A prospective latent analyses study of psychiatric comorbidity of DSM-IV bipolar I and II disorders

Authors

  • Outi Mantere,

    1. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki
    2. Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo
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  • Erkki Isometsä,

    1. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki
    2. Department of Psychiatry, Helsinki University Central Hospital, Helsinki
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  • Mikko Ketokivi,

    1. Department of Industrial Engineering and Management, Helsinki University of Technology, Espoo, Finland
    2. Operations and Technology Department, IE Business School, Madrid, Spain
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  • Olli Kiviruusu,

    1. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki
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  • Kirsi Suominen,

    1. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki
    2. Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo
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  • Hanna M Valtonen,

    1. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki
    2. Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo
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  • Petri Arvilommi,

    1. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki
    2. Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo
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  • Sami Leppämäki

    1. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki
    2. Department of Psychiatry, Helsinki University Central Hospital, Helsinki
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  • The authors of this paper do not have any relevant commercial associations or conflicts of interest to disclose.

Corresponding author:
Professor Erkki Isometsä, M.D., Ph.D.
Institute of Clinical Medicine
Department of Psychiatry
University of Helsinki
P.O. Box 22
00014 Helsinki, Finland
Fax: +358-9-471 63735
E-mail: erkki.isometsa@hus.fi

Abstract

Mantere O, Isometsä E, Ketokivi M, Kiviruusu O, Suominen K, Valtonen HM, Arvilommi P, Leppämäki S. A prospective latent analyses study of psychiatric comorbidity of DSM-IV bipolar I and II disorders.
Bipolar Disord 2010: 12: 271–284. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S.

Objective:  To test two hypotheses of psychiatric comorbidity in bipolar disorder (BD): (i) comorbid disorders are independent of BD course, or (ii) comorbid disorders associate with mood.

Methods:  In the Jorvi Bipolar Study (JoBS), 191 secondary-care outpatients and inpatients with DSM-IV bipolar I disorder (BD-I) or bipolar II disorder (BD-II) were evaluated with the Structured Clinical Interview for DSM-IV Disorders, with psychotic screen, plus symptom scales, at intake and at 6 and 18 months. Three evaluations of comorbidity were available for 144 subjects (65 BD-I, 79 BD-II; 76.6% of 188 living patients). Structural equation modeling (SEM) was used to examine correlations between mood symptoms and comorbidity. A latent change model (LCM) was used to examine intraindividual changes across time in depressive and anxiety symptoms. Current mood was modeled in terms of current illness phase, Beck Depression Inventory (BDI), Young Mania Rating Scale, and Hamilton Depression Rating Scale; comorbidity in terms of categorical DSM-IV anxiety disorder diagnosis, Beck Anxiety Inventory (BAI) score, and DSM-IV-based scales of substance use and eating disorders.

Results:  In the SEM, depression and anxiety exhibited strong cross-sectional and autoregressive correlation; high levels of depression were associated with high concurrent anxiety, both persisting over time. Substance use disorders covaried with manic symptoms (r = 0.16–0.20, p < 0.05), and eating disorders with depressive symptoms (r = 0.15–0.32, p < 0.05). In the LCM, longitudinal intraindividual improvements in BDI were associated with similar BAI improvement (r = 0.42, p < 0.001).

Conclusions:  Depression and anxiety covary strongly cross-sectionally and longitudinally in BD. Substance use disorders are moderately associated with manic symptoms, and eating disorders with depressive mood.

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