To explore gender differences in bipolar I disorder, we compared the longitudinal treatment outcome and baseline demographic and clinical characteristics of 27 male and 45 female adult subjects who were treated for an acute affective episode and longitudinally followed for a period of up to 48 weeks. Females were more likely to report a history of suicidal gestures and a comorbid panic disorder; males were more likely to present with a comorbid obsessive-compulsive disorder, and there was a trend for a more frequent history of alcohol or substance abuse. No significant differences were found between the genders for the time to remission from the index episode, number of recurrences, and time spent with any clinical or subclinical mood symptom during the 48 weeks of maintenance treatment. Although differences may exist between bipolar I male and female subjects, prospective course does not seem to reveal differences in a 48-week period, at least when similar treatment strategies are adopted.
"Secondly, the social disintegration following a long career of what is often regarded as an antisocial behaviour by others creates difficulties in obtaining the kind of representative sample needed in order to generalize (Johnsson & Fridell, 1997). It is further difficult to determine the impact substance abuse as a single factor has on suicide in men, as it is comorbid with affective illness (Isometsä et al., 1995; Benedetti et al., 2007). Past substance abuse more than tripled the risk of future suicidal acts in men with a major depressive episode, (Oquendo et al., 2007). "
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to illuminate the experiences of suicidal behaviour in young Norwegian men with long-term substance abuse and to interpret their narratives with regard to meaning. Data were collected using open-ended, in-depth interviews. A phenomenological hermeneutic approach, inspired by the philosophy of Ricoeur, was used to analyse the data. The naïve reading involved awareness of the perceived sense of pain and hope in the participants. In the structural analysis, three themes were identified: (1) the meaning of relating, (2) the meaning of reflecting and (3) the meaning of acting. A comprehensive understanding of data indicated that the meaning of living with suicidal behaviour could be understood as a movement between different positions of wanting death as an escape from pain and hope for a better life. Our conclusion is that suicidal behaviour in men with substance abuse is a communicative activity about the individual's lived experience of pain and hope. How the participants experienced and constructed masculinity influenced the suicidal behaviour. To reduce pain and create hope by being seen and confirmed in social relationships, and being helped to verbalize existential thoughts and openly discuss possible solutions, are of importance.
International Journal of Qualitative Studies on Health and Well-Being 07/2009; 2(4):246-259. DOI:10.1080/17482620701547008 · 0.93 Impact Factor
"Up to 75% of patients with any bipolar disorder had one or more Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) comorbidities . More specifically, anxiety disorders and substance and alcohol abuse appeared to be relatively common (16–70% for anxiety disorders and 21–34% for substance abuse disorders) among patients with bipolar disorder although this finding was dependent on study inclusion and exclusion criteria [22,26,27]. "
[Show abstract][Hide abstract] ABSTRACT: Bipolar disorder is recognized as a major mental health issue, and its economic impact has been examined in the United States. However, there exists a general scarcity of published studies and lack of standardized data on the burden of the illness across European countries. In this systematic literature review, we highlight the epidemiological, clinical, and economic outcomes of bipolar disorder in Europe.
A systematic review of publications from the last 10 years relating to the burden of bipolar disorder was conducted, including studies on epidemiology, patient-related issues, and costs.
Data from the UK, Germany, and Italy indicated a prevalence of bipolar disorder of ~1%, and a misdiagnosis rate of 70% from Spain. In one study, up to 75% of patients had at least one DSM-IV comorbidity, commonly anxiety disorders and substance/alcohol abuse. Attempted suicide rates varied between 21%-54%. In the UK, the estimated rate of premature mortality of patients with bipolar I disorder was 18%. The chronicity of bipolar disorder exerted a profound and debilitating effect on the patient. In Germany, 70% of patients were underemployed, and 72% received disability payments. In Italy, 63%-67% of patients were unemployed. In the UK, the annual costs of unemployment and suicide were pound1510 million and pound179 million, respectively, at 1999/2000 prices. The estimated UK national cost of bipolar disorder was pound4.59 billion, with hospitalization during acute episodes representing the largest component.
Bipolar disorder is a major and underestimated health problem in Europe. A number of issues impact on the economic burden of the disease, such as comorbidities, suicide, early death, unemployment or underemployment. Direct costs of bipolar disorder are mainly associated with hospitalization during acute episodes. Indirect costs are a major contributor to the overall economic burden but are not always recognized in research studies.
Clinical Practice and Epidemiology in Mental Health 02/2009; 5(1):3. DOI:10.1186/1745-0179-5-3
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