Comparisons of the clinical outcomes between early- and adult-onset bipolar disorders: A prospective cohort analysis
Journal
Journal of Affective Disorders
Journal Volume
260
Pages
1-10
Date Issued
2020
Author(s)
Abstract
Background: This study aimed to explore the impact of age-at-onset on clinical outcomes in bipolar-spectrum disorders, including the development of alcohol or substance use disorder, suicidality, and psychiatric hospitalization. Methods: This population-based study enrolled newly-diagnosed bipolar-spectrum patients, including 4,367 patients with early-onset bipolar disorder (EOBD), 64,787 patients with adult-onset bipolar disorder (AOBD), and the same number of age-controlled comparison subjects without bipolar disorder, from Taiwan's National Health Insurance Research Database. Time-dependent covariate Cox regression models were used to estimate the effect of age-at-onset on clinical outcomes with adjustment for pre-existing psychiatric comorbid conditions and pharmacological treatment patterns. Sensitivity analyses using different definitions of study sample and age cutoffs were conducted. Results: The average follow-up duration was 5.7 years. After adjustment with time-dependent covariates and chronological age, there were no significant differences in the risks for developing new-onset alcohol or substance use disorders and psychiatric hospitalization between EOBD and AOBD patients. Although EOBD patients had a higher risk of hospitalization for suicide and self-harm than did AOBD patients in primary analysis, this finding did not replicated in the sensitivity analyses. Limitations: The symptom profile and severity of bipolar disorder was not available in the NHIRD; therefore, surrogate indicators of clinical outcome might not be sensitive enough to detect the subtle differences. Conclusions: EOBD and AOBD patients had similar risks for developing alcohol or substance use disorders. Their risk of psychiatric hospitalization was similar. Whether EOBD patients might have a higher risk of hospitalization for suicide and self-harm warrants further investigations. ? 2019 Elsevier B.V.
SDGs
Other Subjects
alcohol; antidepressant agent; benzodiazepine; mood stabilizer; neuroleptic agent; adult; age; Article; automutilation; bipolar I disorder; clinical outcome; cohort analysis; comorbidity; controlled study; female; follow up; hospitalization; human; major clinical study; male; priority journal; prospective study; randomized controlled trial; sensitivity analysis; suicidal behavior; suicide; bipolar disorder; drug dependence; factual database; middle aged; onset age; psychology; Taiwan; Adult; Age of Onset; Bipolar Disorder; Comorbidity; Databases, Factual; Female; Hospitalization; Humans; Male; Middle Aged; Prospective Studies; Substance-Related Disorders; Suicide; Taiwan
Type
journal article