Bipolar disorder in children and adolescents: diagnostic inpatient rates from 2000 to 2013 in Germany.

Richard Stewart,Martin Holtmann,Janice W. Y. Wong,Pradeep Rao,Julie K. Moore,Natasha Bear,Florian D. Zepf,Kevin Runions

doi:10.1186/s40345-016-0064-2

Abstract

BackgroundDespite growing consensus on nosology and epidemiology of bipolar disorder (BD) in minors, differences remain. We contribute to this discussion by measuring long-term trends in the inpatient discharge rates of BD in minors.MethodsNationwide German inpatient discharge diagnoses of BD and other related psychiatric disorders were mapped between 2008 and 2013 using registry data from the German Federal Health Monitoring System. This was compared with previously published data, 2000–2007, to assess long-term trends in diagnosis of BD at discharge. Long-term trends (2000–2013) were also computed.ResultsDischarge diagnosis of BD increased by 18% (2.02–2.46 per 100,000) in minors. There was a significant increase of 24.1% in adolescents 15–19 years old (6.56–8.14 per 100,000). BD, at discharge, as a proportion of all psychiatric disorders, increased from 0.26% in 2008 to 0.27% in 2013. When analysing long-term trends (2000–2013), the rates for BD increased significantly as did trends for all mental disorders, except for psychotic disorders, which fell by almost 14%. Between 2000 and 2013, the rate for depression in minors increased by 730%.LimitationsThe dataset consisted of cross-sectional administrative data points with diagnoses based on clinical criteria.ConclusionsThe rate of BD as a discharge diagnosis in German minors has increased significantly, consistently exceeding the general trend for a rise in rates for mental disorders. Overall, the rate of discharge diagnosis of BD from inpatient units in Germany remains a small proportion of all psychiatric diagnoses.

Highlights

Despite growing consensus on nosology and epidemiology of bipolar disorder (BD) in minors, differences remain
The rate of discharge diagnosis of BD from inpatient units in Germany remains a small proportion of all psychiatric diagnoses
The increase in hospitalisations for all mental disorders in children and adolescents was linear, but the increase in hospitalisations for BD was fluctuant in absolute numbers but increasing when calculated per 100,000

Summary

Introduction

Despite growing consensus on nosology and epidemiology of bipolar disorder (BD) in minors, differences remain We contribute to this discussion by measuring long-term trends in the inpatient discharge rates of BD in minors. In 2010, Holtmann et al described the national trend rates of bipolar disorder (BD) in Germany between 2000 and 2007. They found an increase in rate of diagnosis at discharge of BD in German children and. The authors hypothesised a relative lack of data, differences in diagnostic criteria, clinician bias towards other diagnoses such as hyperkinetic, conduct, depressive and personality disorders, possible over diagnosis in the US and/or a true higher prevalence of paediatric BD in the US as possible explanations. A recent meta-analysis (Van Meter et al 2011) suggests there is much less variation in international prevalence but the range of variation in the United States is shown to be high (0.1–6.7%) Notably, this meta-analysis included bipolar disorder subtypes and data from outpatient settings

Objectives

Methods

Results

Discussion

Conclusion