THE EPIDEMIOLOGY OF DSM-III-R BIPOLAR-I DISORDER IN A GENERAL-POPULATION SURVEY

Background. Data are presented on the general population epidemiology of DSM-III-R bipolar I disorder in the United States. Methods. Data co me from the US National Comorbidity Survey (NCS), a general population survey of DSM-III-R disorders. A modified version of the Composite In ternational Diagnostic Interview was used to make diagnoses. Results, A small (N = 59) clinical reappraisal study showed that the only manic symptom profile that could validly be assessed with the CIDI is chara cterized by euphoria, grandiosity and the ability to maintain energy w ithout sleep, which described approximately half of all clinically val idated bipolar I cases in the NCS. Further analysis focused on this sy mptom profile, which involved N = 29 cases in the total sample. Lifeti me prevalence was estimated to be 0.4 % and 12-month prevalence only s lightly lower. Caseness was negatively related to income, education an d age, positively related to urbanicity, and elevated among the previo usly married, never married and non-whites. All cases reported at leas t one other NCS/DSM-III-R disorder and 59.3 % reported that their epis ode of bipolar disorder (either mania or depression) occurred at a lat er age than at least one other NCS/DSM-III-R disorder. Although 93.2 % of lifetime cases reported some lifetime treatment, only 44.7 % of re cent cases were in treatment. Conclusions. The type of bipolar disorde r examined here is highly chronic, co-morbid and impairing. Increased efforts are required to attract current cases into appropriate treatme nt. Methodological research is needed to develop more accurate measure s of other bipolar symptom profiles for use in general population epid emiological studies.