Prevalence and correlates of bipolar II disorder in major depressive patients at a psychiatric outpatient clinic in Hong Kong

doi:10.1016/j.jad.2008.05.006

Journal of Affective Disorders

Volume 112, Issues 1–3, January 2009, Pages 201-205

https://doi.org/10.1016/j.jad.2008.05.006 Get rights and content

Abstract

Background

Western studies indicate a high prevalence of bipolar II disorder defined by a Research Diagnostic Criteria 2-day hypomania duration criterion (30 to 61%) amongst clinically depressive patients. The situation in Chinese patients with depression is unknown.

Methods

64 (52.5% response rate) patients first presenting to a Hong Kong public psychiatric outpatient clinic in 2005 with a diagnosis of major depression were recruited. The SCID and Family History Screen were administered.

Results

DSM-IV bipolar II was found in 20.5% of depressive outpatients; 35.9% had bipolar II disorder defined by RDC 2-day duration criterion for hypomania. Family bipolarity, age of onset, and depressive recurrence distinguished bipolar II subjects from unipolar depressives irrespective of duration criteria chosen for hypomania.

Limitations

Sample size was limited.

Conclusions

Bipolar II disorder is common amongst Chinese depressive outpatients. The evaluation method and 2-day duration criterion for hypomania were supported by bipolar validators. Replication using larger samples is needed to arrive at a more representative prevalence estimate and to enable more refined nosological evaluation.

Introduction

The prevalence of bipolar II disorder amongst clinic patients with major depression has been reported to be 30 to 61% (Angst, 1998, Benazzi, 2003, Benazzi and Akiskal, 2003, Hantouche et al., 1998, Benazzi, 1997, Akiskal and Mallya, 1987, Rybakowski et al., 2005) from American and European samples, substantially higher than earlier estimates of 10–40% (Cassano et al., 1992, Akiskal and Mallya, 1987, Goodwin, 2007). The prevalence figures were supported by a pattern of bipolar validators (elevated family bipolarity (Dunner et al., 1976, Akiskal et al., 1983), atypical depression (Perugi et al., 1999), early depressive onset (Mcmahon et al., 1994, Akiskal et al., 1983, Ghaemi et al., 2002) and high depressive recurrence (Akiskal et al., 2000, Akiskal et al., 1983)) that distinguished bipolar II samples from unipolar depressive samples. This increase in recognition of bipolar II disorders have significant treatment implications as patients with bipolar II disorder are more likely than unipolar-depressed patients to experience anti-depressant-induced hypomanic activation, and show poorer clinical response to antidepressants (Ghaemi et al., 2000, Akiskal and Mallya, 1987), while bipolar II patients were also reported to have higher risk of suicide attempt and ideation (Rihmer and Pestality, 1999) than unipolar-depressed patients.

Comprehensive search of the MEDLINE, PUBMED and PSYCINFO databases, as well as the Chinese language databases (Chinese Academic Journals, Wanfang database) using keywords ‘bipolar disorder’, ‘Chinese’ ,‘China’, ‘Taiwan’, ‘Hong Kong’, or ‘Singapore’ found no data on the prevalence of bipolar II disorder amongst Chinese major depressive patients. Under-recognition of bipolar II disorders has significant implications on psychopharmacological intervention and management of suicide risk. The implications may be profound given the size of Chinese populations globally and the potential availability of antidepressants and mood stabilizers affecting diagnostic practice amongst service providers in China. This study aims to preliminarily evaluate prevalence of bipolar II disorder amongst patients with major depression in a representative Chinese psychiatric tertiary-referral clinic setting, based on systematic evaluation involving trained clinician-administered semi-structured interviews.

Section snippets

Materials and methods

The study was conducted at a public psychiatric specialist clinic which received all psychiatric outpatient referrals in a township of Hong Kong. All patients, including both sexes, aged 18 to 60 first presenting in the year 2005 with a clinically affirmed diagnosis of ICD-10 or DSM-IV-TR major depression were recruited. Patients with mental retardation, history of head injury, epilepsy or other organic brain syndromes were excluded. Demographic and diagnostic information of untraceable and

Sample

64 subjects (52.5%) completed the research interviews. Unreachable subjects were confirmed with the hospital computer registry that none was deceased. Mean age of recruited subjects and non-recruited subjects showed no statistically significant difference (43.88 vs 43.71; Student's t = − 0.1, df = 120, p = 0.92), nor did the sex composition of the two groups (Male: Female ratio = 14:50 (recruited) vs 12:40 (non-recruited); Pearson's Chi-square = 0.25, df = 1, p = 0.87).

Prevalence of bipolar II disorder

All subjects were re-diagnosed with a

Discussion

The 20.5% DSM-IV bipolar II prevalence amongst depressive outpatients was congruous with that of Hantouche's large-scale multi-site French EPIDEP study, where 22% of depressive outpatients were found to have DSM-IV bipolar II disorder upon the first diagnostic assessment (Hantouche et al., 1998). The 35.9% prevalence of bipolar II disorder defined by the 2-day hypomania duration criterion fell in the range of 30 to 61% reported in the West (Angst, 1998, Benazzi, 2003, Benazzi and Akiskal, 2003,

Role of funding source

The author did not receive any funding support in conducting this study.

Conflict of interest

The author declares that he has no conflicts of interest.

Acknowledgements

The author thanks Mr. Adley Tsang who kindly advised on data analysis and Professor Myrna Weissman of Columbia University, who kindly gave permission to use and translate the Family History Screen. This study was conducted as a part of a 2007 Fellowship dissertation for the Hong Kong College of Psychiatrists.

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Brief reportPrevalence and correlates of bipolar II disorder in major depressive patients at a psychiatric outpatient clinic in Hong Kong

Abstract

Background

Methods

Results

Limitations

Conclusions

Introduction

Section snippets

Materials and methods

Sample

Prevalence of bipolar II disorder

Discussion

Role of funding source

Conflict of interest

Acknowledgements

J. Affect. Disord.

J. Affect. Disord.

J. Affect. Disord.

J. Affect. Disord.

J. Affect. Disord.

Compr. Psychiatry.

Compr. Psychiatry.

J. Affect. Disord.

J. Affect. Disord.

J. Affect. Disord.

Psychiatr. Clin. North. Am.

Psychiatr. Clin. North. Am.

J. Affect. Disord.

Brief report
Prevalence and correlates of bipolar II disorder in major depressive patients at a psychiatric outpatient clinic in Hong Kong