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Risk factors for conversion from unipolar psychotic depression to bipolar disorder
Author(s) -
Østergaard Søren Dinesen,
Straszek Sune,
Petrides Georgios,
Skadhede Søren,
Jensen Signe Olrik Wallenstein,
MunkJørgensen Povl,
Nielsen Jimmi
Publication year - 2014
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/bdi.12152
Subject(s) - bipolar disorder , depression (economics) , medicine , danish , odds ratio , logistic regression , psychiatry , population , pediatrics , mood , linguistics , philosophy , environmental health , economics , macroeconomics
Objectives Patients with unipolar psychotic depression ( PD ) are at high risk of developing bipolar disorder ( BD ). This conversion has important implications for the choice of treatment. This study, therefore, aimed to identify risk factors associated with diagnostic conversion from PD to BD . Methods We conducted a population‐based, historical prospective cohort study by merging data from Danish registers. Patients assigned an ICD ‐10 diagnosis of PD between 1 January 1995 and 31 December 2007 were identified in the Danish Central Psychiatric Research Register and were followed until the development of BD , death, loss to follow‐up, or 31 December 2007. Potential risk factors for conversion to BD , also defined through various Danish registers, were tested in multiple logistic regression analyses with risk expressed as adjusted odds ratios ( AOR ). Results We identified 8,588 patients with PD , of whom 609 (7.1%) developed BD during follow‐up. The following characteristics were significantly associated with diagnostic conversion from PD to BD : early onset of PD [ AOR = 0.99 (per year of increasing age), p = 0.044], recurrent depression [ AOR = 1.02 (per episode), p = 0.036], living alone ( AOR = 1.29, p = 0.007), receiving a disability pension ( AOR = 1.55, p < 0.001), and the highest educational level being a technical education ( AOR = 1.55, p < 0.001), short‐cycle higher education ( AOR = 2.65, p < 0.001), or medium‐cycle higher education ( AOR = 1.75, p < 0.001). Conclusions Diagnostic conversion to BD was prevalent among patients with PD . The following characteristics were significantly associated with this conversion: early onset of PD , recurrent depression, living alone, receiving a disability pension, and the highest educational level being a technical education, short‐cycle higher education, or medium‐cycle higher education.