Screening for Bipolar Disorder in the Community
Robert M. A. Hirschfeld, Joseph R. Calabrese, Myrna M. Weissman, Michael Reed, Marilyn A. Davies, Mark A. Frye, Paul E. Keck, Jr., Lydia Lewis, Susan L. McElroy, James P. McNulty, and Karen D. Wagner
J Clin Psychiatry 2003;64(1):53-59
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: Our goal was to estimate the rate of
positive screens for bipolar I and bipolar II disorders in the
general population of the United States.
Method: The Mood Disorder Questionnaire (MDQ), a
validated screening instrument for bipolar I and II disorders,
was sent to a sample of 127,800 people selected to represent the
U.S. adult population by demographic variables. 85,358 subjects
(66.8% response rate) that were 18 years of age or above returned
the survey and had usable data. Of the nonrespondents, 3404
subjects matched demographically to the 2000 U.S. Census data
completed a telephone interview to estimate nonresponse bias.
Results: The overall positive screen rate for
bipolar I and II disorders, weighted to match the 2000 U.S.
Census demographics, was 3.4%. When adjusted for the nonresponse
bias, the rate rose to 3.7%. Only 19.8% of the individuals with
positive screens for bipolar I or II disorders reported that they
had previously received a diagnosis of bipolar disorder from a
physician, whereas 31.2% reported receiving a diagnosis of
unipolar depression. An additional 49.0% reported receiving no
diagnosis of either bipolar disorder or unipolar depression.
Positive screens were more frequent in young adults and low
income households. The rates of migraine, allergies, asthma, and
alcohol and drug abuse were substantially higher among those with
positive screens.
Conclusion: The positive MDQ screen rate of 3.7%
suggests that nearly 4% of American adults may suffer from
bipolar I and II disorders. Young adults and individuals with
lower income are at greater risk for this largely underdiagnosed
disorder.