title: Berkson's bias and the mood dimensions of bipolar disorder.
abstract: In this paper we examined whether manic and depressive dimensions independently contribute to mental health service use and determined the degree of comorbidity between manic and depressive dimensions in individuals with and without mental health service use. If both depressive and manic episodes independently influence help-seeking behaviour, a higher level of comorbidity between these dimensions would be found in clinical as compared to non-clinical samples (i.e. Berkson's Bias). Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiological survey in a representative sample of the Dutch population (N = 7076). Dimensions of depression and mania and mental health service use (MHSU) were assessed with the Composite International Diagnostic Interview (CIDI) at baseline, and prospectively one and three years later. Logistic regression was used to test whether depressive and manic dimensions both had independent effects on mental health service use. The degree of mania-comorbidity given the presence of depressive dimension was assessed as a function of MHSU, both retrospectively and prospectively. Manic and depressive dimensions contributed independently to mental health service use. Mania-comorbidity given the presence of depressive dimension was significantly higher in individuals with mental health service use than in those without, both retrospectively (16.7% versus 7.1%, p = 0.000) and prospectively (10.8% versus 6.6%, p = 0.017). We conclude that the bipolar phenotype consists of manic and depressive dimensions that may be much more loosely associated than (Berkson) biased clinical observations suggest. A dimension-specific approach may be more productive in clarifying the aetiology of mood dysregulation.
authors.affiliation: Altrecht Institute for Mental Health Care, Utrecht, The Netherlands. e.regeer@altrecht.nl
authors.forename: E J
authors.initials: EJ
authors.lastname: Regeer
authors.forename: L
authors.initials: L
authors.lastname: Krabbendam
authors.forename: R
authors.initials: R
authors.lastname: De Graaf
authors.forename: M Ten
authors.initials: MT
authors.lastname: Have
authors.forename: W A
authors.initials: WA
authors.lastname: Nolen
authors.forename: J
authors.initials: J
authors.lastname: Van Os
mesh_terms: D000293:Adolescent; D000328:Adult; D001244:Association; D015982:Bias; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D055815:Young Adult
references.citation: Br J Psychiatry. 2001 Jul;179:39-45
references.pmid: 11435267
references.citation: J Affect Disord. 2004 Apr;79(1-3):71-9
references.pmid: 15023482
references.citation: Soc Psychiatry Psychiatr Epidemiol. 1998 Dec;33(12):587-95
references.pmid: 9857791
references.citation: Bipolar Disord. 2005 Oct;7(5):418-23
references.pmid: 16176434
references.citation: Br J Psychiatry. 2005 Jul;187:87-8
references.pmid: 15994577
references.citation: Acta Psychiatr Scand. 2004 Nov;110(5):374-82
references.pmid: 15458561
references.citation: Acta Psychiatr Scand. 2004 May;109(5):325-31
references.pmid: 15049768
references.citation: Psychiatr Clin North Am. 2002 Dec;25(4):685-98
references.pmid: 12462855
references.citation: Bipolar Disord. 2005 Aug;7(4):344-50
references.pmid: 16026487
references.citation: J Affect Disord. 2003 Jan;73(1-2):133-46
references.pmid: 12507746
references.citation: Arch Gen Psychiatry. 1988 Dec;45(12):1069-77
references.pmid: 2848472
references.citation: Eur Arch Psychiatry Neurol Sci. 1987;236(4):214-22
references.pmid: 3582430
references.citation: J Affect Disord. 2003 Jan;73(1-2):183-97
references.pmid: 12507751
references.citation: Mol Psychiatry. 2005 Sep;10(9):811-26
references.pmid: 15970930
references.citation: Biometrics. 1946 Jun;2(3):47-53
references.pmid: 21001024
references.citation: J Psychiatr Res. 1994 Jan-Feb;28(1):57-84
references.pmid: 8064641
references.citation: Arch Gen Psychiatry. 1978 Nov;35(11):1333-9
references.pmid: 757997
references.citation: Arch Gen Psychiatry. 2006 Apr;63(4):366-73
references.pmid: 16585465
references.citation: Br J Psychiatry. 1991 Nov;159:645-53, 658
references.pmid: 1756340
references.citation: Bipolar Disord. 1999 Sep;1(1):31-5
references.pmid: 11256653
references.citation: Bipolar Disord. 1999 Sep;1(1):36-7
references.pmid: 11256654
references.citation: Am J Epidemiol. 2000 Dec 1;152(11):1039-47
references.pmid: 11117613
references.citation: Arch Gen Psychiatry. 2005 Oct;62(10):1089-96
references.pmid: 16203954
references.citation: Biol Psychiatry. 2005 Aug 15;58(4):307-14
references.pmid: 16005437
references.citation: Bipolar Disord. 1999 Sep;1(1):25-30
references.pmid: 11256651
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2004 Aug;39(8):600-5
references.pmid: 15300369
references.citation: Schizophr Bull. 2006 Jan;32(1):9-16
references.pmid: 16319375
references.citation: J Affect Disord. 2003 Jan;73(1-2):123-31
references.pmid: 12507745
references.citation: Psychol Med. 2004 Oct;34(7):1177-86
references.pmid: 15697044
references.citation: J Affect Disord. 1997 Aug;45(1-2):31-9; discussion 39-40
references.pmid: 9268773
references.citation: Am J Psychiatry. 2003 Jan;160(1):4-12
references.pmid: 12505793
references.citation: Br J Psychiatry. 1991 Nov;159:653-8
references.pmid: 1756341
references.citation: Psychol Med. 2006 May;36(5):619-27
references.pmid: 16438739
references.citation: Bipolar Disord. 2000 Mar;2(1):3-7
references.pmid: 11254017
references.citation: Soc Psychiatry Psychiatr Epidemiol. 1998 Dec;33(12):581-6
references.pmid: 9857790