Table 1.
Details of the studies which report a trimodal age‐at‐onset distribution in bipolar disorder
| Study | N | Country | Diagnosis | Recruitment | Definition of age at onset | Method of determining AAO | Mean age of sample at study entry (SD) | Early onset | Mid‐onset | Late onset | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Upper age limit | Mean (SD), % | Lower and upper age limits | Mean (SD), % |
Lower age limit |
Mean (SD), % | ||||||||
| Azorin et al (2013) | 1082 | France | DSM‐IV BPI | The EPIMAN II Mille study, a multi‐centre naturalistic study conducted in 19 French medical centres | Age at which the patient first met the Research Diagnostic Criteria for an affective episode |
Medical records. Structured interviews with patients and relatives. |
42.9 (13.7) | 20 | 18.6 (2.1), 19% | 21‐29 | 24.3 (5.3), 38.9% | 30 | 36.7 (10.8), 42% |
|
Bellivier et al (2001) |
211 | France | DSM‐IV BPI | Consecutive inpatients and outpatients in France | Age at which DSM‐IV criteria for an affective episode was first met |
Medical records. Diagnostic Interview for Genetic Studies |
42.4 (14.8) | 16.9 (2.7), 41.4% | 26.9 (5.0), 41.8% | 46.2 (8.0), 16.6% | |||
| Bellivier et al (2003) | 579 |
France, Switzerland Germany Ireland |
DSM‐IV BPI |
Inpatients and outpatients across four countries |
Age at which DSM‐IV criteria for an affective episode was first met |
Medical records. Diagnostic Interview for Genetic Studies |
Not reported | 17.4 (2.3), 27.9% | 25.1 (6.2), 50.1% | 40.4 (11.3), 21.9% | |||
| Bellivier et al (2014) | 5891 |
Europe and USA |
DSM‐IV BPI |
Recruited for genetic, pharmacological and observational studies across 18 sites in Europe (N = 3616, incl. participants from the EMBLEM study) and from the Stanley Centre Bipolar Registry in the USA (N = 2275) |
Age at which DSM‐IV criteria for an affective episode were first met | Semi‐structured interview | 44.0 (13.2) | Europe | |||||
| 19 (2.7), 24.8% | 27.2 (6.3), 50.7% | 41.8 (10.7), 24.5% | |||||||||||
| 40.8 (11.7) | USA | ||||||||||||
| 14.5 (4.9), 63.0% | 26.5 (7.6), 28.5% | 39.5 (12.5), 8.5% | |||||||||||
| Biffin et al (2009) | 162 | Australia | DSM‐IV BPI | Recruited as part of the Bipolar Comprehensive Outcome Study (BCOS) in Melbourne, Australia | Self‐reported age at which episode of mania or depression first met diagnostic criteria | Questionnaire developed by the research team |
Early:38.7 (12.6) Mid: 43.7 (12.6) Late: 58.9 (11.5) |
15.5 (2.7), 44.4% | 26.1 (4.8) 48.1% | 50.6 (9.0), 7.4% | |||
| González‐Pinto et al (2009) | 169 | Spain | DSM‐IV BPI | Inpatients and outpatients who were receiving treatment in Alava, a Spanish province. | The age at first treatment for an affective disorder | Medical records. Semi‐structured SCID‐P interview. Emergency service records. Interviews with relatives. | 46.0 (16.0) | 18.2 (2.0), 34.0% | 26.1 (5.5), 44.0% | 50.9 (9.1), 22.0% | |||
| Hamshere et al (2009) | 1369 | UK | DSM‐IV BPI | Large‐scale genetic epidemiological study. Recruited via community mental health teams, general practitioner surgeries and patient support organisations across the UK. | Age at first impairment due to an affective episode according to self‐report | Medical records. Schedules for Clinical Assessment in Neuropsychiatry (SCAN). | Age range: 6 to 73 years | 22 | 18.7 (3.7), 47.1% | 25‐37 | 28.3 (5.5), 38.8% | 40 | 43.3 (9.1), 14.3% |
