Global prevalence of bipolar disorder is estimated at 2% to 2.5%.[19]Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011 Mar;68(3):241-51.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486639
http://www.ncbi.nlm.nih.gov/pubmed/21383262?tool=bestpractice.com
[20]McGrath JJ, Al-Hamzawi A, Alonso J, et al. Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries. Lancet Psychiatry. 2023 Sep;10(9):668-81.
http://www.ncbi.nlm.nih.gov/pubmed/37531964?tool=bestpractice.com
There are slightly higher rates of bipolar disorder reported in higher-income, developed countries, which may reflect higher rates of diagnosis rather than true higher prevalence.[21]Kessler RC, Kazdin AE, Aguilar-Gaxiola S, et al. Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys. World Psychiatry. 2022 Jun;21(2):272-86.
https://onlinelibrary.wiley.com/doi/10.1002/wps.20971
http://www.ncbi.nlm.nih.gov/pubmed/35524618?tool=bestpractice.com
The lifetime prevalence of bipolar disorder type I in the US is estimated to be between 0.5% and 1.0%, affecting men and women equally.[22]Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. Arch Gen Psychiatry. 2007 May;64(5):543-52. [Erratum in: Arch Gen Psychiatry. 2007 Sep;64(9):1039.]
http://archpsyc.jamanetwork.com/article.aspx?articleid=482285
http://www.ncbi.nlm.nih.gov/pubmed/17485606?tool=bestpractice.com
[23]Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Ther Adv Psychopharmacol. 2018 Sep;8(9):251-69.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116765
http://www.ncbi.nlm.nih.gov/pubmed/30181867?tool=bestpractice.com
The lifetime prevalence of bipolar disorder type II in the US is estimated to be between 0.5% and 1.1%, with women more likely than men to be affected.[19]Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011 Mar;68(3):241-51.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486639
http://www.ncbi.nlm.nih.gov/pubmed/21383262?tool=bestpractice.com
[22]Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. Arch Gen Psychiatry. 2007 May;64(5):543-52. [Erratum in: Arch Gen Psychiatry. 2007 Sep;64(9):1039.]
http://archpsyc.jamanetwork.com/article.aspx?articleid=482285
http://www.ncbi.nlm.nih.gov/pubmed/17485606?tool=bestpractice.com
Data from the UK suggest a bipolar disorder lifetime prevalence of 1.7%.[24]Humpston CS, Bebbington P, Marwaha S. Bipolar disorder: prevalence, help-seeking and use of mental health care in England - findings from the 2014 adult psychiatric morbidity survey. J Affect Disord. 2021 Mar 1;282:426-33.
http://www.ncbi.nlm.nih.gov/pubmed/33422818?tool=bestpractice.com
Between 1% and 4% of all patients attending a primary care setting meet the diagnostic criteria for bipolar disorder according to one systematic review.[25]Cerimele JM, Chwastiak LA, Dodson S, et al. The prevalence of bipolar disorder in general primary care samples: a systematic review. Gen Hosp Psychiatry. 2014 Jan-Feb;36(1):19-25.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877721
http://www.ncbi.nlm.nih.gov/pubmed/24144521?tool=bestpractice.com
Between 21% and 54% of women with postnatal depression have bipolar disorder.[26]Sharma V, Doobay M, Baczynski C. Bipolar postpartum depression: an update and recommendations. J Affect Disord. 2017 Sep;219:105-11.
http://www.ncbi.nlm.nih.gov/pubmed/28535448?tool=bestpractice.com
One US patient survey found that 69% of individuals diagnosed with bipolar disorder had been previously misdiagnosed, most frequently with unipolar depression.[27]Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003 Feb;64(2):161-74.
http://www.ncbi.nlm.nih.gov/pubmed/12633125?tool=bestpractice.com
About 35% of these people were symptomatic for >10 years before being accurately diagnosed, with women significantly more likely than men to be misdiagnosed.[27]Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003 Feb;64(2):161-74.
