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. 2023 Dec 12;22(1):52.
doi: 10.1186/s12991-023-00487-6.

Real-world predictors of divorce among outpatients with bipolar disorder: sex differences and clinical implications

Keita Tokumitsu  1 , Norio Sugawara  2 , Naoto Adachi  3 , Yukihisa Kubota  3 , Yoichiro Watanabe  3 , Kazuhira Miki  3 , Takaharu Azekawa  3 , Koji Edagawa  3 , Eiichi Katsumoto  3 , Seiji Hongo  3 , Eiichiro Goto  3 , Hitoshi Ueda  3 , Masaki Kato  4   5 , Reiji Yoshimura  4   6 , Atsuo Nakagawa  4   7 , Toshiaki Kikuchi  4   8 , Takashi Tsuboi  4   9 , Koichiro Watanabe  4   9 , Norio Yasui-Furukori  1   4
Affiliations

Real-world predictors of divorce among outpatients with bipolar disorder: sex differences and clinical implications

Keita Tokumitsu et al. Ann Gen Psychiatry. .

Abstract

Background: Bipolar disorder is a mental illness characterized by recurring episodes of mania and depression and is known to cause social impairment. Additionally, it has been revealed that bipolar disorder increases the risk of divorce and loss of family member support, which can worsen the prognosis. However, there is limited evidence regarding the predictive factors of divorce among patients with bipolar disorder in real-world settings.

Methods: This study utilized an observational approach and involved psychiatrists from 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics. They were requested to conduct a retrospective review of medical records and complete a questionnaire focused on patients diagnosed with bipolar disorder. The data collection period for baseline patient characteristics spanned from September to October 2017. Next, we investigated the incidence of divorce over a 2-year period, ranging from baseline to September to October 2019.

Results: A total of 1071 outpatients with bipolar disorder were included in the analysis, and 2.8% (30/1071) experienced divorce during the first 2 years of observation. The incidence of divorce in this population was considerably higher than that in the general Japanese population. Binomial logistic regression analysis confirmed that a younger baseline age and lower BMI values were statistically significant predictors of divorce occurrence for all study participants. The predictors of divorce were then examined separately by sex. The results revealed that for men, a younger age at baseline and having bipolar I disorder compared to bipolar II disorder were statistically significant predictors of divorce. In contrast, for women, having a lower BMI and using anxiolytics emerged as statistically significant predictors of divorce.

Conclusions: In this study, a younger baseline age and lower BMI values were statistically significant predictors of divorce in patients with bipolar disorder. Notably, the predictors of divorce varied significantly between men and women. These findings provide important insights from a family perspective regarding social support for individuals with bipolar disorder in real-world clinical settings.

Keywords: Bipolar disorder; Divorce; Outpatient; Predictor; Real-world.

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Conflict of interest statement

