title: Increased prospective health service use for depression among adults with childhood onset bipolar disorder.
abstract: OBJECTIVE
  To examine the prospective relationship between age of onset of bipolar disorder and the demographic and clinical characteristics, treatment, new onset of psychiatric comorbidity, and psychosocial functioning among adults with bipolar disorder.
  
  
  METHODS
  As part of the National Epidemiologic Survey on Alcohol and Related Conditions, 1600 adults who met lifetime Statistical Manual of Mental Disorders, 4th edition criteria for bipolar disorder-I (n = 1172) and bipolar disorder-II (n = 428) were included. Individuals were evaluated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV version for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and data were analyzed from Waves 1 and 2, approximately 3 years apart. Individuals with bipolar disorder were divided into three age at onset groups: childhood (<13 years old, n = 115), adolescence (13-18 years old, n = 396), and adulthood (>19 year old, n = 1017).
  
  
  RESULTS
  After adjusting for confounding factors, adults with childhood-onset bipolar disorder were more likely to see a counselor, have been hospitalized, and have received emergency room treatment for depression compared with those with adulthood-onset bipolar disorder. By contrast, there were no differences in the severity of mania or hypomania, new onset of comorbidity, and psychosocial functioning by age of bipolar disorder onset.
  
  
  CONCLUSIONS
  Childhood-onset bipolar disorder is prospectively associated with seeking treatment for depression, an important proxy for depressive severity. Longitudinal studies are needed in order to determine whether prompt identification, accurate diagnosis, and early intervention can serve to mitigate the burden of childhood onset on the long-term depressive burden of bipolar disorder.
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, United Kingdom. Electronic address: regina.sala_cassola@kcl.ac.uk.
authors.forename: Regina
authors.initials: R
authors.lastname: Sala
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
authors.forename: Shuai
authors.initials: S
authors.lastname: Wang
authors.forename: Ludwing
authors.initials: L
authors.lastname: Flórez-Salamanca
authors.forename: Miren
authors.initials: M
authors.lastname: Iza
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D002648:Child; D015897:Comorbidity; D003863:Depression / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012923:Social Class; D014481:United States; D055815:Young Adult
keywords: AUDADIS-IV; Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV; DSM-IV; Diagnostic and Statistical Manual of Mental Disorders, 4th edition; NESARC; National Epidemiologic Survey on Alcohol and Related Conditions
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