence, underscoring the need for early detection and treatment, the researchers said.
“In light of the disability associated with bipolar disorder, the lack of mental health treatment among those with bipolar disorder, particularly in low income countries, is alarming,” the team wrote.
Experts try to explain the higher overall prevalence rate in the U.S. Sara Bodner, an assistant professor of psychiatry at the University of Miami Miller School of Medicine said, “It could be genetics; it could be environment. It also could be the way individuals in different cultures are willing to respond to this kind of an inquiry…Cultural awareness plays a very big role in psychiatry. Some cultures have a huge reluctance to speak about psychiatric things.”
Merikangas added that in the U.S., people with bipolar symptoms may be more likely to be diagnosed with the condition since, “We’re pretty aware of [bipolar disorder].” Lower awareness in lower-income nations carries higher levels of stigma. That means fewer people may be willing to talk about or get treatment for symptoms, which can lead to lower perceived rates of bipolar disorder. “Rates of bipolar disorder were lower in countries with more stigma,” Merikangas said. However intact traditional social structures may also protect poorer countries from bipolar disorders. Merikangas said, “We have less buffers in terms of social networks, in terms of having strong family backgrounds…We’re much more mobile here.”
David Schlager, an assistant professor of psychiatry and behavioral science at the Texas A&M Health Science Center College of Medicine in Round Rock and a psychiatrist with Lone Star Circle of Care feels that the U.S.’s immigrant composition might contribute to the prevalence. Schlager said, “The U.S. attracts people who believe they can achieve a better life…They come to believe they can pick up and start again. It’s a self-selected sample of people who are grandiose and impulsive. It takes a certain suspension of belief to actually believe you can come here and make it happen. Those are a significant percentage of people on the bipolar spectrum.”
The study was conducted by researchers around the world and funded by grants from the National Institute of Mental Health, the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, and a variety of other pharmaceutical companies and public health organizations.