Does the ISBD task force report overestimate the prevalence of pediatric bipolar disorder?

Abstract

Introduction: The International Society for Bipolar Disorder (ISBD) Task Force Report estimated that the international community prevalence for Pediatric Bipolar Disorder (PBD) is 2.06%, based on the meta-analysis of 18 epidemiological studies (Goldstein et al., Bipolar Disord. 2017).1 This suggests that millions of children and adolescents around the world may have undiagnosed bipolar disorder. The current study reexamines the epidemiological studies to determine whether this estimate is likely to be correct. Methods: The re-examination focuses on the methodologies and prevalence rates drawn from the epidemiological studies used by the ISBD Task Force Report and an earlier meta-analysis (Van Meter et al., J. Clin. Psychiatry, 2011).1,2 Results: The 18 surveys were largely unsuitable for meta-analysis because the methodologies varied widely in instrumentation, ages of subjects, concordance between informants, prevalence period, and diagnostic criteria. There was wide variation in the reported prevalence rates, due to the differing definitions of PBD, heterogeneity of study methods, and combining discrepant parent and youth reports. PBD prevalence rates were zero or close to zero in surveys of prepubertal children. Conclusions: This re-examination found that epidemiological surveys rarely detect bipolar disorder before mid-adolescence, which is consistent with the findings of most high-risk offspring studies where bipolar disorder usually begins after mid-adolescence. If bipolar disorder is rare in childhood, there is considerable risk of misdiagnosing bipolar disorder in children who may receive unnecessary treatment that causes iatrogenic harm1.L6271895212019-04-17 <br />