title: More childhood onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention.
abstract: Evidence of a high or increasing incidence of childhood onset bipolar disorder in the United States (US) has been viewed skeptically. Here we review evidence that childhood onsets of bipolar disorder are more common in the US than in Europe, treatment delays are longer, and illness course is more adverse and difficult. Epidemiological data and studies of offspring at high risk also support these findings. In our cohort of outpatients with bipolar disorder, two of the major vulnerability factors for early onset - genetics and environmental adversity in childhood - were also greater in the US than in Europe. An increased familial loading for multiple psychiatric disorders was apparent in 4 generations of the family members of the patients from the US, and that familial burden was linked to early onset bipolar disorder. Since both early onset and treatment delay are risk factors for a poor outcome in adulthood, new clinical, research, and public health initiatives are needed to begin to address and ameliorate this ongoing and potentially devastating clinical situation.
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., USA. Electronic address: robert.post@speakeasy.net.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Post
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA.
authors.forename: Lori L
authors.initials: LL
authors.lastname: Altshuler
authors.affiliation: Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Kupka
authors.affiliation: Lindner Center of HOPE, Mason, OH, USA; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.affiliation: Department of Psychiatry, Mayo Clinic, Rochester, MI, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rowe
authors.affiliation: Paracelsius Medical University, Salzburg, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; V.A. Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Trisha
authors.initials: T
authors.lastname: Suppes
authors.affiliation: Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Lindner Center of HOPE, Mason, OH, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Keck
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, USA.
authors.forename: Gabriele S
authors.initials: GS
authors.lastname: Leverich
authors.affiliation: University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D017668:Age of Onset; D001714:Bipolar Disorder; D002170:Canada; D002648:Child; D005060:Europe; D005190:Family; D006801:Humans; D014481:United States
keywords: Assortative mating; Childhood adversity; Childhood onset bipolar disorder; Cohort effect; Depression; Early intervention; Epigenetics; Genetics; Primary and secondary prevention; Substance abuse