Use of Treatment Services and Pharmacotherapy for Bipolar Disorder in a General Population-Based Mental Health Survey.
J Clin Psychiatry 2006;67(3):386-393
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: This study examined
characteristics of treatment utilization in a large general
population-based sample of bipolar subjects.
Method: Data source was the Canadian
Community Health Survey-Mental Health and Well-Being, a nationally representative,
community mental health survey of over 36,000
individuals conducted from May to December 2002.
Subjects who met study criteria for a current or past
manic episode were classified as having bipolar
disorder. Sociodemographic and illness-related
factors influencing likelihood of accessing
treatment, delay to contact with treatment services, and
use of pharmacotherapy among bipolar subjects were determined.
Results: Among the 852 bipolar
subjects, 45.2% had never accessed treatment
services. Male gender (p = .001), lower level of
education (p = .003), and immigrant status (p < .001)
were each significantly negatively correlated with
use of treatment services. Mean delay from illness onset to contact with any treatment services
was 3.1 years. Sixty-six percent of bipolar
subjects had not taken a mood stabilizer or
antidepressant medication in the past year, and 22% used
antidepressants without a mood stabilizer. Female
bipolar subjects were significantly more likely
than male subjects to be prescribed an
antidepressant medication (OR = 1.99, p = .01), even in the
absence of higher frequency of recent depressions.
Conclusion: Many individuals with
bipolar disorder never receive any form of mental
health treatment, and, among those that do, use of
pharmacotherapy is not consistent with guideline-based recommendations. These findings
reinforce the importance of continued efforts to better
identify bipolar individuals early in their course
of illness, and the need for further educational
focus on bipolar disorder for all mental health