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Bipolar Disorder Related Hospitalizations – a Descriptive Nationwide Study Using a Big Data Approach

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Abstract

Bipolar Disorder (BD) is a mental disorder which frequently requires long hospitalizations and need for acute psychiatric care. The aim of this study was to describe a nationwide perspective of BD related hospitalizations and to use a BigData based approach in mental health research. We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008-2015. Hospitalizations with a primary diagnosis of BD were selected based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 296.xx (excluding 296.2x; 296.3x and 296.9x). From 20,807 hospitalizations belonging to 13,300 patients, around 33.4% occurred in male patients with a median length of stay of 16.0 days and a mean age of 47.9 years. The most common hospitalization diagnosis in BD has the code 296.4x (manic episode) representing 34.3% of all hospitalizations, followed by the code 296.5x (depressed episode) with 21.4%. The mean estimated hospitalization charge was 3,508.5€ per episode, with a total charge of 73M€ in the 8-year period of this study.This is a nationwide study giving a broad perspective of the BD hospitalization panorama at a national level. We found important differences in hospitalization characteristics by sex, age and primary diagnosis.

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Availability of Data and Material

Data was provided by ACSS - Administração Central do Sistema de Saúde I.P upon formal request.

Code Availability

The authors used IBM SPSS Statistics v.25 for Windows (Armonk, NY: IBM Corp) for statistical analysis.

References

  1. Belmaker R. Bipolar disorder. N Engl J Med. 2004;351(5):476–86.

    Article  CAS  Google Scholar 

  2. Merikangas KR, Jin R, He J-P, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011;68(3):241–51.

    Article  Google Scholar 

  3. He H, Hu C, Ren Z, Bai L, Gao F, Lyu J. Trends in the incidence and DALYs of bipolar disorder at global, regional, and national levels: Results from the global burden of Disease Study 2017. J Psychiatr Res. 2020.

  4. de Dios C, Goikolea JM, Colom F, Moreno C, Vieta E. Bipolar disorders in the new DSM-5 and ICD-11 classifications. Revista de Psiquiatría y Salud Mental (English Edition). 2014;7(4):179–85.

    Google Scholar 

  5. Angst J, Ajdacic-Gross V, Rössler W. Bipolar disorders in ICD-11: current status and strengths. Int J Bipolar Disord. 2020;8(1):3.

    Article  Google Scholar 

  6. Association AP. DSM-5: Manual diagnóstico e estatístico de transtornos mentais: Artmed Editora. 2014.

  7. Harrison PJ, Geddes JR, Tunbridge EM. The emerging neurobiology of bipolar disorder. Trends Neurosci. 2018;41(1):18–30.

    Article  CAS  Google Scholar 

  8. Weber NS, Fisher JA, Cowan DN, Niebuhr DW. Psychiatric and general medical conditions comorbid with bipolar disorder in the National Hospital Discharge Survey. Psychiatr Serv. 2011;62(10):1152–8.

    Article  Google Scholar 

  9. Association AP. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry. 2002;159(4 Suppl):1–50.

    Google Scholar 

  10. National Collaborating Centre for Mental H. National institute for health and care excellence: Clinical guidelines. Bipolar disorder: The NICE guideline on the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. London: The British Psychological Society and The Royal College of Psychiatrists © The British Psychological Society & The Royal College of Psychiatrists. 2014.

  11. Peele PB, Xu Y, Kupfer DJ. Insurance expenditures on bipolar disorder: clinical and parity implications. Am J Psychiatry. 2003;160(7):1286–90.

    Article  Google Scholar 

  12. Young AH, Rigney U, Shaw S, Emmas C, Thompson JM. Annual cost of managing bipolar disorder to the UK healthcare system. J Affect Disord. 2011;133(3):450–6. https://doi.org/10.1016/j.jad.2011.06.016.

    Article  PubMed  Google Scholar 

  13. Guo JJ, Keck PE, Li H, Jang R, Kelton CML. Treatment costs and health care utilization for patients with bipolar disorder in a large managed care population. Value Health. 2008;11(3):416–23. https://doi.org/10.1111/j.1524-4733.2007.00287.x.

    Article  PubMed  Google Scholar 

  14. Gupta RD, Guest JF. Annual cost of bipolar disorder to UK society. Br J Psychiatry. 2002;180(3):227–33.

    Article  Google Scholar 

  15. Davis KA, Sudlow CL, Hotopf M. Can mental health diagnoses in administrative data be used for research? A systematic review of the accuracy of routinely collected diagnoses. BMC Psychiatry. 2016;16(1):1–11.

