Reasons for diagnostic delays in Bipolar Disorder: Systematic review and narrative synthesis

BACKGROUND: Bipolar disorder is common, affecting 1% of people. The diagnosis of bipolar disorder is often delayed, which limits access to effective treatment and increases the burden of disease on individuals, families, and society. AIM: This paper investigates the individual, social, and clinical factors that contribute to delays in diagnosis for people with bipolar disorder, including delays that occur before and after a person presents to a primary care clinician. DESIGN AND SETTING: Systematic review and narrative synthesis. METHOD: Four electronic databases - Embase, Medline, PsychInfo, and Global Health - were systematically searched. This search yielded 3078 studies, 21 of which met the inclusion criteria. The data retrieved were analysed using Braun and Clarke’s Thematic Analysis to report a summary of recent research on the delays in the diagnosis of bipolar disorder. RESULTS: Analysis of the data from the 21 studies identified five main themes as reasons for delays in diagnosis: (1) misdiagnosis, (2) healthcare challenges, (3) mental health stigma, (4) the complex nature of bipolar disorder, and (5) individual factors. CONCLUSIONS: The review demonstrates the importance of educating individuals, families, and clinicians on the symptomology of bipolar disorder to avoid misdiagnosis. Furthermore, changes in the accessibility and delivery of mental health services are essential to ensure that people with bipolar disorder are diagnosed and treated in a timely manner. In addition, mental health stigma among individuals, families, and clinicians must be addressed to reduce diagnostic delays.