Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study

  1. Roy H Perlis1,
  2. Ellen B Dennehy2,
  3. David J Miklowitz3,
  4. Melissa P DelBello4,
  5. Michael Ostacher1,
  6. Joseph R Calabrese5,
  7. Rebecca M Ametrano1,
  8. Stephen R Wisniewski6,
  9. Charles L Bowden7,
  10. Michael E Thase8,
  11. Andrew A Nierenberg1,
  12. Gary Sachs1

Article first published online: 8 MAY 2009

DOI: 10.1111/j.1399-5618.2009.00686.x

Issue

Bipolar Disorders

Bipolar Disorders

Volume 11, Issue 4, pages 391–400, June 2009

Additional Information

How to Cite

Perlis, R. H., Dennehy, E. B., Miklowitz, D. J., DelBello, M. P., Ostacher, M., Calabrese, J. R., Ametrano, R. M., Wisniewski, S. R., Bowden, C. L., Thase, M. E., Nierenberg, A. A. and Sachs, G. (2009), Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study. Bipolar Disorders, 11: 391–400. doi: 10.1111/j.1399-5618.2009.00686.x

Author Information

  1. 1

    Bipolar Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA

  2. 2

    Department of Psychological Sciences, Purdue University, West Lafayette, IN

  3. 3

    Departments of Psychology and Psychiatry, University of Colorado, Boulder, CO

  4. 4

    Bipolar Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati

  5. 5

    University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH

  6. 6

    Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA

  7. 7

    Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX

  8. 8

    Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA

*Corresponding author: Roy H. Perlis, M.D. Department of Psychiatry Massachusetts General Hospital, ACC 812 15 Parkman Street Boston, MA 02114, USA Fax: 617-724-3028 e-mail: rperlis@partners.org

Publication History

  1. Issue published online: 8 MAY 2009
  2. Article first published online: 8 MAY 2009
  3. Received 29 July 2008, revised and accepted for publication 7 November 2008

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Keywords:

  • age of onset;
  • bipolar disorder;
  • chronicity;
  • depression;
  • maintenance;
  • mania;
  • recurrence

Objective:  Symptoms of bipolar disorder are increasingly recognized among children and adolescents, but little is known about the course of bipolar disorder among adults who experience childhood onset of symptoms.

Methods:  We examined prospective outcomes during up to two years of naturalistic treatment among 3,658 adult bipolar I and II outpatients participating in a multicenter clinical effectiveness study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Age at illness onset was identified retrospectively by clinician assessment at study entry.

Results:  Compared to patients with onset of mood symptoms after age 18 years (n = 1,187), those with onset before age 13 years (n = 1,068) experienced earlier recurrence of mood episodes after initial remission, fewer days of euthymia, and greater impairment in functioning and quality of life over the two-year follow-up. Outcomes for those with onset between age 13 and 18 years (n = 1,403) were generally intermediate between these two groups.

Conclusion:  Consistent with previous reports in smaller cohorts, adults with retrospectively obtained early-onset bipolar disorder appear to be at greater risk for recurrence, chronicity of mood symptoms, and functional impairment during prospective observation.

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