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Update on Epidemiology, Risk Factors, and Correlates of Bipolar Spectrum Disorder 

Update on Epidemiology, Risk Factors, and Correlates of Bipolar Spectrum Disorder
Chapter:
Update on Epidemiology, Risk Factors, and Correlates of Bipolar Spectrum Disorder
Author(s):

Kathleen R. Merikangas

and Diana Paksarian

DOI:
10.1093/med/9780199300532.003.0002
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date: 21 October 2021

Bipolar disorder is among the leading contributors of disease burden among young people. While bipolar I disorder is generally estimated to affect about 1% of people in community-based studies, there is growing interest in the spectrum of expression of bipolar disorder, with about 1% and 2.4% of US adults reporting lifetime bipolar II and subthreshold bipolar disorder, respectively. Investigation of the boundaries of bipolar disorder remains an important current and future area of research. Community-based longitudinal studies of youth have indicated that the first onset of bipolar disorder generally begins in late adolescence and early adulthood, indicating this time period as a potential target for prevention. Around two-thirds of adults with bipolar disorder report any lifetime treatment, and rates are lower among youth and in low- and middle-income countries. Bipolar disorder is highly comorbid with other mental disorders, especially anxiety and substance use disorders. Rates of physical comorbidities are also high. Studies have generally found equal rates of bipolar disorder by demographic characteristics such as sex and race, although there is emerging evidence of racial/ethnic differences among studies sufficiently powered for analyses of subgroups. Recent studies of nongenetic risk factors for bipolar disorder have implicated a potential etiologic role for childhood stressors such as parental loss, maltreatment, and family violence, although such risk factors appear to lack specificity and studies often rely upon retrospective recall to measure them. A family history of bipolar disorder is the strongest and most consistent risk factor, and heritability estimates indicate that a hefty proportion of phenotypic variation in bipolar disorder is attributable to genes. Despite this, the search for specific causal genetic variants has proven difficult and remains an active area of research. Both family and molecular genetic studies have indicated the presence of genetic overlap between bipolar disorders and other mental disorders such as major depression and schizophrenia. These studies highlight the need for a greater understanding of the boundaries of bipolar disorder as well as elucidation of common and unique pathways to mental disorders.

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