title: Characteristics of unrecognised bipolar disorder in patients treated for major depressive disorder in China: general versus psychiatric hospitals.
abstract: OBJECTIVE
  Bipolar disorder is often misdiagnosed as major depressive disorder. Such misdiagnosis partly depends on the type of treatment setting. This study compared general hospital psychiatric units with psychiatric hospitals in China with respect to basic demographic and clinical characteristics of patients with unrecognised bipolar disorder who are treated for major depressive disorder.
  
  
  METHODS
  Patients treated for major depressive disorder were consecutively examined in 13 health centres (6 general hospital psychiatric units and 7 psychiatric hospitals) in China. Their socio-demographic and clinical features were recorded using a standardised protocol and data collection procedure. The DSM-IV diagnoses were established using the Mini-International Neuropsychiatric Interview.
  
  
  RESULTS
  Of the 1487 patients included in the study, 309 (20.8%) were diagnosed with bipolar disorder. There was no significant difference between general hospital psychiatric units and psychiatric hospitals in the ratio of all types of unrecognised bipolar disorders (χ2 = 0.008, degrees of freedom = 1, p = 0.9) and bipolar II disorders (χ2 = 3.1, degrees of freedom = 1, p = 0.08). The proportions of unrecognised bipolar I disorders (χ2 = 4.1, degrees of freedom = 1, p = 0.04) differed significantly between the 2 types of study site. Multivariate analyses showed that patients with bipolar I disorders with more seasonal depressive episodes were more likely to receive treatment in general hospital psychiatric units (odds ratio = 3.3, 95% confidence interval = 1.1-9.8).
  
  
  CONCLUSIONS
  Patients with bipolar I disorders receiving treatment in general hospital psychiatric units had different clinical characteristics compared to their counterparts treated in psychiatric hospitals in China.
authors.affiliation: Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: F Z
authors.initials: FZ
authors.lastname: Chen
authors.forename: Y T
authors.initials: YT
authors.lastname: Xiang
authors.forename: Z
authors.initials: Z
authors.lastname: Lu
authors.forename: G
authors.initials: G
authors.lastname: Wang
authors.forename: C
authors.initials: C
authors.lastname: Hu
authors.forename: A M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: G S
authors.initials: GS
authors.lastname: Ungvari
authors.forename: Y R
authors.initials: YR
authors.lastname: Fang
authors.forename: T M
authors.initials: TM
authors.lastname: Si
authors.forename: H C
authors.initials: HC
authors.lastname: Yang
authors.forename: K Yc
authors.initials: KY
authors.lastname: Lai
authors.forename: J
authors.initials: J
authors.lastname: Hu
authors.forename: Z Y
authors.initials: ZY
authors.lastname: Chen
authors.forename: Y
authors.initials: Y
authors.lastname: Huang
authors.forename: J
authors.initials: J
authors.lastname: Sun
authors.forename: X P
authors.initials: XP
authors.lastname: Wang
authors.forename: H C
authors.initials: HC
authors.lastname: Li
authors.forename: J B
authors.initials: JB
authors.lastname: Zhang
authors.forename: X Y
authors.initials: XY
authors.lastname: Zhang
authors.forename: H F K
authors.initials: HF
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis*; D002681:China; D003865:Major Depressive Disorder / Q000175:diagnosis*; D003951:Diagnostic Errors; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006769:Hospitals, General; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Bipolar disorder; China; Mental health services