Differences in Axis I and II Comorbidity Between Bipolar I and II Disorders and Major Depressive Disorder

Outi Mantere, M.D.; Tarja K. Melartin, M.D., Ph.D.; Kirsi Suominen, M.D., Ph.D.; Heikki J. Rytsälä, M.D.; Hanna M. Valtonen, M.D.; Petri Arvilommi, M.D.; Sami Leppämäki, M.D.; and Erkki T. Isometsä, M.D., Ph.D.

Objective: To obtain a comprehensive view of differences in current comorbidity between bipolar I and II disorders (BD) and (unipolar) major depressive disorder (MDD), and Axis I
and II comorbidity in BD in secondary-care psychiatric settings.

Method: The psychiatric comorbidity of 90 bipolar I and 101 bipolar II patients from the Jorvi Bipolar Study and 269 MDD patients from the Vantaa Depression Study were compared.
We used DSM-IV criteria assessed by semistructured interviews. Patients were inpatients and outpatients from secondary-care psychiatric units. Comparable information was collected on clinical history, index episode, symptom status, and patient characteristics.

Results: Bipolar disorder and MDD differed in prevalences of current comorbid disorders, MDD patients having significantly more Axis I comorbidity (69.1% vs. 57.1%), specifically anxiety disorders (56.5% vs. 44.5%) and cluster A (19.0% vs. 9.9%) and C (31.6% vs. 23.0%) personality disorders. In contrast, BD had more single cluster B personality disorders (30.9% vs. 24.6%). Bipolar I and bipolar II were similar in current overall comorbidity, but the prevalence of comorbidity was strongly associated with the current illness phase.

Conclusions: Major depressive disorder and BD have somewhat different patterns in the prevalences of comorbid disorders at the time of an illness episode, with differences particularly in the prevalences of anxiety and personality disorders. Current illness phase explains differences in psychiatric comorbidity of BD patients better than type of disorder.

(J Clin Psychiatry 2006;67:584-593)

Received June 14, 2005; accepted Sept. 27, 2005. From the Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland (all authors); the Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland (Drs. Mantere, Suominen, Valtonen, and Arvilommi); the Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland (Drs. Melartin, Leppämäki, and Isometsä); and the Department of Psychiatry, Peijas Hospital, Helsinki University Central Hospital, Vantaa, Finland (Dr. Rytsälä).

Supported by a research grant from the Academy of Finland, Helsinki.

The authors report no additional financial affiliations or other relationships relevant to the subject of this article.

Corresponding author and reprints: Erkki T. Isometsä, M.D., Ph.D., Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland (e-mail: erkki.isometsa@ktl.fi).