Comorbid physical, psychiatric disorders common in BD

By Ingrid Grasmo, medwireNews Reporter

Findings from the Singapore Mental Health Study show that over two-thirds of individuals with bipolar disorder (BD) have other lifetime mental disorders, with approximately half also experiencing at least one chronic physical condition.

Despite this, the findings published in the Journal of Affective Disorders show that only one-third of the BD patients in the study had sought any kind of treatment, emphasizing the need to improve access to care.

Mythily Subramaniam (Institute of Mental Health, Buangkok Green Medical Park, Singapore) and co-authors say that in order to tackle poor treatment access, it will be necessary to address factors influencing help-seeking behavior, such as the patient's perception of their illness, societal attitudes, economic factors, and the fear of discrimination and stigma.

Initial findings from the cross-sectional epidemiologic survey of 6616 citizens and permanent residents of Singapore revealed lifetime and 12-month prevalence estimates of 1.2% and 0.6% for BD.

The median age of onset for BD was found to be 24 years, with the highest rate of lifetime and 12-month prevalence observed among individuals aged 18-34 years compared with those aged 35-49 years, who showed a 40% reduced risk for developing BD.

The study also revealed that half of the individuals with BD also had other lifetime psychiatric disorders, including generalized anxiety disorder (GAD; 18.1%), obsessive compulsive disorder (OCD; 25.9%), alcohol abuse (8.8%) and dependence (1.1%). After adjusting for age, gender, and ethnicity, BD was significantly associated with a 28.4-, 10.6-, and 2.9-fold significantly increased risk for GAD, OCD, and alcohol abuse, respectively.

Similar findings were observed for comorbid physical disorders, with 52.6% of individuals with lifetime BD having at least one chronic physical condition. Chronic pain was the most prevalent condition for both BD-I (28.3%) and BD-II (59.3%), with BD significantly associated with a 3.0-fold increased risk for chronic pain after adjusting for confounding factors.

Despite an additional 81.0% of individuals reporting severe or moderate major depressive episodes and 52.5% reporting severe or moderate manic/hypomanic episodes, only 35.3% sought professional help (37.4% BD-I vs 6.2% BD-II).

However, 61.2% of patients who ever sought professional help reported that treatment was helpful.

"Measures to increase access to care for those with BD… has to take into consideration the age of onset, and the local cultural and religious beliefs and attitudes in the planning and implementation of mental health literacy and destigmatization programmes," conclude the researchers.

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