Screening for bipolar disorder in the primary care: A Brazilian survey

Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Journal of Affective Disorders (Impact Factor: 3.38). 09/2012; 143(1-3). DOI: 10.1016/j.jad.2012.05.040
Source: PubMed

ABSTRACT BACKGROUND: Two recent studies conducted in the US and in France found an unexpectedly high prevalence of a positive screen for bipolar disorder (BD) in primary care (PC). There are few studies of the prevalence of BD in PC and no information exists on the epidemiology of BD in Brazilian PC services. This study investigated the prevalence and correlates of a positive screen for BD among patients attending three Brazilian PC centers. METHODS: This cross-sectional survey recruited a systematic sample of 720 patients between 18 and 70 years of age who were seeking primary care treatment. Study measures included the Mood Disorder Questionnaire, the Center for Epidemiologic Studies Depression Scale, the World Health Organization Quality of Life instrument-Abbreviated version, the Functional Comorbidity Index, the Functioning Assessment Short Test, data on past mental health care, service utilization and a review of medical records for coded diagnosis. RESULTS: The prevalence of receiving positive screen for BD was 7.6% (n=55; 95% CI: 5.6-9.5%), but only 2 (3.6%) were recognized by general practitioners. A positive screen for BD was associated with significant depressive symptoms (CES-D score ≥16; 70.9%) and more general medical conditions, along with higher primary care utilization. Patients who screened positive for BD reported worse health-related quality of life as well as impaired functioning, compared to those who screened negative. LIMITATIONS: Co-morbid mental disorders were not assessed. The cross-sectional design prevents firm cause-effect inferences. CONCLUSIONS: The prevalence of a positive screening for BD is high, clinically significant and under-recognized in Brazilian PC settings.

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    • "To our knowledge this is the first study that compared differences in medical comorbidity and PC service utilization among PC patients who screen positive for 'bipolar' versus 'unipolar' depression. Previously, we reported that a positive screen for bipolar disorder is associated with a greater general medical burden and were more frequent utilizers of PC services (Castelo et al., 2012). "
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    ABSTRACT: 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. 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. 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. 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. 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.
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    ABSTRACT: To obtain an estimate of the prevalence of bipolar disorder in primary care. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method to conduct a systematic review in January 2013. We searched seven databases with a comprehensive list of search terms. Included articles had a sample size of 200 patients or more and assessed bipolar disorder using a structured clinical interview or bipolar screening questionnaire in random adult primary care patients. Risk of bias in each study was also assessed. We found 5595 unique records in our search. Fifteen studies met our inclusion criteria. The percentage of patients with bipolar disorder found on structured psychiatric interviews in 10 of 12 studies ranged from 0.5% to 4.3%, and a positive screen for bipolar disorder using a bipolar disorder questionnaire was found in 7.6% to 9.8% of patients. In 10 of 12 studies using a structured psychiatric interview, approximately 0.5% to 4.3% of primary care patients were found to have bipolar disorder, with as many as 9.3% having bipolar spectrum illness in some settings. Prevalence estimates from studies using screening measures that have been found to have low positive predictive value were generally higher than those found using structured interviews.
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    ABSTRACT: Studies suggest that misdiagnosis of bipolar disorders (BD) is frequent in primary care. This study aimed to evaluate agreement between referral for BD by general practitioners (GP) and BD diagnosis by secondary care psychiatrists, and to evaluate the impact of age, gender, and BD type on agreement. The study was conducted at Hôpital du Sacré-Coeur de Montréal׳s "Module Evaluation/Liaison" (MEL), which establishes/clarifies psychiatric diagnoses requested mainly from GPs and directs patients to appropriate treatment and care. Socio-demographic variables, reason for referral, and psychiatric diagnosis were compiled for patients assessed from 1998 to 2010. GP-psychiatrist agreement was established for BD type, gender, and age group (18-25, 26-35, 36-45, >45) using Cohen׳s Kappa coefficient (Κ). From 1998 to 2010, MEL psychiatrists received 18,111 requests and carried out 10,492 (58%) assessments. There were 583 referrals for BD suspicion, while 640 assessments (6.1%) received a BD diagnosis (40.3% type I, 40.5% type II). The overall K was 0.35 (95% CI [0.31, 0.38]), and was significantly higher for type I than type II (I=0.35, 95% CI [0.30, 0.39]; II=0.25, 95% CI [0.21, 0.30]), though age group and gender had no impact. Reasons for referral were converted into keywords and categories to facilitate agreement analyses. Only the main psychiatric diagnosis was available. Our study suggests diagnosing BD remains strenuous, regardless of age and gender, though BD type I seems better understood by primary care GPs. The true measure of BD diagnosis remains a critical issue in clinical practice. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 11/2014; 174C:225-232. DOI:10.1016/j.jad.2014.10.057 · 3.38 Impact Factor