http://www.ncbi.nlm.nih.gov/pubmed/12633125?tool=bestpractice.com
Data reporting delays to diagnosis and management have been replicated.[28]Dagani J, Signorini G, Nielssen O, et al. Meta-analysis of the interval between the onset and management of bipolar disorder. Can J Psychiatry. 2017 Apr;62(4):247-58.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407546
http://www.ncbi.nlm.nih.gov/pubmed/27462036?tool=bestpractice.com
The UK National Institute for Health and Care Excellence estimates the lifetime prevalence of bipolar I disorder at 1% of the adult population, while bipolar II disorder is believed to affect approximately 0.4% of adults.[29]National Institute for Health and Care Excellence. Bipolar disorder: assessment and management. Dec 2023 [internet publication].
https://www.nice.org.uk/guidance/cg185
People with bipolar disorder are symptomatic for nearly half of the time, with depressive symptomatology predominating in their subjective experience.[30]Judd LL, Akiskal HS, Schettler PJ, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002 Jun;59(6):530-7.
http://archpsyc.jamanetwork.com/article.aspx?articleid=206451
http://www.ncbi.nlm.nih.gov/pubmed/12044195?tool=bestpractice.com
US data report that up to 50% of all people with bipolar disorder have been estimated to make at least one suicide attempt in their lifetime, with 10% to 15% of untreated patients with bipolar disorder dying by suicide.[31]Goodwin FK, Jamison KR. Manic-depressive illness: bipolar disorders and recurrent depression. 2nd ed. New York, NY: Oxford University Press; 2007.[32]Dong M, Lu L, Zhang L, et al. Prevalence of suicide attempts in bipolar disorder: a systematic review and meta-analysis of observational studies. Epidemiol Psychiatr Sci. 2019 Oct 25;29:e63.
https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/prevalence-of-suicide-attempts-in-bipolar-disorder-a-systematic-review-and-metaanalysis-of-observational-studies/494471CA6E53CECADA92AAF9246FDC5F
http://www.ncbi.nlm.nih.gov/pubmed/31648654?tool=bestpractice.com
[33]Miller JN, Black DW. Bipolar disorder and suicide: a review. Curr Psychiatry Rep. 2020 Jan 18;22(2):6.
http://www.ncbi.nlm.nih.gov/pubmed/31955273?tool=bestpractice.com
The highest rates of suicidality occur during the acutely depressed phase of bipolar disorder, with the majority of the suicidal attempts or deaths occuring during the depressive phase.[34]Dome P, Rihmer Z, Gonda X. Suicide risk in bipolar disorder: a brief review. Medicina (Kaunas). 2019 Jul 24;55(8):403.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723289
http://www.ncbi.nlm.nih.gov/pubmed/31344941?tool=bestpractice.com
[35]Slama F, Bellivier F, Henry C, et al. Bipolar patients with suicidal behavior: toward the identification of a clinical subgroup. J Clin Psychiatry. 2004 Aug;65(8):1035-9.
http://www.ncbi.nlm.nih.gov/pubmed/15323586?tool=bestpractice.com
[36]Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018 Mar;20(2):97-170.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5947163
http://www.ncbi.nlm.nih.gov/pubmed/29536616?tool=bestpractice.com
Comorbid panic disorder has been reported to increase the risk of suicidal behaviour and indicate a more severe course.[8]Preti A, Vrublevska J, Veroniki AA, et al. Prevalence and treatment of panic disorder in bipolar disorder: systematic review and meta-analysis. Evid Based Ment Health. 2018 May;21(2):53-60.
http://www.ncbi.nlm.nih.gov/pubmed/29636354?tool=bestpractice.com
Most people with bipolar disorder have at least one comorbid condition that may complicate diagnosis and treatment. The most common comorbidities include substance use disorders, anxiety disorders, panic disorders, attention-deficit disorders, personality disorders, and common medical conditions such as obesity, diabetes, hypertension, migraine, and irritable bowel syndrome.[7]McIntyre RS, Konarski JZ, Yatham LN. Comorbidity in bipolar disorder: a framework for rational treatment selection. Hum Psychopharmacol. 2004 Aug;19(6):369-86.
