Clinical characteristics and functioning of adults with bipolar I disorder

Abstract

Background: Knowledge of clinical, treatment and life circumstances of individuals with bipolar I disorder (BP-I) in US households is informed by decades old epidemiological surveys.
Methods: The Mental and Substance Use Disorders Prevalence Study was conducted October 2020-October 2022. Clinicians administered the Structured Clinical Interview for the DSM-5 diagnosing 12-month prevalence of BP-I and other mental health disorders (MHD) among 4,764 adults aged 18-65 years and collected sociodemographic information. We examined clinical characteristics, differences by sex and age among adults with BP-I, and compared adults with BP-I versus no MHD regarding sociodemographic characteristics, functioning, and substance use disorders (SUDs).
Results: Prevalence of BP-I in the MDPS was 1.5%. Among those with BP-I, 73.4% had comorbid psychiatric disorders, and 43.4% had comorbid SUDs. Alcohol use disorder was higher in those with BP-I versus no MHD (33.0% vs. 6.3%). Mean Global Assessment of Functioning scores were lower among those with BP-I versus no MHD (53.2 vs. 77.0). Of individuals with BP-I, 64.9% had past-year outpatient, 5.4% inpatient, and 18.7% minimally adequate treatment (≥1 antimanic agent and ≥4 outpatient visits). Individuals with BP-I were less likely to be employed (37.3% vs. 63.0%) and have a family income ≥$20,000 (48.2% vs. 81.9%) versus no MDPS MHD.
Limitations: The survey response rate was low.
Conclusions: In this sample, many individuals with BP-I had psychiatric and SUD comorbidities, lived in poverty and had functional impairment. Few received adequate treatment; women and younger individuals were particularly disadvantaged. Early detection and treatment represent substantial opportunities to improve outcomes.