    Article  Google Scholar 

  16. Kessing LV. Diagnostic stability in bipolar disorder in clinical practise as according to ICD-10. J Affect Disord. 2005;85(3):293–9. https://doi.org/10.1016/j.jad.2004.11.001.

    Article  PubMed  Google Scholar 

  17. Passos IC, Ballester PL, Barros RC, Librenza-Garcia D, Mwangi B, Birmaher B, et al. Machine learning and big data analytics in bipolar disorder: A position paper from the International Society for Bipolar Disorders Big Data Task Force. Bipolar Disord. 2019;21(7):582–94.

    Article  Google Scholar 

  18. Estatística I-INd. Estatísticas de Saúde 2017: INE. 2019.

  19. Gonçalves-Pinho M, Ribeiro JP, Freitas A. Schizophrenia related hospitalizations–a big data analysis of a national hospitalization database. Psychiatr Quart 2020;1-10.

  20. Stensland MD, Jacobson JG, Nyhuis A. Service utilization and associated direct costs for bipolar disorder in 2004: An analysis in managed care. J Affect Disord. 2007;101(1):187–93. https://doi.org/10.1016/j.jad.2006.11.019.

    Article  PubMed  Google Scholar 

  21. Monteith S, Glenn T, Geddes J, Whybrow PC, Bauer M. Big data for bipolar disorder. Int J Bipolar Disord. 2016;4(1):10.

    Article  Google Scholar 

  22. Gonzalez-Pinto AM, Dardennes R, de Zélicourt M, López P, Oliveros RG, Vieta E, et al. In-patient care costs of patients with bipolar I disorder: A comparison between two European centers. J Affect Disord. 2010;121(1):152–5. https://doi.org/10.1016/j.jad.2009.05.010.

    Article  CAS  PubMed  Google Scholar 

  23. Vieta E, Langosch JM, Figueira ML, Souery D, Blasco-Colmenares E, Medina E, et al. Clinical management and burden of bipolar disorder: results from a multinational longitudinal study (WAVE-bd). Int J Neuropsychopharmacol. 2013;16(8):1719–32.

    Article  Google Scholar 

  24. Angst J, Azorin J-M, Bowden CL, Perugi G, Vieta E, Gamma A, et al. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Arch Gen Psychiatry. 2011;68(8):791–9.

    Article  Google Scholar 

  25. Stensland MD, Jacobson JG, Nyhuis A. Service utilization and associated direct costs for bipolar disorder in 2004: an analysis in managed care. J Affect Disord. 2007;101(1–3):187–93.

    Article  Google Scholar 

  26. Fellinger M, Waldhör T, Blüml V, Williams N, Vyssoki B. Influence of gender on inpatient treatment for bipolar disorder: An analysis of 60,607 hospitalisations. J Affect Disord. 2018;225:104–7. https://doi.org/10.1016/j.jad.2017.08.007.

    Article  PubMed  Google Scholar 

  27. Gonzalez-Pinto A, Dardennes R, De Zélicourt M, Lopez P, Oliveros R, Vieta E, et al. In-patient care costs of patients with bipolar I disorder: a comparison between two European centers. J Affective Disord. 2010;121(1–2):152–5.

    Article  CAS  Google Scholar 

  28. Matheson FI, Smith KL, Fazli GS, Moineddin R, Dunn JR, Glazier RH. Physical health and gender as risk factors for usage of services for mental illness. J Epidemiol Community Health. 2014;68(10):971–8.

    Article  Google Scholar 

  29. Schaffer A, Cairney J, Cheung AH, Veldhuizen S, Levitt AJ. Use of treatment services and pharmacotherapy for bipolar disorder in a general population-based mental health survey. J Clin Psychiatry. 2006;67(3):386–93.

    Article  Google Scholar 

  30. Oliver MI, Pearson N, Coe N, Gunnell D. Help-seeking behaviour in men and women with common mental health problems: cross-sectional study. The British Journal of Psychiatry. 2005;186(4):297–301.

    Article  Google Scholar 

  31. Vigod SN, Kurdyak P, Fung K, Gruneir A, Herrmann N, Hussain-Shamsy N, et al. Psychiatric hospitalizations: a comparison by gender, sociodemographics, clinical profile, and postdischarge outcomes. Psychiatr Serv. 2016;67(12):1376–9.

    Article  Google Scholar 

  32. Loftus J, Scott J, Vorspan F, Icick R, Henry C, Gard S, et al. Psychiatric comorbidities in bipolar disorders: An examination of the prevalence and chronology of onset according to sex and bipolar subtype. J Affect Disord. 2020;267:258–63. https://doi.org/10.1016/j.jad.2020.02.035.

