The prevalence of bipolar disorder in China: A meta-analysis☆
Introduction
Bipolar disorder (BD) is a severe and chronic psychiatric disorder that causes significant social and economic burden; it was ranked sixth in the burden of disease attributable to mental and substance use disorders as measured by disability-adjusted life years (DALYs) (Whiteford et al., 2013).
The estimated lifetime prevalence of type I bipolar (BD-I) and type II bipolar disorder (BD-II) in general population worldwide was 1.06% and 1.57%, respectively (Clemente et al., 2015). A recent meta-analysis found that the overall prevalence of BD in primary care was 1.9% (Stubbs et al., 2016). In mainland China (thereafter: China), a number of studies have examined the patterns of BD in past decades. The results have been inconsistent with rates usually lower than those reported in most parts of the world. For example, 12- and 7-region surveys using the same Chinese version of the Present State Examination with similar sampling methods were conducted in 1982 and 1993, respectively. The point prevalence of affective psychoses (comparable to BD and major depression with psychotic features combined) was 0.076–0.052% (Twelve-Region Psychiatric Epidemiological Study Work Group, 1986, Zhang et al., 1998). The Chinese World Mental Health Survey Initiative (WMHS), which screened 5201 subjects in urban Beijing and Shanghai in 2001 using the Composite International Diagnostic Interview (CIDI) found a 12-month prevalence of 0.1%. Yet, the rural population was often not involved even though three quarters of the Chinese population reside in rural areas. Although diagnostic instruments similar to Western surveys were used in the WMHS, low prevalence of major psychiatric disorders was found, which was attributed to stigma-related non-disclosure, conceptual and measurement problems and culture influence (Shen et al., 2006).
Over the past two decades China has experienced rapid socioeconomic changes, associated with social problems, such as the rapidly rising health care costs, increasing divorce rate, weakening of family ties, large migration to urban areas for temporary jobs, and widening poverty gap (Phillips et al., 1999). These problems have impacted on mental health in general in particularly mood disorders (Lee et al., 2007). Hence, epidemiological studies of the prevalence of BD are clearly warranted.
To the best of our knowledge, no meta-analysis on prevalence of BD in China has been published. This study is a systematic, quantitative meta-analysis of the pooled prevalence of BD in the general adult population in China. In addition to international literature, Chinese databases, which are not usually reviewed in the international literature, were also searched.
Section snippets
Search strategy
Two reviewers independently and systematically conducted a search PubMed, EMBASE, PsycINFO, China National Knowledge Infrastructure (CNKI), WanFang and SinoMed databases from their inception to April 29, 2016. The search items were as follows: (“bipolar disorder” or “manic-depressive disorder” or “affective disorder” or “mood disorder” or “mental disorder” or “mental illness” or “psychiatric disorder” or “hypomania” or “mania”) and (“prevalence” or “incidence” or “epidemiology”) and (“China” or
Studies characteristics
Of the 18,468 potentially eligible papers identified by the initial literature search 32 studies (2 in English and 30 in Chinese) met the study entry criteria and were included for analyses (Fig. 1). The provinces covered in the studies are shown in Supplemental Fig. 1. Characteristics of the included studies are shown in Table 1. The sample sizes ranged from 1244 to 121,606, with a total number of 470,411 and a median of 10,116, the age ranged between 15 and 104 years. The diagnostic criteria
Overall prevalence of BD
The pooled point, 12-month and lifetime prevalence of BD were 0.09%, 0.17% and 0.11%, respectively. The pooled point and lifetime prevalence of BD-I were 0.06% and 0.09%, respectively and for BD-II they were both 0.04%. Although most studies (28/32) included the spectrum of BD, the pooled estimates were still much lower than the Western-based prevalence reported in systematic reviews: point prevalence of 0.741% (Ferrari et al., 2011); 12-month prevalence of 1% and lifetime prevalence of 2% (
Conclusions
This was the first meta-analysis of the pooled prevalence of BD in the general population of China. The prevalence estimates of BD, BD-I and BD-II are generally lower than those reported in Western countries.
Role of the Funding source
The study was supported by the Start-up Research Grant (SRG2014-00019-FHS) and the Multi-Year Research Grant (MYRG2015-00230-FHS) from the University of Macau, the Capital City Clinical Practice and Research Funding of Beijing Municipal Science & Technology Commission (Z141107002514033) and the Clinical Medicine Development Funding of Beijing Municipal Administration of Hospitals (ZYLX201607).
