Open AccessBerkson's bias and the mood dimensions of bipolar disorder
Author(s) -
Regeer E.J.,
Krabbendam L.,
De Graaf R.,
Ten Have M.,
Nolen W.A.,
Van Os J.
Publication year - 2009
Publication title -
international journal of methods in psychiatric research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.275
H-Index - 73
eISSN - 1557-0657
pISSN - 1049-8931
DOI - 10.1002/mpr.290
Subject(s) - cidi , mania , comorbidity , mental health , bipolar disorder , psychiatry , psychology , mood , clinical psychology , epidemiology , national comorbidity survey , depression (economics) , population , medicine , environmental health , economics , macroeconomics
Abstract In this paper we examined whether manic and depressive dimensions independently contribute to mental health service use and determined the degree of comorbidity between manic and depressive dimensions in individuals with and without mental health service use. If both depressive and manic episodes independently influence help‐seeking behaviour, a higher level of comorbidity between these dimensions would be found in clinical as compared to non‐clinical samples (i.e. Berkson's Bias). Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiological survey in a representative sample of the Dutch population ( N = 7076). Dimensions of depression and mania and mental health service use (MHSU) were assessed with the Composite International Diagnostic Interview (CIDI) at baseline, and prospectively one and three years later. Logistic regression was used to test whether depressive and manic dimensions both had independent effects on mental health service use. The degree of mania‐comorbidity given the presence of depressive dimension was assessed as a function of MHSU, both retrospectively and prospectively. Manic and depressive dimensions contributed independently to mental health service use. Mania‐comorbidity given the presence of depressive dimension was significantly higher in individuals with mental health service use than in those without, both retrospectively (16.7% versus 7.1%, p = 0.000) and prospectively (10.8% versus 6.6%, p = 0.017). We conclude that the bipolar phenotype consists of manic and depressive dimensions that may be much more loosely associated than (Berkson) biased clinical observations suggest. A dimension‐specific approach may be more productive in clarifying the aetiology of mood dysregulation. Copyright © 2009 John Wiley & Sons, Ltd.