Newswise — Bipolar disorder contributes to about five percent of youth suicides. Earlier research indicates a significant time lag between the emergence of bipolar disorder and its accurate identification and therapy. A recent study conducted by Karolinska Institutet reveals a correlation between higher prevalence of bipolar diagnoses and decreased suicide rates among boys in Swedish regions. Published in JAMA Psychiatry, this study has the potential to enhance proactive healthcare approaches aimed at reducing suicide incidents.
"The onset of bipolar disorder during early life is frequently more distressing, and it is one of the psychiatric conditions most closely linked to the risk of suicide," stated Peter Andersson, the primary author of the study and a doctoral student at the Department of Clinical Neuroscience, Karolinska Institutet.
Typically, bipolar disorder emerges within the age range of 12 to 25, featuring recurrent episodes of mania and depression. Previous research has demonstrated that the process of diagnosing and treating bipolar disorder can extend up to six years. Comparisons with data from previous comprehensive prevalence studies suggest that under-diagnosis is particularly prevalent among individuals aged 15-19 in Sweden.
Large regional differences
By analyzing registry data encompassing all 21 regions of Sweden from 2008 to 2021, a team of researchers from Karolinska Institutet investigated variations among regions regarding the diagnosis of bipolar disorder among individuals aged 15 to 19. Additionally, they examined the relationship between population size-adjusted diagnoses and confirmed suicides, differentiating between males and females.
The study's findings, which involved a total of 585 confirmed suicides within the specified age group, revealed significant variations among regions in terms of the proportion of young individuals diagnosed with bipolar disorder.
Additionally, the study identified a correlation between a greater number of bipolar diagnoses adjusted for population size and reduced suicide rates among boys.
According to Adrian E. Desai Boström, the corresponding author of the study and a resident in child and adolescent psychiatry in Stockholm, as well as a postdoctoral researcher at the Department of Clinical Neuroscience, Karolinska Institutet, the results indicate that regions with higher rates of bipolar diagnoses experience an approximately five percent lower suicide rate among boys. These findings suggest that enhancing the diagnosis and treatment of bipolar disorder could potentially reduce suicide incidents among teenage boys in Sweden.
Sometimes wrongly diagnosed
The study's additional analyses revealed that the correlation between the quantity of bipolar diagnoses and decreased suicide rates among boys remained consistent regardless of the number of care episodes or diagnoses related to depression or schizophrenia. This finding suggests that the observed relationship between bipolar diagnoses and lower suicide rates among boys is independent of other factors such as care utilization or co-occurring mental health conditions.
Interestingly, despite a higher number of established bipolar diagnoses, the study found a decrease in the number of prescriptions for the mood stabilizer lithium. However, there was an observed increase in the number of boys who received lithium at least once. The researchers suggested that this could be interpreted as an indication that boys with bipolar disorder often initiate lithium therapy but subsequently switch to alternative mood-stabilizing medications for various reasons.
Andersson highlights that certain young individuals with bipolar disorder may be referred from psychiatric services to social services based on laws pertaining to the care of youth and individuals with functional impairments. Moreover, it is known that bipolar patients are occasionally misdiagnosed with "ordinary" depression, further adding to the complexity of accurate diagnoses and appropriate treatment.
In a recently published study in Nature Communications, researchers discovered significant regional disparities in the utilization of advanced psychiatric treatments in the field of child and adolescent psychiatry in Sweden. As a result, they have planned additional investigations to examine the effects of advanced psychiatric treatments on young individuals diagnosed with bipolar disorder and other severe psychiatric conditions. The aim is to gain deeper insights into the impacts of these treatments and enhance the understanding and provision of care for these specific populations.
The study represented a collaborative effort involving researchers from various institutions in Sweden, including Karolinska Institutet, Uppsala University, Umeå University, Lund University, Region Halland, and Region Stockholm. The Swedish Research Council provided financial support for the study. It is worth noting that co-author Jussi Jokinen has served as a member of an advisory committee for the pharmaceutical company Janssen, specifically concerning the use of esketamine in depression treatment. However, no other conflicts of interest have been reported by the researchers involved in the study.
Publication: ”Association of Bipolar Disorder Diagnosis With Suicide Mortality Rates in Adolescents in Sweden”. Peter Andersson, Jussi Jokinen, Håkan Jarbin, Johan Lundberg, Adrian E. Desai Boström. JAMA Psychiatry, online 24 May 2023, doi: 10.1001/jamapsychiatry.2023.1390.
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