References (73)
- et al.
Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders
J. Affect Disord.
(2000) The emerging epidemiology of hypomania and bipolar II disorders
J. Affect. Disord.
(1998)- et al.
A systematic review of the global distribution and availability of prevalence data for bipolar disorders
J. Affect Disord.
(2011) - et al.
Prevalence and clinical characteristics of bipolar I disorder in Butajira, Ethiopia: a community-based study
J. Affect Disord.
(2005) - et al.
Prevalence and burden of bipolar disorders in European countries
Eur. Neuropsychopharmacol.
(2005) - et al.
Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010
Lancet
(2013) - et al.
Gender differences in bipolar disorder: retrospective data from the first 500 STEP-BD participants
Bipolar Disord.
(2005) - et al.
Prevalence of suicidal ideation and suicide attempts in the general population of China: a meta-analysis
Int. J. Psychiatry Med.
(2015) - et al.
Prevalence of suicidal ideation and suicide attempts in the general population of China: a meta-analysis
Int. J. Psychiatry Med.
(2015) The Chinese Classification of Mental Disorders, edition 3 (CCMD-3) [in Chinese]
(2001)
Lifetime and 12-month prevalence of DSM-IV psychiatric disorders among Korean adults
J. Nerv. Ment. Dis.
Bipolar disorder prevalence: a systematic review and meta-analysis of the literature
Rev. Bras. Psiquiatr
Psychiatric disorders and urbanization in Germany
BMC Public Health
Epidomiological survey of the mental illness in leshan city of Sichuan province [in Chinese]
Med. J. Chin. People Health
Is sex important? Gender differences in bipolar disorder
Int. Rev. Psychiatry
Epidemiological survey of mental disorders in adults in Tianshui City of Gansu Province [in Chinese]
Health Vocat. Educ.
Epidemiological survey of mental disorders in people aged 18 and older in Tianshui City of Gansu Province [in Chinese]
Chin. Ment. Health J.
Epidemiological survey of mental disorders in Weihai [in Chinese]
J. Clin. Psychiatry
Epidemiological survey of mental disorder in Fujian province [in Chinese]
Chin. J. Psychiatry
Prevalence, correlates, and comorbidity of bipolar I disorder and axis I and II disorders: results from the national epidemiologic survey on alcohol and related conditions
J. Clin. Psychiatry
Psychiatric epidemiological surveys in China 1960–2010: how real is the increase of mental disorders
Curr. Opin. Psychiatry
Psychiatric epidemiological surveys in China 1960–2010: how real is the increase of mental disorders
Curr. Opin. Psychiatry
Epidemiological survey of mental disorder in rural area of Xiangzhou District, Xiangfan City [in Chinese]
World Health Dig. Med. Period.
Cross-national prevalence and cultural correlates of bipolar I disorder
Soc. Psychiatry Psychiatr. Epidemiol.
Twelve-month prevalence, severity, and treatment of common mental disorders in communities in Japan: preliminary finding from the World Mental Health Japan Survey 2002-2003
Psychiatry Clin. Neurosci.
The epidemiology of DSM-III-R bipolar I disorder in a general population survey
Psychol. Med.
Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States
Int J. Methods Psychiatr. Res
A European approach to rural-urban differences in mental health: the ESEMeD 2000 comparative study
Can. J. Psychiatry
Cultures in psychiatric nosology: the CCMD-2-R and international classification of mental disorder
Cult., Med. Psychiatry
Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China
Psychol. Med.
A cross-sectional study of 4 mental disorders in Chifeng City of Inner Mongolia Autonomous Region [in Chinese]
Chin. Ment. Health J.
Epidemiological survey of mental disorders in the people aged 18 and older in Hebei Province
Asian J. Psychiatry
Epidemiological survey of mental disorders in persons aged 15 and older in Zhengzhou City [in Chinese]
The prevalence of mood disorder, anxiety disorder and substance use disorder in community residents in Beijing: a cross-sectional study [in Chinese]
Chin. Ment. Health J.
A cross-sectional study of mental disorders in Ximeng Wa Autonomous County of Yunnan Province [in Chinese]
Chin. Ment. Health J.
Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication
Arch. Gen. Psychiatry
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