| Lin et al (2006) | 211 | USA |
DSM‐III‐R BP‐I |
NIMH Genetics Initiative for Bipolar Disorder 85 | Self‐reported age at which episode of (hypo)mania or depression first met diagnostic criteria | Medical records. Diagnostic Interview for Genetic Studies. | Age range: 0 to >61 years | 21 | 16.6 (5.1), 79.7% | 22‐28 | 26.0 (1.4), 7.2% | 28 | 34.7 (6.6), 13.1% |
|
Manchia et al (2008) |
181 | Sardinia |
RDC‐BPI |
Recruited from the Lithium Clinic of the Clinical Psychopharmacology Centre, University of Cagliari, Italy |
Age at first reliably diagnosed (hypo)manic or depressive episode |
Medical records. Semi‐structured interview | 42.8 (14.8) | 20 |
18.1 (2.3), 36.0% |
21‐33 |
24.3 (5.3), 39.0% |
34 |
41.0 (11.5), 25.0% |
| Nowrouzi et al (2016) | 194 | Canada |
DSM‐III‐R or DSM‐IV BPI BPII |
Recruited from four clinical sites across Ontario, Alberta and British Columbia, Canada | Unknown | Unknown |
25.2 (9.51), range 14‐65 years |
18.0 (2.9), 69.0% | 28.7 (3.5), 22.0% | 47.3 (7.8), 9.0% | |||
| Ortiz et al (2011) | 379 | Canada |
DSM‐IV or RDC BPI BPII |
Recruited through the Maritime Bipolar Registry, a community‐based project in the Maritime Provinces of Canada 86 |
Age at which DSM‐IV criteria for an affective episode was first met (according to medial case notes and interviews) | Medical records. Schedule for Affective Disorders and Schizophrenia, Lifetime version | 50.1 (12.7) | 19 |
15.5 (2.0), 29.0% |
20‐31 | 22.8 (4.6), 37.1% | 32 | 36.1 (10.1), 33.4% |
| Severino et al (2009) | 300 | Italy |
RDC BPI BPII Schizoaffective bipolar manic type |
Outpatients at the Lithium Clinic of the Clinical Psychopharmacology Centre, University of Cagliari, Italy | Age at first reliably diagnosed (hypo)mania or depression according to RDC criteria (using medical records) | Medical records. Semi‐structured interview | 42.9 (14.8) | 22 | 18.5 (2.6), 43.0% | 23‐37 | 27.5 (6.1), 42.0% | 38 | 43.0 (10.8), 15.0% |
| Tozzi et al (2011) | 964 | UK and Canada |
DSM‐IV or ICD‐10 BP‐I BP‐II |
Recruited across three sites: Toronto (Canada) at the Centre for Addiction and Mental Health, London (UK), at the Institute of Psychiatry, and Dundee (UK) at the University of Dundee | Self‐reported age at which episode of mania or depression first met diagnostic criteria | Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview |
47.2 (12.1), range 18‐84 years |
24 | 16.1 (4.2), 64.0% | 25 | 25.4 (2.5), 6.0% | 26 | 32.2 (9.5), 30.0% |
| Grigoroiu‐Serbanescu et al (2014)a | 1857 |
Germany Poland Romania |
DSM‐IV BPI | Consecutive inpatients recruited at three sites: | Age at which DSM‐IV criteria for an affective episode were first met | Medical records. Semi‐structured interview with patients and relatives | 43.4 (13.4) | Romania | |||||
| 17.6 (3.2), 43.0% | N/A | 20‐21 | 29.9 (8.2), 57.0% | ||||||||||
| 17.3 (2.8) 33.0% | 25.6 (6.3), 46.0% | 40.9 (5.3), 21.0% | |||||||||||
| 44.0 (13.4) | Germany | ||||||||||||
| 20.7 (6.0), 67.0% | N/A | 25 | 38.4 (6.5), 33.0% | ||||||||||
| 19.3 (5.5), 46.0% | 28.5 (7.1), 41.0% | 45.4 (4.7) 13.0% | |||||||||||
| 45.0 (14.1) | Poland | ||||||||||||
| 20.47 (3.91), 65% | N/A | 24‐25 | 33.57 (9.12), 35% | ||||||||||
| 20.7 (3.7), 44.0% | 33.0 (6.1), 45.0% | 49.0 (5.3), 11.0% | |||||||||||
Age bounds for the subgroups are provided. Numbers reported to one decimal place.
Two component and three component models fitted the data equally well.