    Article  CAS  PubMed  Google Scholar 

  33. Kessing LV. Diagnostic subtypes of bipolar disorder in older versus younger adults. Bipolar Disord. 2006;8(1):56–64.

    Article  Google Scholar 

  34. Patel RS, Manikkara G, Chopra A. Bipolar disorder and comorbid borderline personality disorder: patient characteristics and outcomes in US hospitals. Medicina. 2019;55(1):13.

    Article  Google Scholar 

  35. Harman JS, Cuffel BJ, Kelleher KJ. Profiling hospitals for length of stay for treatment of psychiatric disorders. J Behav Health Serv Res. 2004;31(1):66–74.

    Article  Google Scholar 

  36. Rocca P, Mingrone C, Mongini T, Montemagni C, Pulvirenti L, Rocca G, et al. Outcome and length of stay in psychiatric hospitalization, the experience of the University Clinic of Turin. Soc Psychiatry Psychiatr Epidemiol. 2010;45(6):603–10.

    Article  Google Scholar 

  37. Ragazan DC, Eberhard J, Ösby U, Berge J. Gender influence on the bipolar disorder inpatient length of stay in Sweden, 2005–2014: A register-based study. J Affect Disord. 2019;256:183–91. https://doi.org/10.1016/j.jad.2019.05.052.

    Article  PubMed  Google Scholar 

  38. de Zelicourt M, Dardennes R, Verdoux H, Gandhi G, Khoshnood B, Chomette E, et al. Frequency of hospitalisations and inpatient care costs of manic episodes. Pharmacoeconomics. 2003;21(15):1081–90.

    Article  Google Scholar 

  39. Jacobs R, Gutacker N, Mason A, Goddard M, Gravelle H, Kendrick T, et al. Determinants of hospital length of stay for people with serious mental illness in England and implications for payment systems: a regression analysis. BMC Health Serv Res. 2015;15(1):439.

    Article  Google Scholar 

  40. Figueroa R, Harman J, Engberg J. Use of claims data to examine the impact of length of inpatient psychiatric stay on readmission rate. Psychiatr Serv. 2004;55(5):560–5.

    Article  Google Scholar 

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Acknowledgements

We would like to acknowledge ACSS - Administração Central do Sistema de Saúde I.P. for providing the administrative database used in this research.

Funding

This work was financed by FEDER - Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020 - Operacional Programme for Competitiveness and Internationalisation (POCI), and by Portuguese funds through FCT - Fundação para a Ciência e Tecnologia in the framework of the project POCI-01-0145-FEDER-030766 (“1st.IndiQare - Quality indicators in primary health care: validation and implementation of quality indicators as an assessment and comparison tool”). This article was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020).

Author information

Authors and Affiliations

  1. Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

    Manuel Gonçalves-Pinho & Alberto Freitas

  2. Center for Health Technology and Services Research (CINTESIS), Porto, Portugal

    Manuel Gonçalves-Pinho & Alberto Freitas

  3. Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal

    Manuel Gonçalves-Pinho, Orlando von Doellinger & João Pedro Ribeiro

Authors
  1. Manuel Gonçalves-Pinho
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  2. Alberto Freitas
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  3. Orlando von Doellinger
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  4. João Pedro Ribeiro
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Contributions

Author Manuel Gonçalves-Pinho designed the study and participated in all phases of the study. Author João Pedro Ribeiro and Orlando von Doellinger participated in the clinical analyses and writing of the paper. Authors Manuel Gonçalves-Pinho and Alberto Freitas undertook the statistical analysis, and author Manuel Gonçalves-Pinho wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Corresponding author

Correspondence to Manuel Gonçalves-Pinho.

Ethics declarations

Informed Consent

No informed consent was needed once we used an administrative database built for hospital billing with no access to patients’ identification.

Research Involving Human Participants and/or Animals

The data used was given by a Portuguese governmental agency guaranteeing all identification information was anonymous.

Conflicts of Interest/Competing Interests

The authors declare no conflicts of interest.

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Gonçalves-Pinho, M., Freitas, A., von Doellinger, O. et al. Bipolar Disorder Related Hospitalizations – a Descriptive Nationwide Study Using a Big Data Approach. Psychiatr Q 93, 325–333 (2022). https://doi.org/10.1007/s11126-021-09951-6

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  • DOI: https://doi.org/10.1007/s11126-021-09951-6

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