http://www.ncbi.nlm.nih.gov/pubmed/15303241?tool=bestpractice.com
[8]Preti A, Vrublevska J, Veroniki AA, et al. Prevalence and treatment of panic disorder in bipolar disorder: systematic review and meta-analysis. Evid Based Ment Health. 2018 May;21(2):53-60.
http://www.ncbi.nlm.nih.gov/pubmed/29636354?tool=bestpractice.com
[9]Compton WM, Thomas YF, Stinson FS, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry. 2007 May;64(5):566-76.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482282
http://www.ncbi.nlm.nih.gov/pubmed/17485608?tool=bestpractice.com
[10]Preti A, Vrublevska J, Veroniki AA, et al. Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder: a systematic review and meta-analysis. Evid Based Ment Health. 2016 Aug;19(3):73-81.
https://ebmh.bmj.com/content/19/3/73.long
http://www.ncbi.nlm.nih.gov/pubmed/27405742?tool=bestpractice.com
[11]Grant BF, Stinson FS, Hasin DS, et al. Prevalence, correlates, and comorbidity of bipolar I disorder and axis I and II disorders: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2005 Oct;66(10):1205-15.
http://www.ncbi.nlm.nih.gov/pubmed/16259532?tool=bestpractice.com
[12]Ayerbe L, Forgnone I, Addo J, et al. Hypertension risk and clinical care in patients with bipolar disorder or schizophrenia; a systematic review and meta-analysis. J Affect Disord. 2018 Jan 1;225:665-70.
http://www.ncbi.nlm.nih.gov/pubmed/28915505?tool=bestpractice.com
[13]Fornaro M, Orsolini L, Marini S, et al. The prevalence and predictors of bipolar and borderline personality disorders comorbidity: Systematic review and meta-analysis. J Affect Disord. 2016 May;195:105-18.
http://www.ncbi.nlm.nih.gov/pubmed/26881339?tool=bestpractice.com
[14]Schiavone P, Dorz S, Conforti D, et al. Comorbidity of DSM-IV personality disorders in unipolar and bipolar affective disorders: a comparative study. Psychol Rep. 2004 Aug;95(1):121-8.
http://www.ncbi.nlm.nih.gov/pubmed/15460367?tool=bestpractice.com
[15]Mantere O, Melartin TK, Suominen K, et al. Differences in axis I and II comorbidity between bipolar I and II disorders and major depressive disorder. J Clin Psychiatry. 2006 Apr;67(4):584-93.
http://www.ncbi.nlm.nih.gov/pubmed/16669723?tool=bestpractice.com
[16]Salvi V, Ribuoli E, Servasi M, et al. ADHD and bipolar disorder in adulthood: clinical and treatment implications. Medicina (Kaunas). 2021 May 10;57(5):466.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151516
http://www.ncbi.nlm.nih.gov/pubmed/34068605?tool=bestpractice.com
Among all serious mental health disorders, people with bipolar disorder are known to have some of the highest rates of comorbid substance use disorders.[11]Grant BF, Stinson FS, Hasin DS, et al. Prevalence, correlates, and comorbidity of bipolar I disorder and axis I and II disorders: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2005 Oct;66(10):1205-15.
http://www.ncbi.nlm.nih.gov/pubmed/16259532?tool=bestpractice.com
In the US, the lifetime prevalence of any substance use disorder in people with bipolar I disorder is 5.1 times and in those with bipolar II disorder is 2.4 times higher than in those without the condition.[9]Compton WM, Thomas YF, Stinson FS, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry. 2007 May;64(5):566-76.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482282
http://www.ncbi.nlm.nih.gov/pubmed/17485608?tool=bestpractice.com