Ethnic differences in first clinical presentation of bipolar disorder: results from an epidemiological study

BACKGROUND: Although high incidence rates of mania have been described in some ethnic minority populations, little is known about any ethnic differences in the early clinical presentation of bipolar disorder. METHODS: All cases of operationalised DSM-IV bipolar I disorder (BPI), first manic episode, within a defined epidemiological catchment area over a 35-year period, were identified; sociodemographic data, including ethnicity, and clinical information were then extracted. The proportion of African-Caribbean (n=52), African (n=33) and white European (n=149) cases who experienced a depressive episode before onset of mania and psychotic symptoms at first mania were compared. RESULTS: African-Caribbean and African groups were significantly less likely to have experienced a depressive episode before onset of first mania, at 13.5% and 6.1%, respectively, compared with 28.1% in the white European group. African-Caribbean and African groups also experienced more severe psychotic symptoms at first mania, but there were no differences in mood incongruent or first rank symptoms between ethnic groups. LIMITATIONS: Data pertaining to diagnosis and clinical symptoms were extracted by retrospective case note review. CONCLUSIONS: Ethnic differences in clinical presentation of bipolar disorder may have implications for assessment and treatment of ethnic minority patients.