Ethnic differences in first clinical presentation of bipolar disorder: results from an epidemiological study

Abstract

Background Although high incidence rates of mania have been described in some ethnic minority populations, little is known about any ethnic differences in the early clinical presentation of bipolar disorder. Methods All cases of operationalised DSM-IV bipolar I disorder (BPI), first manic episode, within a defined epidemiological catchment area over a 35-year period, were identified; sociodemographic data, including ethnicity, and clinical information were then extracted. The proportion of African–Caribbean ( n=52), African ( n=33) and white European ( n=149) cases who experienced a depressive episode before onset of mania and psychotic symptoms at first mania were compared. Results African–Caribbean and African groups were significantly less likely to have experienced a depressive episode before onset of first mania, at 13.5% and 6.1%, respectively, compared with 28.1% in the white European group. African–Caribbean and African groups also experienced more severe psychotic symptoms at first mania, but there were no differences in mood incongruent or first rank symptoms between ethnic groups. Limitations Data pertaining to diagnosis and clinical symptoms were extracted by retrospective case note review. Conclusions Ethnic differences in clinical presentation of bipolar disorder may have implications for assessment and treatment of ethnic minority patients.