About bipolar disorder Pendulum: stories and information Lifetime prevalence of BD and BD pts access to mental health care in England This is a study aiming at discovering how many people in England live with bipolar disorder (BD), how often they use mental health services, and which factors are associated with successfully obtaining the care needed. The study used data from the Adult Psychiatric Morbidity Survey (APMS) from 2014, which is thought to be representative of the whole nation and included 7546 adults. The included participants were assessed for a potential BD prevalence using the Mood Disorders Questionnaire (MDQ) assessment scale, as well as asked about any help-seeking in the last year for mental and emotional problems. Such help or treatment could include attending hospital, both as an in- and out-patient, but also discussing their mental health with their GP, psychiatrist or psychologist, or any other type of healthcare professional. Data on their social and demographic background and other mental health related factors such as suicidal ideation and psychotic symptoms were also collected. The lifetime prevalence of BD in England was found to be 1.72%, meaning that less than 2% of the people assessed in the APMS has experience of BD. This is similar to the global prevalence of BD. More people with BD were female, under age 45, educational level of secondary school or higher, and living by themselves. Over half of people screening positive for BD had experienced either persecutory delusions or auditory-verbal hallucinations, and almost 1/3 had thoughts of suicide in the previous year. In the last 12 months before the survey, less than 60% had received any mental health care, leaving 4/10 without any. Of those who had successfully obtained treatment, more were women, and were unemployed or retired. They had higher likelihood of an additional borderline personality disorder, persecutory delusions, or auditory-verbal hallucinations. They were also more likely to experience suicide ideation in the previous year and be diagnosed with a depressive episode. The authors speculate that the presence of these more severe symptoms increases the chances of getting treatment and help when seeking it, or even that these symptoms are the requirement for getting help in secondary mental health care. Around 1/7 of people with BD who reported having sought help in the last year, had been denied this. Only 17% of those who got help had received specific treatments for BD, such as mood stabilising medication. Although the MDQ has a specificity of 0.97 to correctly find people with BD symptoms, it’s sensitivity is only 0.28, meaning that only around ¼ of people with BD were identified, but that almost all who were identified confidentiality can be thought of as having BD. This low sensitivity might especially exclude people with subsyndromal bipolar states such as cyclothymia, and thus making the real prevalence of BD higher than reported. Other factors to consider in this study is the lack of longitudinal data. There was no follow-up of the participants over longer periods of time, how their symptoms changed or how they attempted accessing the appropriate care over time. It would appear that secondary mental health services in England are leaving a lot of people without care. Only 17% received treatment with BD specific medication, and although we don’t know the specific clinical needs of those without treatment in the last year, 4/10 people with BD symptoms did not get access to secondary mental health services, and 1/7 who requested and asked for help were denied it. Thoughts of suicide was the only factor which was statistically significant associated with successfully getting help, questioning whether this severe state of mental health is needed before help is provided. The authors of the study suggest more screening for BD symptoms at GP sessions, more investment in BD clinics and their specific focus on treating BD, and implement better intervention for early signs of BD.