Exploring factors of diagnostic delay for patients with bipolar disorder: a population-based cohort study

Lublóy, Ágnes; Keresztúri, Judit Lilla; Németh, Attila; Mihalicza, Péter

doi:10.1186/s12888-020-2483-y

BMC Psychiatry

Table 3 Factors associated with diagnostic delay in patients with bipolar disorder (N = 7876)

From: Exploring factors of diagnostic delay for patients with bipolar disorder: a population-based cohort study

Factors		Number of patients	Percentage	Model 1			Model 2
Factors		Number of patients	Percentage	Adjusted hazard ratio	95% confidence interval	Sig.	Adjusted hazard ratio	95% confidence interval	Sig.
Age categories	18–27	1061	13.47%	Reference			Reference
	28–37	1434	18.21%	0.65	0.60–0.71	0.000 ***	0.63	0.58–0.69	0.000 ***
	38–47	1930	24.50%	0.51	0.47–0.56	0.000 ***	0.50	0.46–0.55	0.000 ***
	48–57	1994	25.32%	0.47	0.43–0.51	0.000 ***	0.46	0.42–0.50	0.000 ***
	58–65	1457	18.50%	0.46	0.42–0.50	0.000 ***	0.44	0.41–0.49	0.000 ***
Gender	Female	4663	59.21%	Reference			Reference
Gender	Male	3213	40.79%	1.03	0.98–1.08	0.242	1.02	0.97–1.07	0.366
First mental health visit	Inpatient	1157	14.69%	Reference			Reference
First mental health visit	Outpatient	6719	85.31%	0.62	0.58–0.67	0.000 ***	0.65	0.61–0.70	0.000 ***
First diagnosis with bipolar disorder	Inpatient	5955	75.61%	Reference			Reference
First diagnosis with bipolar disorder	Outpatient	1921	24.39%	1.01	0.96–1.07	0.678	1.01	0.95–1.06	0.806
Prior F31 diagnosis, assigned mostly as additional diagnosis (proportion of patients)		2737	34.75%	1.01	1.01–1.01	0.000 ***	1.01	1.01–1.01	0.000 ***
Time between prior F31 diagnosis (mostly additional diagnosis) and first F31 diagnosis as defined in this study (years)		2814	35.73%	1.00	1.00–1.00	0.000 ***	1.00	1.00–1.00	0.000 ***
Patient was hospitalized with mental problems	No	3012	38.24%	Reference			Reference
Patient was hospitalized with mental problems	Yes	4864	61.76%	0.92	0.87–0.98	0.006 *	0.91	0.86–0.97	0.002 *
Mania at first presentation	No	2782	35.32%	Reference			Reference
Mania at first presentation	Yes	5094	64.68%	0.98	0.93–1.03	0.391	0.96	0.92–1.01	0.132
Inpatient care	alcohol misuse/dependence	733	9.31%	0.93	0.90–0.96	0.000 ***	0.95	0.92–0.98	0.000 ***
	illicit drug misuse/dependence	347	4.41%	0.98	0.92–1.05	0.563	1.01	0.95–1.08	0.721
	schizophrenia and related disorders	1672	21.23%	0.97	0.96–0.98	0.000 ***	0.97	0.96–0.98	0.000 ***
	anxiety disorder	1422	18.05%	0.99	0.97–1.02	0.696	1.01	0.98–1.04	0.498
	specific, mixed and other personality disorders other than borderline personality disorder, and enduring personality changes	345	4.38%	0.90	0.83–0.98	0.014 *	0.95	0.88–1.03	0.248
	borderline personality disorder	173	2.20%	0.88	0.75–1.04	0.128	0.98	0.83–1.16	0.832
	psychotic depression	312	3.96%	1.07	0.98–1.17	0.129	1.13	1.03–1.23	0.008 *
	unipolar depression without psychotic symptoms	1833	23.27%	0.98	0.97–1.00	0.042 *	0.99	0.97–1.00	0.065 †
	mood affective disorders other than the ones listed above	607	7.71%	0.99	0.94–1.04	0.594	1.00	0.95–1.05	0.931
	organic, including symptomatic, mental disorders	223	2.83%	1.02	0.91–1.14	0.706	1.02	0.91–1.14	0.728
