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. 2021 Oct;15(5):1136-1145.
doi: 10.1111/eip.13051. Epub 2020 Oct 15.

Which factors delay treatment in bipolar disorder? A nationwide study focussed on duration of untreated illness

Massimiliano Buoli  1   2 , Bruno Mario Cesana  3 , Andrea Fagiolini  4 , Umberto Albert  5 , Giuseppe Maina  6 , Andrea de Bartolomeis  7 , Maurizio Pompili  8 , Emi Bondi  9 , Luca Steardo Jr  10 , Mario Amore  11   12 , Antonello Bellomo  13 , Alessandro Bertolino  14 , Marco Di Nicola  15   16 , Guido Di Sciascio  17 , Andrea Fiorillo  18 , Paola Rocca  19 , Emilio Sacchetti  20   21 , Gabriele Sani  22 , Alberto Siracusano  23   24 , Giorgio Di Lorenzo  23   24 , Alfonso Tortorella  25 , Alfredo Carlo Altamura  1   2 , Bernardo Dell'Osso  26   27   28 ; ISBD Italian Chapter Epidemiologic Group
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Free article

Which factors delay treatment in bipolar disorder? A nationwide study focussed on duration of untreated illness

Massimiliano Buoli et al. Early Interv Psychiatry. 2021 Oct.
Free article

Abstract

Aim: The aim of the present study was to detect factors associated with duration of untreated illness (DUI) in bipolar disorder (BD).

Method: A total of 1575 patients were selected for the purposes of the study. Correlation analyses were performed to analyse the relation between DUI and quantitative variables. The length of DUI was compared between groups defined by qualitative variables through one-way analyses of variance or Kruskal-Wallis's tests according to the distribution of the variable. Linear multivariable regressions were used to find the most parsimonious set of variables independently associated with DUI: to this aim, qualitative variables were inserted with the numeric code of their classes by assuming a proportional effect moving from one class to another.

Results: An inverse significant correlation between length of DUI and time between visits in euthymic patients was observed (r = -.52, P < .001). DUI resulted to be longer in patients with: at least one lifetime marriage/partnership (P = .009), a first psychiatric diagnosis of major depressive disorder or substance abuse (P < .001), a depressive polarity of first episode (P < .001), no lifetime psychotic symptoms (P < .001), BD type 2 (P < .001), more lifetime depressive/hypomanic episodes (P < .001), less lifetime manic episodes (P < .001), presence of suicide attempts (P = .004), depressive episodes (P < .001), hypomanic episodes (P = .004), hospitalizations (P = .011) in the last year.

Conclusions: Different factors resulted to increase the length of DUI in a nationwide sample of bipolar patients. In addition, the DUI was found to show a negative long-term effect in terms of more suicidal behaviour, more probability of hospitalization and depressive/hypomanic episodes.

Keywords: bipolar disorder (BD); clinical features; duration of untreated illness (DUI); outcome.

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