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Predictors of diagnostic conversion from major depression to bipolar disorder : A Swedish national longitudinal study

Rhee, Sang Jin ; Ohlsson, Henrik LU ; Sundquist, Jan LU ; Sundquist, Kristina LU and Kendler, Kenneth S. LU (2023) In Psychological Medicine 53(16). p.7805-7816
Abstract

Background It is clinically important to predict the conversion of major depression (MD) to bipolar disorder (BD). Therefore, we sought to identify related conversion rates and risk factors. Methods This cohort study included the Swedish population born from 1941 onward. Data were collected from Swedish population-based registers. Potential risk factors, including family genetic risk scores (FGRS), which were calculated based on the phenotypes of relatives in the extended family and not molecular data, and demographic/clinical characteristics from these registers were retrieved. Those with first MD registrations from 2006 were followed up until 2018. The conversion rate to BD and related risk factors were analyzed using Cox proportional... (More)

Background It is clinically important to predict the conversion of major depression (MD) to bipolar disorder (BD). Therefore, we sought to identify related conversion rates and risk factors. Methods This cohort study included the Swedish population born from 1941 onward. Data were collected from Swedish population-based registers. Potential risk factors, including family genetic risk scores (FGRS), which were calculated based on the phenotypes of relatives in the extended family and not molecular data, and demographic/clinical characteristics from these registers were retrieved. Those with first MD registrations from 2006 were followed up until 2018. The conversion rate to BD and related risk factors were analyzed using Cox proportional hazards models. Additional analyses were performed for late converters and with stratification by sex. Results The cumulative incidence of conversion was 5.84% [95% confidence interval (95% CI) 5.72-5.96] for 13 years. In the multivariable analysis, the strongest risk factors for conversion were high FGRS of BD [hazard ratio (HR) = 2.73, 95% CI 2.43-3.08], inpatient treatment settings (HR = 2.64, 95% CI 2.44-2.84), and psychotic depression (HR = 2.58, 95% CI 2.14-3.11). For late converters, the first registration of MD during the teenage years was a stronger risk factor when compared with the baseline model. When the interactions between risk factors and sex were significant, stratification by sex revealed that they were more predictive in females. Conclusions Family history of BD, inpatient treatment, and psychotic symptoms were the strongest predictors of conversion from MD to BD.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bipolar disorder, conversion, family genetic risk scores, major depression
in
Psychological Medicine
volume
53
issue
16
pages
7805 - 7816
publisher
Cambridge University Press
external identifiers
  • pmid:37427550
  • scopus:85164912820
ISSN
0033-2917
DOI
10.1017/S0033291723001848
language
English
LU publication?
yes
id
893b255a-11d5-4316-a9a1-33f2abefa2c1
date added to LUP
2023-10-04 10:43:44
date last changed
2024-04-19 01:53:54
@article{893b255a-11d5-4316-a9a1-33f2abefa2c1,
  abstract     = {{<p>Background It is clinically important to predict the conversion of major depression (MD) to bipolar disorder (BD). Therefore, we sought to identify related conversion rates and risk factors. Methods This cohort study included the Swedish population born from 1941 onward. Data were collected from Swedish population-based registers. Potential risk factors, including family genetic risk scores (FGRS), which were calculated based on the phenotypes of relatives in the extended family and not molecular data, and demographic/clinical characteristics from these registers were retrieved. Those with first MD registrations from 2006 were followed up until 2018. The conversion rate to BD and related risk factors were analyzed using Cox proportional hazards models. Additional analyses were performed for late converters and with stratification by sex. Results The cumulative incidence of conversion was 5.84% [95% confidence interval (95% CI) 5.72-5.96] for 13 years. In the multivariable analysis, the strongest risk factors for conversion were high FGRS of BD [hazard ratio (HR) = 2.73, 95% CI 2.43-3.08], inpatient treatment settings (HR = 2.64, 95% CI 2.44-2.84), and psychotic depression (HR = 2.58, 95% CI 2.14-3.11). For late converters, the first registration of MD during the teenage years was a stronger risk factor when compared with the baseline model. When the interactions between risk factors and sex were significant, stratification by sex revealed that they were more predictive in females. Conclusions Family history of BD, inpatient treatment, and psychotic symptoms were the strongest predictors of conversion from MD to BD.</p>}},
  author       = {{Rhee, Sang Jin and Ohlsson, Henrik and Sundquist, Jan and Sundquist, Kristina and Kendler, Kenneth S.}},
  issn         = {{0033-2917}},
  keywords     = {{Bipolar disorder; conversion; family genetic risk scores; major depression}},
  language     = {{eng}},
  number       = {{16}},
  pages        = {{7805--7816}},
  publisher    = {{Cambridge University Press}},
  series       = {{Psychological Medicine}},
  title        = {{Predictors of diagnostic conversion from major depression to bipolar disorder : A Swedish national longitudinal study}},
  url          = {{http://dx.doi.org/10.1017/S0033291723001848}},
  doi          = {{10.1017/S0033291723001848}},
  volume       = {{53}},
  year         = {{2023}},
}