TY - JOUR
T1 - Bipolar features in major depressive disorder
T2 - Results from the Iranian mental health survey (IranMHS)
AU - Amin-Esmaeili, Masoumeh
AU - Motevalian, Abbas
AU - Rahimi-Movaghar, Afarin
AU - Hajebi, Ahmad
AU - Sharifi, Vandad
AU - Mojtabai, Ramin
AU - Gudarzi, Shahrokh S.
N1 - Funding Information:
The Iran Mental Health Survey (IranMHS) was financially supported by the Ministry of Health-Tehran University of Medical Sciences [contract number 132–1491] and Mental Health Research Network [the contract number 89-D-432-143]. The funding source had no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; and in the decision to submit the article for publication.
Publisher Copyright:
© 2018
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Background: Past research suggests that individuals suffering from depressive disorders with bipolar features might have different clinical outcomes resembling bipolar disorders. The objectives of this study are to determine the prevalence of bipolar features among individuals meeting the criteria for 12-month major depressive disorder (MDD) in the Iranian population and to examine the demographic and clinical characteristics associated with these features. Methods: Data were drawn from the Iranian Mental Health Survey (IranMHS), a representative household survey of the Iranian population aged 15–64 years. The study sample consisted of all individuals with a 12-month MDD (n = 1014) ascertained by the Composite International Diagnostic Interview (CIDI 2.1) without a lifetime history of bipolar I or II disorders. Mood Disorder Questionnaire (MDQ) was used to screen for the lifetime history of bipolar features among participants with MDD. Results: Among participants meeting the 12-month MDD criteria, 22.1% (95% CI: 19.6–24.7) had a lifetime history of bipolar features. Compared with those without these features, participants with bipolar features had higher odds of endorsing suicidal ideations and suicide attempts, comorbid anxiety and substance use disorders, severe impairment, history of psychotic symptoms, some features of atypical depression and fewer depressive symptoms. Associations with comorbid anxiety disorders [Odds Ratio (OR) = 1.43; 95% confidence interval (CI): 1.00–2.03] and history of psychotic symptoms (OR = 2.63 95% CI: 1.81–3.81) persisted in multivariable models. Limitation: Relying on self-reports of lifetime bipolar symptoms which is open to recall bias, and cross-sectional study design which limits interpretation of outcome and course of MDD are two major limitations of this study. Conclusion: The presence of bipolar features is associated with a distinct demographic and clinical profile in MDD. Identifying these cases would enhance the homogeneity of the depressive disorder phenotype in general population surveys. Identifying MDD patients with these features has potential clinical implications.
AB - Background: Past research suggests that individuals suffering from depressive disorders with bipolar features might have different clinical outcomes resembling bipolar disorders. The objectives of this study are to determine the prevalence of bipolar features among individuals meeting the criteria for 12-month major depressive disorder (MDD) in the Iranian population and to examine the demographic and clinical characteristics associated with these features. Methods: Data were drawn from the Iranian Mental Health Survey (IranMHS), a representative household survey of the Iranian population aged 15–64 years. The study sample consisted of all individuals with a 12-month MDD (n = 1014) ascertained by the Composite International Diagnostic Interview (CIDI 2.1) without a lifetime history of bipolar I or II disorders. Mood Disorder Questionnaire (MDQ) was used to screen for the lifetime history of bipolar features among participants with MDD. Results: Among participants meeting the 12-month MDD criteria, 22.1% (95% CI: 19.6–24.7) had a lifetime history of bipolar features. Compared with those without these features, participants with bipolar features had higher odds of endorsing suicidal ideations and suicide attempts, comorbid anxiety and substance use disorders, severe impairment, history of psychotic symptoms, some features of atypical depression and fewer depressive symptoms. Associations with comorbid anxiety disorders [Odds Ratio (OR) = 1.43; 95% confidence interval (CI): 1.00–2.03] and history of psychotic symptoms (OR = 2.63 95% CI: 1.81–3.81) persisted in multivariable models. Limitation: Relying on self-reports of lifetime bipolar symptoms which is open to recall bias, and cross-sectional study design which limits interpretation of outcome and course of MDD are two major limitations of this study. Conclusion: The presence of bipolar features is associated with a distinct demographic and clinical profile in MDD. Identifying these cases would enhance the homogeneity of the depressive disorder phenotype in general population surveys. Identifying MDD patients with these features has potential clinical implications.
KW - Affective disorders
KW - Bipolar spectrum
KW - Depressive disorders
KW - Subthreshold mania
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U2 - 10.1016/j.jad.2018.08.014
DO - 10.1016/j.jad.2018.08.014
M3 - Article
C2 - 30142591
AN - SCOPUS:85051763210
SN - 0165-0327
VL - 241
SP - 319
EP - 324
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -