Are rates of pediatric bipolar disorder increasing? Results from a nationwide register study

Studies from the USA suggest that rates of pediatric bipolar disorder have increased since the mid-90s, but no study outside the USA has been published on the rates of pediatric bipolar disorder. Further, it is unclear whether an increase in rates reflects a true increase in the illness or more diagnostic attention. Using nationwide registers of all inpatients and outpatients contacts to all psychiatric hospitals in Denmark, we investigated (1) gender-specific rates of incident pediatric mania/bipolar disorder during a period from 1995 to 2012, (2) whether age and other characteristics for pediatric mania/bipolar disorder changed during the calendar period (1995 to 2003 versus 2004 to 2012), and (3) whether the diagnosis is more often made at first psychiatric contact in recent time compared to earlier according to gender. Totally, 346 patients got a main diagnosis of a manic episode (F30) or bipolar affective disorder (F31) at least once during the study period from 1995 to 2012. For both sexes, annual rates of mania/bipolar disorder two to four doubled during the study period (0.001% before year 2004 to 0.002%-0.004% in 2010). Median age at the index diagnosis was very similar during the two calendar periods (17.2, quartiles, 16.2-18.3 versus 17.4, quartiles, 16.1-18.2) indicating that the diagnosis of mania/bipolar disorder was not made earlier in the recent calendar period. Similarly, there were no differences between early versus late in the study period in the fractions of first contact diagnosis of mania/bipolar disorder diagnoses, the contact number at which patients got the diagnosis or the duration from first psychiatric contact to the diagnosis of mania/bipolar disorder. The rate of diagnosis of mania/bipolar disorder increased from 1995 to 2014, which did not seem to be explained by more diagnostic attention.