Use of Treatment Services and Pharmacotherapy for Bipolar Disorder in a General Population-Based Mental Health Survey

Ayal Schaffer, M.D., F.R.C.P.C.; John Cairney, Ph.D.; Amy H. Cheung, M.D., F.R.C.P.C.; Scott Veldhuizen, B.A.; and Anthony J. Levitt, M.D., F.R.C.P.C.

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 treatment providers.

(J Clin Psychiatry 2006;67:386-393)

Received Sept. 14, 2005; accepted Jan. 3, 2006. From the Department of Psychiatry, Sunnybrook & Women's College Health Sciences Centre, University of Toronto (Drs. Schaffer, Cheung, and Levitt); Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Departments of Psychiatry and Public Health Science, University of Toronto (Dr. Cairney); and Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health (Mr. Veldhuizen), Toronto, Canada.

Fully supported by a grant from the Ontario Mental Health Foundation/Ministry of Health and Long-Term Care, Ontario, Canada.

Dr. Schaffer has received grant/research support from Sanofi-Aventis, has received honoraria from Eli Lilly Canada, and has served on the speakers or advisory boards of Eli Lilly Canada and AstraZeneca. Dr. Cheung has served on the speakers or advisory boards of Eli Lilly. Dr. Levitt has been a consultant to Janssen and Eli Lilly; has received grant/research support from Sanofi-Aventis; and has received honoraria from Eli Lilly, Janssen, and Lundbeck. Dr. Cairney and Mr. Veldhuizen report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Ayal Schaffer, M.D., F.R.C.P.C., Department of Psychiatry, Sunnybrook & Women's College Health Sciences Centre, 2075 Bayview Ave., Toronto, Ontario, Canada, M4N 3M5 (e-mail: ayal.schaffer@sw.ca).