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Increase in out-based physician diagnoses of bipolar disorder in youth in the USA

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Mark Olfson

Correspondence to: Mark Olfson, MD, MPH, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA;



How do patterns of outpatient visits with a diagnosis of bipolar disorder differ between 1994 and 2003 for youths and adults?


Representative sample of people visiting out-based physicians in the USA. Data were collected through the National Ambulatory Medical Care Survey (NAMCS), an annual survey which samples a nationally representative group of visits to doctors engaged in direct patient care.


Out-based physicians across the USA; 1994–2003.


As part of the NAMCS, for one week during the year selected physicians completed a questionnaire about each patient visit (collecting demographic, clinical and treatment characteristics). To look at temporal trends in visits with a diagnosis of bipolar disorder, researchers pooled data for the following years: 1994–5, 1996–7, 1998–9, 2000–1, and 2002–3. Trends were compared in two different age groups, 0–19 year olds (youths) and 20+ year olds (adults).


Visits per 100 000 population at which a diagnosis of bipolar disorder (ICD-9-CM) was received, proportion of visits …

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  • Notes: Response rates over the years ranged from 70% to 73%. Diagnoses of mental illnesses were based on the judgement of the treating physician. The NAMCS records visits made rather than individual patients, so there may be double counting for some people. The study is also limited by only recording visits to out-based physicians not in other centres (for example, community mental health centres, hospitals, etc) where bipolar disorders may present. The authors put forward two hypotheses to explain the increase in diagnoses: firstly that bipolar disorder is no longer under-diagnosed as it might have been historically or that it is now being over-diagnosed in this age group.

  • Source of funding: Alicia Kaplowitz Foundation Fellowship in Child and Adolescent Psychiatry, the Spanish Ministry of Health, Instituto de Salud Carlos III, Red de Enfermedades Mentales, and National Institutes of Mental Health, National Institutes of Health, US Department of Health and Human Services.


  • Competing interests: In the preceding five years, JCB has received research and travel support from Abbott Laboratories Inc, and travel support from Otsuka America Pharaceutical Inc.

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