Bipolar affective disorder in India: A multi-site population-based cross-sectional study

Bhavika Vajawat; Satish Suhas; Sydney Moirangthem; Channaveerachari Naveen Kumar; Mathew Varghese; Gopalkrishna Gururaj; Vivek Benegal; Girish N Rao; NMHS National Collaborators Group

doi:10.4103/indianjpsychiatry.indianjpsychiatry_838_23

Bipolar affective disorder in India: A multi-site population-based cross-sectional study

Indian J Psychiatry. 2023 Dec;65(12):1230-1237. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_838_23. Epub 2023 Dec 11.

Authors

Bhavika Vajawat¹, Satish Suhas¹, Sydney Moirangthem¹, Channaveerachari Naveen Kumar¹, Mathew Varghese¹, Gopalkrishna Gururaj², Vivek Benegal¹, Girish N Rao²; NMHS National Collaborators Group

Affiliations

¹ Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
² Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.

PMID: 38298870
PMCID: PMC10826869
DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_838_23

Abstract

Introduction: Bipolar Affective Disorder (BPAD) merits careful consideration within the medical and healthcare communities, researchers, and policymakers. This is due to its substantial disability burden, elevated prevalence of co-morbidities, heightened lifetime risk of suicidality, and a significant treatment gap. This article focuses on the lifetime and current prevalence, correlates, co-morbidities, associated disabilities, socio-economic impact, and treatment gap for BPAD in the adult population of the National Mental Health Survey (NMHS) 2016.

Materials and methods: The NMHS 2016 was a nationally representative study conducted across 12 Indian states between 2014 and 2016. A multi-stage, stratified, random cluster sampling technique based on probability proportionate to size at each stage was used. The diagnosis of BPAD was based on Mini-International Neuropsychiatric Interview 6.0.0. Sheehan's Disability Scale was used to assess the disability.

Results: A total of 34,802 adults were interviewed. The overall weighted prevalence of BPAD was 0.3% [95% confidence interval (CI): 0.29-0.31] for current and 0.5% (95% CI: 0.49-0.51) for lifetime diagnosis. Male gender [odds ratio (OR) 1.56] and residence in urban metropolitans (OR 2.43) had a significantly higher risk of a lifetime diagnosis of BPAD. Substantial cross-sectional co-morbidities were noted as per MINI 6.0.0 with the diagnosis of current BPAD such as tobacco use disorder (33.3%), other substance use disorders (14.6%), and anxiety disorders (10.4%). Two-thirds of persons with current BPAD reported disability of varying severity at work (63%), social (59.3%), and family life (63%). The treatment gap for current BPAD was 70.4%.

Conclusion: Most individuals with current BPAD reported moderate-severe disability. There were substantial co-morbidities and a large treatment gap. These warrant concentrated efforts from policymakers in devising effective strategies.

Keywords: Bipolar affective disorder; India; cost; disability; epidemiology; national mental health survey; prevalence; treatment gap.