title: A systematic review of the evidence of the burden of bipolar disorder in Europe.
abstract: BACKGROUND
  Bipolar disorder is recognized as a major mental health issue, and its economic impact has been examined in the United States. However, there exists a general scarcity of published studies and lack of standardized data on the burden of the illness across European countries. In this systematic literature review, we highlight the epidemiological, clinical, and economic outcomes of bipolar disorder in Europe.
  
  
  METHODS
  A systematic review of publications from the last 10 years relating to the burden of bipolar disorder was conducted, including studies on epidemiology, patient-related issues, and costs.
  
  
  RESULTS
  Data from the UK, Germany, and Italy indicated a prevalence of bipolar disorder of ~1%, and a misdiagnosis rate of 70% from Spain. In one study, up to 75% of patients had at least one DSM-IV comorbidity, commonly anxiety disorders and substance/alcohol abuse. Attempted suicide rates varied between 21%-54%. In the UK, the estimated rate of premature mortality of patients with bipolar I disorder was 18%. The chronicity of bipolar disorder exerted a profound and debilitating effect on the patient. In Germany, 70% of patients were underemployed, and 72% received disability payments. In Italy, 63%-67% of patients were unemployed. In the UK, the annual costs of unemployment and suicide were pound1510 million and pound179 million, respectively, at 1999/2000 prices. The estimated UK national cost of bipolar disorder was pound4.59 billion, with hospitalization during acute episodes representing the largest component.
  
  
  CONCLUSIONS
  Bipolar disorder is a major and underestimated health problem in Europe. A number of issues impact on the economic burden of the disease, such as comorbidities, suicide, early death, unemployment or underemployment. Direct costs of bipolar disorder are mainly associated with hospitalization during acute episodes. Indirect costs are a major contributor to the overall economic burden but are not always recognized in research studies.
authors.affiliation: Health Economics and Outcomes, AstraZeneca R&D, Södertälje, Sweden. liberty.fajutrao@astrazeneca.com.
authors.forename: Liberty
authors.initials: L
authors.lastname: Fajutrao
authors.forename: Julie
authors.initials: J
authors.lastname: Locklear
authors.forename: Jennifer
authors.initials: J
authors.lastname: Priaulx
authors.forename: Anne
authors.initials: A
authors.lastname: Heyes