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Predictive factors of diagnostic conversion from major depressive disorder to bipolar disorder in young adults ages 19-34: A nationwide population study in South Korea

Authors
Kim, HyewonKim, YuwonBaek, Ji HyunFava, MaurizioMischoulon, DavidNierenberg, Andrew A.Choi, Kwan WooNa, Eun JinShin, Myung-HeeJeon, Hong Jin
Issue Date
Mar-2020
Publisher
ELSEVIER
Keywords
Major depressive disorder; Dipolar disorder; Bipolar conversion; Young adults
Citation
Journal of Affective Disorders, v.265, pp.52 - 58
Indexed
SCIE
SSCI
SCOPUS
Journal Title
Journal of Affective Disorders
Volume
265
Start Page
52
End Page
58
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/928
DOI
10.1016/j.jad.2020.01.009
ISSN
0165-0327
Abstract
Background: Predicting patients who convert to bipolar disorder is important for deciding appropriate treatment for young adults with major depressive disorder (MDD). We focused on the predictive factors of bipolar conversion in a large population of young adults. Methods: A nationwide, population-based electronic medical records database from the Health Insurance Review & Assessment service of South was used to investigate adjusted hazard ratio (HR) of each potential predictor of the bipolar converter group compared to the non-converter group using Cox regression analysis including age of onset, medication use, clinical features, comorbid disorders, admission, self-harm, and negative life events in childhood. Results: Among 291,721 subjects who were initially diagnosed with MDD in young adults, 12,376 subjects experienced diagnostic conversion to bipolar disorder. The cumulative incidence was 6.46% during the average 3.26 years of follow-up. Among the predictive factors during diagnosis of MDD, antipsychotic use (HR 3.12, 95%CI, 2.99-3.26, p < 0.0001) and mood stabilizers (HR 2.45, 95%CI, 2.35-2.55, p < 0.0001) showed the strongest association with diagnostic conversion to bipolar disorder. In addition, female sex, younger age of onset, mood stabilizer use, recurrent depression, psychotic symptoms, and admission to a psychiatric ward during diagnosis of MDD were also associated with diagnostic conversion to bipolar disorder. Conclusion: In young adults with MDD, antipsychotic and mood stabilizer use during diagnosis of MDD were the strongest predictive factors with diagnostic conversion to bipolar disorder during follow-up. If young adults with MDD need antipsychotics or mood stabilizer, patients should be carefully evaluated for possibility of bipolar disorder.
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