Children and youth in the United States are leaving hospitals with a diagnosis of bipolar disorder 72.1 times more often than children and youth in the UK, according to a study led by University of Oxford researchers published in the Journal of the American Academy of Child & Adolescent Psychiatry. US children receive a diagnosis of bipolar at a rate of 100.9 per 100,000 population compared to 1.4 per 100,000 in the UK.
“Controversy exists over the diagnosis and prevalence of pediatric bipolar disorder (PBD),” wrote the researchers. “Although several small surveys suggest that the rate of the PBD diagnosis in clinical settings is higher in the United States than in other countries, no comprehensive cross-national comparisons of clinical practice have been performed.” The researchers analyzed data about US and UK hospital discharges through the years 2000 to 2010, for patients aged 1 to 19 years.
“There was a 72.1-fold difference in discharge rates for PBD in youth between the United States and England,” wrote the researchers. “After controlling for cross-national differences in length of stay, discharge rates for PBD remained 12.5 times higher in the United States than in England.”
The researchers noted that bipolar diagnoses increased with age in both countries; however, there wasn’t a single case of a UK child under 7 years of age being discharged with a PBD diagnosis, whereas by 6 years of age US children were being diagnosed with PDB at the same rate as British 19 year olds.
“This suggests that the difference in discharge rates for PBD may be due to differing diagnostic practices for PBD in the United States versus in England,” concluded the researchers.
In a press release, lead author Dr. Anthony James of the University of Oxford said that “the study design does not allow us to answer the question whether US clinicians are too liberal in assigning the diagnosis of bipolar disorder to youth or, alternatively, whether English clinicians fail to recognize or diagnose these illnesses.” However, in the study the researchers noted that the US PBD rates were also many times higher than the rates in most other nations that have been studied.
US children and adolescents were also generally 3.9 times more likely to be diagnosed with any form of mental illness than their counterparts in the UK, at 261.2 per 100,000 population in the US compared to 67.8 per 100,000 in the UK. “For ADHD, the rate is 13.2 times higher in the United States than in England,” wrote the researchers, while “unipolar depression in children and adolescents is 4.2-fold higher.”
Though the study was published in June, it seems to have largely gone unreported in the news media.
A Comparison of American and English Hospital Discharge Rates for Pediatric Bipolar Disorder, 2000 to 2010 (James, Anthony et al. Journal of the American Academy of Child & Adolescent Psychiatry. June 2014. Vol. 53, Issue 6, Pages 614-624. DOI: 10.1016/j.jaac.2014.02.008)
Bipolar disease in children, adolescents: Discharge rates much higher in the US compared to UK (Press Release from Elsevier on Science Daily, May 22, 2014)