Abstract
Socioeconomic factors can affect healthcare management. The aim was to investigate if patient educational attainment is associated with management of bipolar disorder. We included patients with bipolar disorder type 1 (n = 4289), type 2 (n = 4020) and not otherwise specified (n = 1756), from the Swedish National Quality Register for Bipolar Disorder (BipoläR). The association between patients' educational level and pharmacological and psychological interventions was analysed by binary logistic regression. We calculated odds ratios after adjusting for demographic and clinical variables. Higher education was associated with increased likelihood of receiving psychotherapy (adjusted odds ratio 1.34, 95% CI 91.22-1.46) and psychoeducation (adjusted odds ratio 1.18, 95% CI 1.07-1.46), but with lower likelihood of receiving first-generation antipsychotics (adjusted odds ratio 0.76, 95% CI 0.62-0.94) and tricyclic antidepressants (adjusted odds ratio 0.76, 95% CI 0.59-0.97). Higher education was also associated with lower risk for compulsory in-patient care (adjusted odds ratio 0.79, 95% CI 0.67-0.93). Pharmacological and psychological treatment of bipolar disorder differ depending on patients' educational attainment. The reasons for these disparities remain to be explained.
Highlights
Higher education was associated with increased likelihood of receiving psychotherapy and psychoeducation, but with lower likelihood of receiving first-generation antipsychotics
Higher education was associated with lower risk for compulsory in-patient care
Bipolar disorder is a serious psychiatric condition associated with high societal costs.[1]
Summary
We included patients with bipolar disorder type 1 (n = 4289), type 2 (n = 4020) and not otherwise specified (n = 1756), from the Swedish National Quality Register for Bipolar Disorder (BipoläR). We used data from the Swedish National Quality Register for Bipolar Disorder (BipoläR), which has been described previously.[15] BipoläR contains data on bipolar diagnosis, including subtypes, comorbid psychiatric and somatic diagnoses, outcome data (such as number of depressive, hypomanic, manic and mixed episodes during the past 12 months; compulsory institutional care; and duration of in-patient care during the past 12 months), data on treatment (drug treatment, electroconvulsive therapy (ECT) and psychological treatment) and data on psychosocial functioning. The participation is voluntary for both the physician and patient. All demographic areas across Sweden, and both public and private mental healthcare providers, are represented in BipoläR. After the first registration, which can occur at any time point during out-patient treatment, information is updated annually
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