Keita Tokumitsu, Norio Sugawara, Naoto Adachi, Yoichiro Watanabe, and Kazuhisa Miki declare no conflicts of interest regarding this article. Yukihisa Kubota has received consultant fees from Pfizer and Meiji-Seika Pharma and speaker’s honoraria from Meiji-Seika Pharma, MSD, Eli Lilly, Janssen Pharmaceutical, Dainippon Sumitomo Pharma, Mitsubishi Tanabe Pharma, Yoshitomi Yakuhin, Otsuka Pharmaceutical, Takeda Pharmaceutical, Lundbeck Japan, and Eisai. Takaharu Azekawa has received speaker’s honoraria from Otsuka Pharmaceutical, Sumitomo Pharma and Janssen Pharmaceutical. Hitoshi Ueda has received manuscript fees or speaker’s honoraria from Eli Lilly, Janssen Pharmaceutical, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Pfizer, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, and Yoshitomi Yakuhin. Koji Edagawa has received speaker’s honoraria from Eli Lilly, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Pfizer, Sumitomo Dainippon Pharma, Kyowa, Yoshitomi Yakuhin, and Takeda Pharmaceutical. Eiichi Katsumoto has received speaker’s honoraria from Daiichi Sankyo, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Pharmaceutical, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Pfizer, Sumitomo Dainippon Pharma, UCB, and Viatris. Seiji Hongo has received manuscript fees or speaker honoraria from Eli Lilly, Janssen Pharmaceutical, Kyowa Pharmaceutical, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Shionogi, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, and Yoshitomi Yakuhin. Eiichiro Goto has received manuscript fees or speaker’s honoraria from Eli Lilly, Janssen Pharmaceutical, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Takeda Pharmaceutical, Eisai, Ono Pharmaceutical, Kyowa Pharmaceutical Industry and Sumitomo Dainippon Pharma. Hitoshi Ueda has received manuscript fees or speaker’s honoraria from Eli Lilly, Janssen Pharmaceutical, Kyowa Pharmaceutical, Meiji Seika Pharma, Otsuka Pharmaceutical, Pfizer, Shionogi, Dainippon Sumitomo Pharma, Takeda Pharmaceutical, Lundbeck Japan and Yoshitomi Yakuhin. Masaki Kato has received grant funding from the Japanese Ministry of Health, Labor and Welfare, the Japan Society for the Pro- motion of Science, SENSHIN Medical Research Foundation, the Japan Research Foundation for Clinical Pharmacology and the Japanese Society of Clinical Neuropsychopharmacology and speaker’s honoraria from Sumitomo Dainippon Pharma, Otsuka, Meiji-Seika Pharma, Eli Lilly, MSD K.K., Pfizer, Janssen Pharmaceutical, Shionogi, Mitsubishi Tanabe Pharma, Takeda Pharmaceutical, Lundbeck and Ono Pharmaceutical and participated in an advisory/review board for Otsuka, Sumitomo Dainippon Pharma, Shionogi and Boehringer Ingelheim. Reiji Yoshimura has received speaker honoraria from Eli Lilly, Dainippon Sumitomo, Otsuka, and Esai. Atsuo Nakagawa has received speaker’s honoraria from Pfizer, Eli Lilly, Otsuka, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Mochida, Dainippon Sumitomo and NTT Docomo and participated in an advisory board for Takeda, Meiji Seika, Tsumura and Yoshitomi Yakuhin. Toshiaki Kikuchi has received consultant fees from Takeda Pharmaceutical and the Center for Cognitive Behavioral Therapy and Training. Takashi Tsuboi has received consultant fees from Pfizer and speaker’s honoraria from Eli Lilly, Meiji- Seika Pharma, MSD, Janssen Pharmaceutical, Dainippon Sumitomo Pharma, Mitsubishi Tanabe Pharma, Yoshitomi Yakuhin, Mochida Pharmaceutical, Otsuka Pharmaceutical, Kyowa Pharmaceutical, and Takeda Pharmaceutical. Koichiro Watanabe has received manuscript fees or speaker’s honoraria from Daiichi Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutical, Kyowa Pharmaceutical, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Pfizer, Shionogi, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, and Yoshitomi Yakuhin, has received research/grant support from Daiichi Sankyo, Eisai, MSD, Mitsubishi Tanabe Pharma, Meiji Seika Pharma, Otsuka Pharmaceutical, Pfizer, Shionogi, Sumitomo Dainippon Pharma, Takeda Pharmaceutical and is a consultant for Boehringer Ingelheim, Daiichi Sankyo, Eisai, Eli Lilly, Kyowa Pharmaceutical, Lundbeck Japan, Otsuka Pharmaceutical, Sumitomo Dainippon Pharma, Taisho Toyama Pharmaceutical, Takeda Pharmaceutical, and Viatris. Norio Yasui-Furukori has received grant/research support or honoraria from and speaker’s honoraria of Dainippon-Sumitomo Pharma, Mochida Pharmaceutical, MSD, and Otsuka Pharmaceutical. The authors report no other competing interests in this work.

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