Screening for bipolar depression in family medicine practices: prevalence and clinical correlates.
BACKGROUND
To compare individuals in primary care (PC) who screen positive for bipolar depression to those who screened positive for unipolar depression on mental health care ouctomes, PC service utilization, medical comorbidities, suicidal ideation, health-related quality of life (HRQoL) and psychosocial functioning.


METHODS
In this cross-sectional study, participants (N=1197) answered self-reported measures of depressive symptoms (Center for epidemiologic studies depression scale), HRQoL (World Health Organization Quality of Life instrument-Abbreviated version), medical comorbidity (functional comorbidity index) and functioning (Functional Assessment Short test). Participants were partitioned into 'bipolar' and 'unipolar' depression groups based on a predefined cutoff on the Brazilian mood disorder questionnaire.


RESULTS
The prevalence of bipolar depression was in PC was 4.6% (95% CI: 3.4-5.8). Participants with bipolar depression were more likely to endorse suicidal ideation, present with more medical comorbidities, report a worse physical HRQoL and have a higher rate of PC services utilization as compared to participants who screened positive for unipolar depression. Only six (10.9%) participants were recognized by the general practitioner as having a diagnosis of bipolar depression.


CONCLUSIONS
The cross-sectional design prevents firm causal inferences from being drawn. A positive screen for BD does not substantiate the actual diagnosis. Co-morbid mental disorders were not accessed.


CONCLUSIONS
Bipolar depression is common and under-recognized in Brazilian PC services. A positive screen for bipolar depression was associated with worse clinical outcomes and greater PC service utilization.
Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Fortaleza, Ceará, Brazil. Electronic address: andrefc7@terra.com.br.
André F
AF
Carvalho
Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Paulo R
PR
Nunes-Neto
Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Fortaleza, Ceará, Brazil.
Milena S
MS
Castelo
Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Danielle S
DS
Macêdo
3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Dimos
D
Dimellis
Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of Sao Paulo (IPq-HC-FMUSP), Brazil.
Márcio G
MG
Soeiro-de-Souza
Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, ON, Canada.
Joanna K
JK
Soczynska
Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
Roger S
RS
McIntyre
Department of Psychiatry, School of Medicine, University of Ioannina, Ioannina, Greece.
Thomas N
TN
Hyphantis
3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Konstantinos N
KN
Fountoulakis
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult
Bipolar depression; Bipolar disorder; Functioning; Primary care; Quality of life; Service utilization