Elsevier

Journal of Affective Disorders

Volume 207, 1 January 2017, Pages 413-421
Journal of Affective Disorders

The prevalence of bipolar disorder in China: A meta-analysis

https://doi.org/10.1016/j.jad.2016.08.062Get rights and content

Highlights

  • This is a meta-analysis of the pooled prevalence of bipolar disorders (BD) in the general population of China.

  • The estimated point, 12-month and lifetime prevalence of BD in mainland China were 0.09%, 0.17% and 0.11%, respectively.

  • The pooled prevalence of BD in China are generally lower that those reported in Western countries.

Abstract

Objective

This is a meta-analysis of the prevalence of bipolar disorders (BD) in the general population of China.

Methods

A systematic literature search was conducted via the following databases: PubMed, EMBASE, PsycINFO, China National Knowledge Infrastructure (CNKI), WanFang and SinoMed. Studies on the prevalence of BD in the general population in China were identified. Statistical analyses were performed using the Comprehensive Meta-Analysis program.

Results

Altogether 32 studies conducted between 1984 and 2013 with 470,411 participants met the inclusion criteria for the analysis; the median age was 44.6 years and 49.6% of participants were female. The estimated point, 12-month and lifetime prevalence of BD in China were 0.09% (95% Confidence interval [CI]: 0.06–0.12%), 0.17% (95% CI: 0.10–0.29%) and 0.11% (95% CI: 0.07–0.17%), respectively. For BD-I, the estimated point, 12-month and lifetime prevalence rates were 0.06% (95% CI: 0.04–0.10%), 0.08% (95% CI: 0.02–0.30%) and 0.09% (95% CI: 0.05–0.16%), respectively. For BD-II, the estimated point and lifetime prevalence rates were 0.04% (95% CI: 0.02–0.06%) and 0.04% (95% CI: 0.02–0.09%), respectively. The 12-month prevalence of BD before the year 2010 was significantly lower than that after 2010 (0.12% vs. 0.26%, P=0.04). Meta-regression analysis revealed that younger age was significantly associated with higher 12-month prevalence of BD (coefficient=0.096, 95% CI: 0.027, 0.164, P=0.006).

Conclusion

This first meta-analysis of the pooled prevalence of BD in China found that rates are generally lower than those reported in Western countries. Future studies with more rigorous and refined methodology are needed.

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)

  • M.J. Cho et al.

    Lifetime and 12-month prevalence of DSM-IV psychiatric disorders among Korean adults

    J. Nerv. Ment. Dis.

    (2007)
  • A.S. Clemente et al.

    Bipolar disorder prevalence: a systematic review and meta-analysis of the literature

    Rev. Bras. Psiquiatr

    (2015)
  • J. Dekker et al.

    Psychiatric disorders and urbanization in Germany

    BMC Public Health

    (2008)
  • X.F. Deng et al.

    Epidomiological survey of the mental illness in leshan city of Sichuan province [in Chinese]

    Med. J. Chin. People Health

    (2003)
  • A. Diflorio et al.

    Is sex important? Gender differences in bipolar disorder

    Int. Rev. Psychiatry

    (2010)
  • Z.J. Ding et al.

    Epidemiological survey of mental disorders in adults in Tianshui City of Gansu Province [in Chinese]

    Health Vocat. Educ.

    (2015)
  • Z.J. Ding et al.

    Epidemiological survey of mental disorders in people aged 18 and older in Tianshui City of Gansu Province [in Chinese]

    Chin. Ment. Health J.

    (2010)
  • A.L. Dong et al.

    Epidemiological survey of mental disorders in Weihai [in Chinese]

    J. Clin. Psychiatry

    (2008)
  • X. Fang et al.

    Epidemiological survey of mental disorder in Fujian province [in Chinese]

    Chin. J. Psychiatry

    (2011)
  • B.F. Grant et al.

    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

    (2005)
  • W.-j. Guo et al.

    Psychiatric epidemiological surveys in China 1960–2010: how real is the increase of mental disorders

    Curr. Opin. Psychiatry

    (2011)
  • W.J. Guo et al.

    Psychiatric epidemiological surveys in China 1960–2010: how real is the increase of mental disorders

    Curr. Opin. Psychiatry

    (2011)
  • D.S. Jiang et al.

    Epidemiological survey of mental disorder in rural area of Xiangzhou District, Xiangfan City [in Chinese]

    World Health Dig. Med. Period.

    (2011)
  • K.R. Johnson et al.

    Cross-national prevalence and cultural correlates of bipolar I disorder

    Soc. Psychiatry Psychiatr. Epidemiol.

    (2014)
  • N. Kawakami et al.

    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.

    (2005)
  • R.C. Kessler et al.

    The epidemiology of DSM-III-R bipolar I disorder in a general population survey

    Psychol. Med.

    (1997)
  • R.C. Kessler et al.

    Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States

    Int J. Methods Psychiatr. Res

    (2012)
  • V. Kovess-Masfety et al.

    A European approach to rural-urban differences in mental health: the ESEMeD 2000 comparative study

    Can. J. Psychiatry

    (2005)
  • S. Lee

    Cultures in psychiatric nosology: the CCMD-2-R and international classification of mental disorder

    Cult., Med. Psychiatry

    (1996)
  • S. Lee et al.

    Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China

    Psychol. Med.

    (2007)
  • G.H. Li et al.

    A cross-sectional study of 4 mental disorders in Chifeng City of Inner Mongolia Autonomous Region [in Chinese]

    Chin. Ment. Health J.

    (2015)
  • K.Q. Li et al.

    Epidemiological survey of mental disorders in the people aged 18 and older in Hebei Province

    Asian J. Psychiatry

    (2008)
  • J. Liu

    Epidemiological survey of mental disorders in persons aged 15 and older in Zhengzhou City [in Chinese]

    (2012)
  • Z.R. Liu et al.

    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.

    (2013)
  • W.X. Lu et al.

    A cross-sectional study of mental disorders in Ximeng Wa Autonomous County of Yunnan Province [in Chinese]

    Chin. Ment. Health J.

    (2015)
  • K.R. Merikangas et al.

    Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication

    Arch. Gen. Psychiatry

    (2007)
  • Cited by (35)

    • Bipolar disorder: An evolutionary psychoneuroimmunological approach

      2021, Neuroscience and Biobehavioral Reviews
      Citation Excerpt :

      Prevention of bipolar disorder and other mental disorders should be the first duty of healthcare systems and societies, not only because mental disorders cause a substantial economic burden for the society, but also because they cause tremendous suffering for patients and their families. It is well known that societies with high wealth inequality have much higher problems with mental health and criminal behavior than more equal societies (e.g. Byrne and James, 2020; Ribeiro et al., 2014; Wilkinson and Pickett, 2009; Yu, 2018). Greater potential variation in gaining resources in a given society could be expected to increase competition and cause stress in those who are in disadvantaged positions.

    • Investigation into the psychological resilience of family caregivers burdened with in-home treatment of patients with bipolar disorder

      2021, Journal of Affective Disorders Reports
      Citation Excerpt :

      Bipolar disorder (BD) is a debilitating disease that inflicts suffering on many patients. A study conducted by scholars in Hong Kong has shown that the prevalence of BD in China is generally lower than those reported by Western countries (Zhang et al., 2017). The estimated point, 12-month and lifetime prevalence of BD in China were 0.09%, 0.17%, and 0.11% respectively.

    View all citing articles on Scopus

    Trial registration: CRD 42016039471.

    1

    These authors equally contributed to the work.

    View full text