Abstract
Despite evidence of gender differences in bipolar disorder characteristics and comorbidity, there is little research on the differences in treatment and service use between men and women with bipolar disorder. To use routine data to describe specialist mental health service contact for bipolar disorder, including in-patient, community and support service contacts; to compare clinical characteristics and mental health service use between men and women in contact with secondary services for bipolar disorder. Cross-sectional analysis of mental health patients with bipolar disorder in New Zealand, based on complete national routine health data. A total of 3639 individuals were in contact with specialist mental health services with a current diagnosis of bipolar disorder in 2015. Of these 58% were women and 46% were aged 45 and over. The 1-year prevalence rate of bipolar disorder leading to contact with specialist mental health services was 1.56 (95% CI 1.50-1.63) per 100 000 women and 1.20 (95% CI 1.14-1.26) per 100 000 men. Rates of bipolar disorder leading to service contact were 30% higher in women than men (rate ratio 1.30, 95% CI 1.22-1.39). The majority (68%) had a diagnosis of bipolar I disorder. Women were more likely to receive only out-patient treatment and have comorbid anxiety whereas more men had substance use disorder, were convicted for crimes when unwell, received compulsory treatment orders and received in-patient treatment. Although the prevalence of bipolar disorder is equal between men and women in the population, women were more likely to have contact with specialist services for bipolar disorder but had a lower intensity of service interaction.
Highlights
Despite evidence of gender differences in bipolar disorder characteristics and comorbidity, there is little research on the differences in treatment and service use between men and women with bipolar disorder
This was a cross-sectional analysis of mental health patients with bipolar disorder in New Zealand, based on complete nationallevel routine clinical data collated in the Programme for Integrated Mental Health Data (PRIMHD)
Among the population accessing secondary mental health services with a diagnosis of bipolar disorder, one-third had a hospital admission in 2015, with women less likely to have had an admission than men (RR = 0.85, 95% CI 0.76–0.96), and having a lower mean rate of annual admissions
Summary
Bipolar disorder is a recurrent, disabling mental health condition affecting 1–2.5% of the population over their lifetime.[1]. Depressive morbidity in patients with bipolar disorder accounts for 86% of the time ill and even patients with bipolar disorder receiving treatment are ill for about 40% of the time.[9] The risk of suicide in bipolar disorder is 20 to 30 times that in the general population.[10] Consequentially people with bipolar disorder have high rates of specialist mental health service use (in-patient and community based) during acute episodes. The impact of hormonal and reproductive factors are well documented.[11,16] There is evidence of higher rates of comorbid substance use disorders,[17] criminal activity[12] and completed suicide in men.[10] Differential treatment in both clinical and justice services may influence reported gender differences.[18]. A recent study from Austria[20] reported that women had higher rates of hospital admissions for bipolar disorder than men, despite a similar population prevalence. Population counts for 2015 were calculated by age and gender groups by linear extrapolation of changes in population counts between the 2006 and 2013 censuses
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