	neurotic, stress-related and somatoform disorders	119	1.51%	0.77	0.64–0.94	0.008 *	0.77	0.63–0.93	0.008 *
	behavioural syndromes associated with physiological disturbances and physical factors	29	0.37%	0.81	0.71–0.93	0.003 *	0.82	0.72–0.93	0.002 *
	disorders of adult personality and behavior other than the ones listed above	25	0.32%	1.01	0.82–1.25	0.937	1.01	0.83–1.24	0.903
	mental and behavioural disorders other than the ones listed above	362	4.60%	0.93	0.87–0.99	0.026 *	0.94	0.88–1.01	0.087 †
	poisoning and toxic substances	1753	22.26%	0.98	0.94–1.02	0.366	1.00	0.96–1.04	0.818
	intentional self-harm	1208	15.34%	1.04	0.99–1.09	0.129	1.03	0.98–1.08	0.256
Outpatient care	alcohol misuse/dependence	1790	22.73%	1.00	1.00–1.00	0.088 †	0.99	0.98–0.99	0.000 ***
	illicit drug misuse/dependence	1371	17.41%	1.00	0.99–1.00	0.025 *	0.98	0.98–0.99	0.000 ***
	schizophrenia and related disorders	2693	34.19%	0.99	0.99–1.00	0.000 ***	0.99	0.99–0.99	0.000 ***
	anxiety disorder	6530	82.91%	1.00	0.99–1.00	0.000 ***	0.99	0.99–0.99	0.000 ***
	specific, mixed and other personality disorders other than borderline personality disorder, and enduring personality changes	1857	23.58%	1.00	0.99–1.00	0.005 *	0.97	0.95–0.99	0.005 *
	borderline personality disorder	858	10.89%	0.99	0.99–1.00	0.003 *	0.96	0.94–0.99	0.002 *
	psychotic depression	550	6.98%	1.00	0.99–1.01	0.702	0.98	0.97–0.99	0.006 *
	unipolar depression without psychotic symptoms	5087	64.59%	0.99	0.99–0.99	0.000 ***	0.99	0.99–0.99	0.000 ***
	mood affective disorders other than the ones listed above	1689	21.44%	0.99	0.98–0.99	0.000 ***	0.98	0.97–0.98	0.000 ***
	organic, including symptomatic, mental disorders	1200	15.24%	1.00	0.99–1.00	0.315	0.98	0.97–0.99	0.000 ***
	neurotic, stress-related and somatoform disorders	1117	14.18%	1.01	1.00–1.01	0.001 *	0.97	0.95–0.98	0.000 ***
	behavioural syndromes associated with physiological disturbances and physical factors	1400	17.78%	1.00	0.99–1.00	0.071 †	1.01	0.97–1.05	0.592
	disorders of adult personality and behavior other than the ones listed above	217	2.76%	1.00	0.95–1.06	0.928	1.00	0.99–1.01	0.897
	mental and behavioural disorders other than the ones listed above	1343	17.05%	0.98	0.98–0.99	0.000 ***	0.97	0.96–0.97	0.000 ***
	intentional self-harm	821	10.42%	0.98	0.95–1.02	0.362	0.98	0.94–1.02	0.331

In inpatient care, in both model 1 and model 2 principal diagnosis alone was considered. In outpatient care, in model 1 all diagnoses in patient’s medical history were counted, while in model 2 we tested the effect of considering only the principal diagnosis. Variables with Exp(β) smaller than one are associated with decreased hazard; the lower the variable, the lower the hazard of the event. For example, in model 1 for the variable alcohol misuse/dependence in inpatient care the interpterion of Exp(β) is as follows: the probability of being diagnosed early with bipolar disorder for the first time is by 7% lower (1–0.93 = 0.07) if a patient has received an additional diagnosis of alcohol misuse/dependence in inpatient care
† p < 0.1; * p < 0.05; *** p < 0.0001

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