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Review
. 2017 Apr;62(4):247-258.
doi: 10.1177/0706743716656607. Epub 2016 Jul 11.

Meta-analysis of the Interval between the Onset and Management of Bipolar Disorder

Jessica Dagani  1 , Giulia Signorini  1 , Olav Nielssen  2 , Moira Bani  1 , Adriana Pastore  3 , Giovanni de Girolamo  1 , Matthew Large  4
Affiliations
Review

Meta-analysis of the Interval between the Onset and Management of Bipolar Disorder

Jessica Dagani et al. Can J Psychiatry. 2017 Apr.

Abstract
in English, French

Objective: To evaluate the length of the interval between the onset and the initial management of bipolar disorder (BD).

Method: We conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches located studies reporting estimates of the age of onset (AOO) and indicators of the age at initial management of BD. We calculated a pooled estimate of the interval between AOO and age at management. Factors influencing between-study heterogeneity were investigated using sensitivity analyses, meta-regression, and multiple meta-regression.

Results: Twenty-seven studies, reporting 51 samples and a total of 9415 patients, met the inclusion criteria. The pooled estimate for the interval between the onset of BD and its management was 5.8 years (standardized difference, .53; 95% confidence interval, .45 to .62). There was very high between-sample heterogeneity ( I2 = 92.6; Q = 672). A longer interval was found in studies that defined the onset according to the first episode (compared to onset of symptoms or illness) and defined management as age at diagnosis (rather than first treatment or first hospitalization). A longer interval was reported among more recently published studies, among studies that used a systematic method to establish the chronology of illness, among studies with a smaller proportion of bipolar I patients, and among studies with an earlier mean AOO.

Conclusions: There is currently little consistency in the way researchers report the AOO and initial management of BD. However, the large interval between onset and management of BD presents an opportunity for earlier intervention.

Objectif:: Évaluer la durée de l’intervalle entre l’apparition et la prise en charge initiale du trouble bipolaire (TB).

Méthode:: Nous avons mené une méta-analyse à l’aide des lignes directrices des éléments de rapport à privilégier pour les revues systématiques et les méta-analyses. Des recherches systématiques ont repéré des études faisant état des estimations de l’âge d’apparition (ADA) et des indicateurs de l’âge lors de la prise en charge initiale du TB. Nous avons calculé une estimation regroupée de l’intervalle entre l’ADA et l’âge à la prise en charge. Les facteurs influençant l’hétérogénéité entre les études ont été recherchés à l’aide d’analyses de sensibilité, de méta-régression et de multiple méta-régression.

Résultats:: Vingt-sept études, comportant 51 échantillons et un total de 9 415 patients satisfaisaient aux critères d’inclusion. L’estimation regroupée de l’intervalle entre l’apparition du TB et sa prise en charge était de 5,8 ans (écart normalisé = 0,53; Intervalle de confiance à 95% 0,45 à 0,62). L’hétérogénéité entre échantillons était très élevée (I-carré = 92,6; valeur Q = 672). Un intervalle plus long a été observé dans les études qui définissaient l’apparition en fonction du premier épisode (comparativement à l’apparition de symptômes ou de la maladie), et définissaient la prise en charge comme étant l’âge au diagnostic (plutôt qu’au premier traitement ou à la première hospitalisation). Un intervalle plus long était rapporté dans les études publiées plus récemment, dans les études qui utilisaient une méthode systématique pour établir la chronologie de la maladie, dans les études ayant une proportion moindre de patients bipolaires I et dans les études ayant un ADA moyen plus précoce.

Conclusions:: Il y a présentement peu de cohérence dans la manière dont les chercheurs rapportent l’ADA et la prise en charge initiale du TB. Toutefois, le large intervalle entre l’apparition et la prise en charge du TB offre l’occasion d’une intervention précoce.

Keywords: age of onset; bipolar disorders; clinical management; duration of untreated bipolar disorder; meta-analysis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Age of onset in bipolar disorders. *Search performed on 31 July 2014, using the search string “onset AMD bipolar.” **Exclusion of irrelevant studies, duplicated studies, other meta-analyses, reviews, case reports, and small case series (<3 subjects). ***Studies not reporting mean age, standard deviation, and sample size for age at onset and management of bipolar disorder; studies with mixed samples of bipolar and schizophrenia spectrum disorders; studies with overlapping samples (priority was given to studies with the largest samples size reported on an age-specific populations, such older [>64 years] or younger [<14 years] patients); and studies reporting only measure of onset or measure of initial management (only studies presenting both measures were included).
Figure 2.
Figure 2.
Random effects meta-analysis of the interval between age at onset and age at management of bipolar disorders.
See this image and copyright information in PMC

References

    1. Berk M, Berk L, Dodd S, et al. Stage managing bipolar disorder. Bipolar Disord. 2014;16(5):471–477. - PubMed
    1. Norman RM, Malla AK. Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med. 2001;31(3):381–400. - PubMed
    1. Large M, Nielssen O, Slade T, et al. Measurement and reporting of the duration of untreated psychosis. Early Interv Psychiatry. 2008;2(4):201–211. - PubMed
    1. Perkins DO, Gu H, Boteva K, et al. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005;162(10):1785–1804. - PubMed
    1. Penttila M, Jaaskelainen E, Hirvonen N, et al. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. Br J Psychiatry. 2014;205(2):88–94. - PubMed

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