title: Screening for bipolar disorder in the primary care: a Brazilian survey.
abstract: BACKGROUND
  Two recent studies conducted in the US and in France found an unexpectedly high prevalence of a positive screen for bipolar disorder (BD) in primary care (PC). There are few studies of the prevalence of BD in PC and no information exists on the epidemiology of BD in Brazilian PC services. This study investigated the prevalence and correlates of a positive screen for BD among patients attending three Brazilian PC centers.
  
  
  METHODS
  This cross-sectional survey recruited a systematic sample of 720 patients between 18 and 70 years of age who were seeking primary care treatment. Study measures included the Mood Disorder Questionnaire, the Center for Epidemiologic Studies Depression Scale, the World Health Organization Quality of Life instrument-Abbreviated version, the Functional Comorbidity Index, the Functioning Assessment Short Test, data on past mental health care, service utilization and a review of medical records for coded diagnosis.
  
  
  RESULTS
  The prevalence of receiving positive screen for BD was 7.6% (n=55; 95% CI: 5.6-9.5%), but only 2 (3.6%) were recognized by general practitioners. A positive screen for BD was associated with significant depressive symptoms (CES-D score ≥16; 70.9%) and more general medical conditions, along with higher primary care utilization. Patients who screened positive for BD reported worse health-related quality of life as well as impaired functioning, compared to those who screened negative.
  
  
  CONCLUSIONS
  Co-morbid mental disorders were not assessed. The cross-sectional design prevents firm cause-effect inferences.
  
  
  CONCLUSIONS
  The prevalence of a positive screening for BD is high, clinically significant and under-recognized in Brazilian PC settings.
authors.affiliation: Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Milena S
authors.initials: MS
authors.lastname: Castelo
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Hyphantis
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Macêdo
authors.forename: Gabriela O
authors.initials: GO
authors.lastname: Lemos
authors.forename: Yuri O
authors.initials: YO
authors.lastname: Machado
authors.forename: Flávio
authors.initials: F
authors.lastname: Kapczinski
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.forename: André F
authors.initials: AF
authors.lastname: Carvalho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult