Screening for bipolar depression in family medicine practices: Prevalence and clinical correlates

Abstract Background To compare individuals in primary care (PC) who screen positive for bipolar depression to those who screened positive for unipolar depression on mental health care ouctomes, PC service utilization, medical comorbidities, suicidal ideation, health-related quality of life (HRQoL) a...

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Bibliographic Details
Published in:Journal of affective disorders 2014-06, Vol.162, p.120-127
Main Authors: Carvalho, André F, R. Nunes-Neto, Paulo, S. Castelo, Milena, S. Macêdo, Danielle, Dimellis, Dimos, G. Soeiro-de-Souza, Márcio, K. Soczynska, Joanna, S. McIntyre, Roger, N. Hyphantis, Thomas, N. Fountoulakis, Konstantinos
Format: Article
Language:English
Subjects:
Adult
Adult and adolescent clinical studies
Aged
Biological and medical sciences
Bipolar affective disorder
Bipolar depression
Bipolar disorder
Bipolar Disorder - diagnosis
Bipolar Disorder - epidemiology
Bipolar Disorder - physiopathology
Bipolar disorders
Brazil - epidemiology
Comorbidity
Cross-Sectional Studies
Diagnosis
Family Practice - organization & administration
Female
Functioning
Health status
Humans
Male
Medical sciences
Middle Aged
Miscellaneous
Mood disorders
Prevalence
Primary care
Psychiatry
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Quality of Life
Service utilization
Surveys and Questionnaires
Young Adult
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Summary:Abstract Background To compare individuals in primary care (PC) who screen positive for bipolar depression to those who screened positive for unipolar depression on mental health care ouctomes, PC service utilization, medical comorbidities, suicidal ideation, health-related quality of life (HRQoL) and psychosocial functioning. Methods In this cross-sectional study, participants ( N =1197) answered self-reported measures of depressive symptoms (Center for epidemiologic studies depression scale), HRQoL (World Health Organization Quality of Life instrument-Abbreviated version), medical comorbidity (functional comorbidity index) and functioning (Functional Assessment Short test). Participants were partitioned into ‘bipolar’ and ‘unipolar’ depression groups based on a predefined cutoff on the Brazilian mood disorder questionnaire. Results The prevalence of bipolar depression was in PC was 4.6% (95% CI: 3.4–5.8). Participants with bipolar depression were more likely to endorse suicidal ideation, present with more medical comorbidities, report a worse physical HRQoL and have a higher rate of PC services utilization as compared to participants who screened positive for unipolar depression. Only six (10.9%) participants were recognized by the general practitioner as having a diagnosis of bipolar depression. Limitations The cross-sectional design prevents firm causal inferences from being drawn. A positive screen for BD does not substantiate the actual diagnosis. Co-morbid mental disorders were not accessed. Conclusions Bipolar depression is common and under-recognized in Brazilian PC services. A positive screen for bipolar depression was associated with worse clinical outcomes and greater PC service utilization.
ISSN:0165-0327
1573-2517
DOI:10.1016/j.jad.2014.03.040