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Lithium was used in our study as an additional referent for BD classifications. Lithium is likely to be prescribed primarily for treatment of recurrent mood disorders, particularly BD. Of course, the lack of agreement between these different measures may also be due to poor recognition and undertreatment of BD. In the absence of a gold standard, it is unclear to what extent misclassification occurred in each subgroup. An additional indication that misclassification has occurred arises from the observation that both CIDI-defined subgroups showed a parabolic pattern of change in prevalence with age, with a distinct decline in prevalence from mid- to late-adulthood.

This is not concordant with the trend that would be expected for a lifelong, recurrent condition in the absence of an extremely strong effect of BD on mortality. This is also in contrast to of a systematic review that found age-specific lifetime prevalence remained relatively steady across ages 18 to 64 years. Theoretically, it could be explained, to some extent, by a reduced life expectancy among people with BD, 14 but it is unlikely that early mortality could fully explain the marked decline.

Another potential explanation could be a cohort effect, with diagnoses made more frequently in more recent birth cohorts, 15 but this explanation is also unlikely because prevalence was not unexpectedly high, even in younger ages.

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Finally, the trend may be explained by recall bias. Studies of other mood disorders, such as depression, have observed similar declines with age when using lifetime prevalence, 16 which has led to a greater emphasis on month prevalence in the more recent literature. Unfortunately, types of prevalence other than lifetime to study BD may be unsuitable because definitions of BD depend on major mood episodes that occur during the life course.

Specifically, the lifetime occurrence of a manic or hypomanic episode determines the definitive diagnosis of BD. However, in any given year, there may only be episodes of manic and or hypomanic or depressive polarity.

For example, people may only have an MDE during the past year, and yet have a BD I diagnosis owing to a manic episode. The apparent flaws of lifetime prevalence, and its vulnerability to recall bias, coupled with the need to focus on lifetime prevalence may contribute to the discrepancy in CIDI classifications. on how to date Canadian women, where to find sex and how to get of conservativeness and women are free to visit clubs and pubs. Passion is the. Even much higher specificity would result in a high proportion of CIDI-positive subjects being false positive, which, combined with suboptimal sensitivity could explain these.

It is possible that fully structured interviews are inadequate for accurate diagnosis of BD in the general population.

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Notably, earlier versions of the CIDI included diagnostic modules for psychotic disorders, 18 but the modules were excluded from later versions of the instrument because their outputs were invalid. For example, false-positive rates for psychotic symptoms, such as delusions and hallucinations, were found to be quite high, possibly owing to misunderstanding of the interview questions, lack of insight, drug-induced states, or religious beliefs. For example, it may be difficult for a fully structured diagnostic interview to distinguish a normative adolescent experience from hypomanic symptoms.

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In Canada, mental health policy and planning still relies heavily on information collected from population surveys. If the measurement tools used in these surveys are not valid information sources, then more resources must be allocated to developing infrastructure for surveillance through administrative data. As this is a relatively new initiative, the quality of information collected is yet to be determined.

However, additional surveillance using health administration data does not solve all problems, as BD is believed to be an undertreated condition and physician billing and hospital discharge data reflect only the treated prevalence. Prevalence research lays the framework for understanding burden of disease in the population.

Many countries still rely heavily on population surveys for collecting public health information and surveillance. The CIDI is one of the most widely used instruments internationally. In light of the of our study, it is recommended that future and past studies that use the CIDI be interpreted with caution. While the research and analysis are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada. National Center for Biotechnology InformationU. Journal List Can J Psychiatry v. Can J Psychiatry. Find articles by Keltie C McDonald.

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