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23-07-2013 | Mental health | Article

Preventive medical care critical for bipolar patients

Abstract

Free abstract

medwireNews: A large part of the increased mortality risk among patients with bipolar disorder may be due to delayed diagnosis and treatment of comorbidities, suggests research published in JAMA Psychiatry.

In line with previous findings, the results of the Swedish national cohort study show that women with bipolar disorder died an average of 9.0 years earlier than women in the general population, and men with bipolar disorder died an average of 8.5 years earlier than other men.

The risk for death from suicide was increased 10-fold among women with bipolar disorder, and eightfold among men, with this accounting for 5.4% and 9.6% of deaths, respectively. However, this did not fully account for the earlier deaths among bipolar disorder patients; after excluding deaths from suicide and unintentional injuries, women and men with the condition died a respective 7.5 and 6.6 years earlier than their counterparts without bipolar disorder.

As for the general population, cardiovascular disease was the condition accounting for the greatest proportion of deaths among bipolar disorder patients (3918 women and 2700 men). Patients were between 1.2- and 1.6-fold more likely to be diagnosed with cardiovascular disease and stroke than the general populace, and were about twice as likely to die of these conditions, after accounting for age, demographic variables, and substance abuse.

With the exception of suicide and unintentional injuries, diabetes and influenza or pneumonia were the conditions most strongly associated with increased mortality. In addition, chronic obstructive pulmonary disease (COPD) and cancer (the latter in women only) were associated with increased mortality. Influenza or pneumonia, diabetes, and COPD were all more frequent in bipolar disorder patients than in other men and women.

For chronic conditions (ischemic heart disease, diabetes, COPD, and cancer), bipolar disorder patients who had been diagnosed with these conditions at least 30 days before death were 1.40-fold more likely to die of them than people in the general population. Although statistically significant, this increase was considerably smaller than the 2.38-fold increased risk among those without a prior diagnosis.

This suggests that “timely medical diagnosis and treatment may effectively reduce mortality among bipolar disorder patients to approach that of the general population,” say lead researcher Casey Crump (Stanford University, California, USA) and team.

“More complete provision of primary, preventive medical care among bipolar disorder patients is needed to reduce early mortality in this vulnerable population.”

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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