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Mental Health Treatment Received by Youths in the Year Before and After a New Diagnosis of Bipolar Disorder

Dr. Olfson is affiliated with the Department of Psychiatry, Columbia University, New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032 (e-mail: mo49{at}columbia.edu). Dr. Crystal and Dr. Huang are with the Institute for Health, Health Care Policy, and Aging Research, and Dr. Gerhard is with the Ernest Mario School of Pharmacy, both at Rutgers University, New Brunswick, New Jersey. Dr. Carlson is with the Department of Psychiatry and Behavioral Medicine, Stony Brook University School of Medicine, Stony Brook, New York.

OBJECTIVE: Despite a marked increase in treatment for bipolar disorder among youths, little is known about their pattern of service use. This article describes mental health service use in the year before and after a new clinical diagnosis of bipolar disorder. METHODS: Claims were reviewed between April 1, 2004, and March 31, 2005, for 1,274,726 privately insured youths (17 years and younger) who were eligible for services at least one year before and after a service claim; 2,907 youths had new diagnosis of bipolar disorder during this period. Diagnoses of other mental disorders and prescriptions filled for psychotropic drugs were assessed in the year before and after the initial diagnosis of bipolar disorder. RESULTS: The one-year rate of a new diagnosis of bipolar disorder was .23%. During the year before the new diagnosis of bipolar disorder, youths were commonly diagnosed as having depressive disorder (46.5%) or disruptive behavior disorder (36.7%) and had often filled a prescription for an antidepressant (48.5%), stimulant (33.0%), mood stabilizer (31.8%), or antipsychotic (29.1%). Most youths with a new diagnosis of bipolar disorder had only one (28.8%) or two to four (28.7%) insurance claims for bipolar disorder in the year starting with the index diagnosis. The proportion starting mood stabilizers after the index diagnosis was highest for youths with five or more insurance claims for bipolar disorder (42.1%), intermediate for those with two to four claims (24.2%), and lowest for those with one claim (13.8%). CONCLUSIONS: Most youths with a new diagnosis of bipolar disorder had recently received treatment for depressive or disruptive behavior disorders, and many had no claims listing a diagnosis of bipolar disorder after the initial diagnosis. The service pattern suggests that a diagnosis of bipolar disorder is often given tentatively to youths treated for mental disorders with overlapping symptom profiles and is subsequently reconsidered.

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