With Some Bipolar Here, Some Bipolar There

Posted on August 26, 2012 by

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Sometimes it’s just hard to know what to  make of statistics.

For example, according to The Humor Blog, 0.3% of all accidents in Canada involve a moose and only 30% of people can flare their nostrils, and according to another Crazy Statistics post more than ten people a year are killed by vending machines.

Just where do you go with information like that?

More–much more–to the point, what do we do with the fact that the prevalence of Bipolar Disorder (BD) varies widely–quite widely–across country lines?

Is it about diagnostic tools? Access to healthcare? A passing fancy?

It’s a question one really needs to grapple with after reading last year’s study from the Archives of General Psychiatry entitled “Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative.”

The study analyzed 61,392 people in eleven countries around the world (in the Americas, Asia, Europe, the Middle East, and New Zealand) using the World Health Organization’s (WHO) World Mental Health (WMH) survey, which utilizes definitions for mental disorders found in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV).

Given that the diagnostic tool was uniform, I would have guessed that rates of BD would be relatively even across the world. And, as is the case when I have to guess about which direction is home I would have guessed wrong.

The degree of variability was surprising.

Perhaps not surprising at all, the U.S. ‘won’ the BD race, clocking in with a lifetime prevalence rate of 4.4%. And, perhaps also not surprising, India had the lowest rate–but the discrepancy in percentage is somewhat shocking, for the rate of BD in India is (for real) 0.1%.

Something is clearly up.

I beg your forgiveness on the inelegance of my bar graph–I’ve switched from a PC to a Mac and am still looking for my ‘page down’ key, so this was the best I could do in terms of visuals–but I think it makes the point, which is that BD rates are, well, all over the map.

International Life-Time BD Prevalence Graph

One theory was that wealthier countries had higher rates of BD, almost in a direct proportion.

But then a few countries bucked that trend (I’ll tell you, as I’m sure your eyesight isn’t good enough to determine who was a trend-bucker from my display of visual talent).

For example, Japan, a higher-income country, had a lifetime prevalence of only 0.7%, while Columbia, on the lower-income side, had a relatively high occurrence of 2.6%.

World-wide, 2.4% of the population is bipolar.

That puts us way in the lead, and even more than I’d like to know how moose are involved in .3% of all accidents in Canada, I’d like to know why the U.S. is so far ahead of the world average in BD rates.

All I have is theories–and I’d like to hear yours, which I’m sure are as good if not better.

There’s the stigma card–perhaps, despite all our concern about and continued suffering from stigma, we are still a more open society when it comes to mental illness than any other. So we as Americans are more likely to go ahead in to see a psychiatrist and actually get a proper diagnosis when we’re suffering.

Of course there’s access. Perhaps the poorest countries simply don’t have the medical force required both to see the ill in their offices, and to properly diagnose the disorder.

Possibly medical awareness of the illness is greater among the diagnostic professionals in higher-income countries, where more education is available for healthcare professionals.

And, it’s always possible, maybe BD has gotten so much ‘play’ in the press that there’s a tendency to over-diagnose now in the U.S.

Or perhaps, although BD clearly has a biochemical component, the stress of life in American sets off the illness in the vulnerable. What if we had lifetime job security, and our children didn’t travel far away to go to university? What if all too many of our citizens didn’t live in projects rife with drugs and violence? What if guns didn’t pervade our culture, with random shootings terrorizing innocents? What if we had less diversity–we all grew up with the same set of standards, and were all fairly similar?  Waht if our urban to rural population was a different ratio?

If you think about it, there are countries on this list where security and stability are the foundation rock of their culture–would that, just maybe, mean that Japan, with its more monolithic society and better job security, would exert less stress on its citizens, and thus do less to activate the potential for mood disregulation?

I don’t know–but I’d like to.

What I do know is what I read in the rest of the article about the status of treatment of BD world-wide, and it isn’t too heartening.

Did you know that:

  • Less than half of those with BD received mental health treatment, and. . .
  • In low-income countries, only 25.2% received mental health care for the disorder?
  • 75% of those with BD also had another disorder; more than half of whom had 3 or more other disorders?
  • Of these, anxiety disorders were the most common comorbid conditions, followed by behavior disorders (44.8%) with substance use disorders rounding out third place (36.6%)?
  • The breakdown of the total percentage of BD worldwide is as follows: 0.6% for Bipolar I, 0.4% for Bipolar II, and 1.4% for subthreshold BD?

So while I was never one who cared about and would engage in ‘why did the chicken cross the road?’ discussions, and faked deafness when kids would ask ‘why is the sky blue?’, I would love to know why the lifetime prevalence of BD is 0.3% in Bulgaria but 2.4% in Lebanon, 1% in Brazil, a similar 1.9% in Mexico and 1.8% in Romania, and 44 times more common in America than in India.

And I’d love to know how to create a graph and import it into WordPress so people could actually read the thing.

For today, though, I would settle for knowing where my Page Down key went.