Research report
Risks associated with gender differences in bipolar I disorder

https://doi.org/10.1016/j.jad.2013.08.031Get rights and content

Abstract

Background

Previous studies have demonstrated that bipolar patients may differ in several features according to gender, but a number of the differences found remain controversial.

Methods

The demographic, illness course, clinical, comorbidity and temperament characteristics of a total of 1090 consecutive DSM-IV bipolar I manic inpatients were compared according to gender.

Results

Bipolar illness in women was characterised by the predominance of depression, as indicated by a depressive polarity at onset, higher rates of mixed mania, more suicidal behaviour, and a greater number of temperaments with depressive propensities. In contrast, the manic component was found to predominate in men. Men also had an earlier onset of their illness. Women displayed more comorbidities with eating, anxiety, and endocrine/metabolic disorders, whereas men were more comorbid with alcoholism and other forms of substance abuse, neurological, and cancer disorders. The following independent variables were associated with male gender: being single (+), depressive temperament (−), excessive alcohol use (+), cyclothymic temperament (−), excessive other substance use (+), mood congruent psychotic features (+), and manic polarity at onset (+).

Limitations

The retrospective design and the sample being potentially not representative of the bipolar disorder population are limitations.

Conclusions

Findings from this study tend to confirm most of the differences previously observed among bipolar men and women. Furthermore, these results draw attention to the risks that may be specifically linked to gender differences in bipolar I patients.

Introduction

Studies of gender differences in major depressive disorder indicate that women are more prone to depression, experience different symptoms, and have a more refractory course of illness (Goodwin and Jamison, 1990). Less attention has been paid to the study of gender differences in bipolar disorder, despite an increasing number of publications in recent years (McElroy et al., 2011). Although mania appears to be equally prevalent in women and men, bipolar disorder may differ between the two genders in clinically important ways. The main differences are likely to concern the phenomenology, course, and comorbidity of the bipolar spectrum (McElroy et al., 2011). However, a number of these differences remain controversial (Nivoli et al., 2011). Therefore, there is a need for further studies in this domain.

The Epidemiology of Mania (EPIMAN) II-Mille study represents one of the largest observational studies conducted in patients suffering from bipolar disorder. This large-scale study offers a unique opportunity to examine specific aspects of this pathology. The aims of the current investigation were (1) to examine this large sample of bipolar I patients with respect to the sex ratio, (2) to determine the main characteristics of bipolar I patients according to gender, and (3) to assess the clinical correlates and features of bipolar disorder in males compared to females.

Section snippets

Study population

Patients included in the study were hospitalised for a manic episode of bipolar I disorder. The diagnosis was made using the French version of the Structured Clinical Interview for DSM-IV (SCID) (First et al., 1997, Bordeleau, 1997).

Study design

EPIMAN II Mille, implemented in France, was a multicentre naturalistic study conducted at 19 medical centres between December 2000 and April 2002. The primary aim of the study was to further characterise the validity of the different subtypes of bipolar I disorder

Patients

A total of 1090 manic patients were included in the study. All were bipolar I patients who had experienced manic plus depressive episodes (bipolar I disorder, most recent episode manic or mixed, according to DSM-IV), except for 82 patients who experienced their first episode of illness (bipolar I disorder, single manic or mixed episode) at inclusion. The mean current age was 43±14 years. The mean number of prior episodes was 7.2±8. Multiple hospitalisations were recorded in 66.1% of patients.

Prevalence

Prevalence

According to the vast majority of epidemiological studies, bipolar I disorder is considered to be approximately equally common in men and women, whereas bipolar II disorder may be more common in women than in men (American Psychiatric Association, 1994). We observed a higher prevalence of women in our study. Three main explanations may account for this discrepancy. The first explanation is related to the fact that we included only patients who were hospitalised. It has been previously reported

Conclusions

Despite these limitations, the current study was able to confirm several of the differences associated with gender in bipolar patients. Depressive features may predominate in women, whereas manic features are at the fore in men. This phenomenon is likely to influence the diagnosis process and illness course, as well as treatment. Bipolar women and bipolar men appear to differ in regards to psychiatric comorbidity. We also found differences in medical comorbidities with more endocrine/metabolic

Role of funding source

This study was supported by an unrestricted grant from Sanofi-aventis, CNS Department, Paris, France. Sanofi-aventis had no further role in study design, in the collection and analysis of data, in the writing of the report, and in the decision to submit the article for publication.

Conflict of interest

No conflict declared.

Acknowledgement

The authors of this report would like to thank the support of Sanofi-aventis, CNS Department, Paris, France.

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