title: Onset-age of bipolar disorders at six international sites.
abstract: BACKGROUND
  Onset-age is a stable characteristic of bipolar disorder (BPD) patients of clinical and probable psychobiological importance, but large pooled clinical samples from multiple sites employing modern diagnostic criteria to quantify onset-age remain rare.
  
  
  METHODS
  We pooled diagnostic, demographic, and clinical data from 1566 BPD patients from six international sites (5 European, 1 US) to compare onset-ages in subgroups.
  
  
  RESULTS
  Median+/-IQR onset in 1090 BP-I patients was 5.8 years younger than 476 BP-II cases (24.3+/-18.3 vs. 30.1+/-13.8 years; p<0.0001). Onset-age ranked: [a] BP-I men (23.0+/-12.8); [b] BP-I women (26.0+/-14.2); [c] BP-II men (29.7+/-19.1); and [d] BP-II women (30.1+/-17.5 years. Juvenile-onset (<or=age 20) was more common in Europe than the US (27% vs. 16%), as was childhood-onset (<13 years: 3.3% vs. 0%; both p<0.001). Proportion of all cases, and median onset for first episodes ranked: [a] BP-I psychotic (6.3%; 22.7+/-9.2); [b] BP-I manic (29.3%; 24.0+/-12.1); [c] BP-I depressed (25.1%; 24.5+/-14.9); [d] BP-I mixed (9.7%; 27.9+/-16.0); [e] BP-II depressed (26.9%; 30.0+/-19.5); and [f] BP-II hypomanic (2.8%; 33.6+/-15.1 years; p<0.0001). Among BP-I patients, onset was similar for various forms of mania and major depression; in BP-II patients initial depression was 9.6-times more frequent and diagnosed earlier than hypomania.
  
  
  CONCLUSIONS
  There was some variance among sites and only 34.1% of patients were evaluated at onset.
  
  
  CONCLUSIONS
  Type I BPD began much earlier than type II; its mainly psychotic presentations occurred earliest, but BP-I men were younger than women, especially at psychotic or mixed onsets.
authors: Department of Psychiatry & Neuroscience Program, Harvard Medical School, USA. rjb@mclean.org
authors: R J
authors: RJ
authors: Baldessarini
authors: L
authors: L
authors: Bolzani
authors: N
authors: N
authors: Cruz
authors: P B
authors: PB
authors: Jones
authors: M
authors: M
authors: Lai
authors: B
authors: B
authors: Lepri
authors: J
authors: J
authors: Perez
authors: P
authors: P
authors: Salvatore
authors: M
authors: M
authors: Tohen
authors: L
authors: L
authors: Tondo
authors: E
authors: E
authors: Vieta
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D055815:Young Adult