Research reportGender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores
Introduction
Studies of gender differences in major depressive disorder (MDD) indicate that women are more susceptible to depression, may experience different symptoms and have a more refractory course of illness (Goodwin and Jamison, 1990). Less attention has been directed at the empirical study of women with bipolar disorder (BD). The data would suggest that there is no gender difference in prevalence rates of bipolar disorder (Weissman et al., 1988) but that women may have a different course of illness. These differences would include (1) a rapid cycling course (Bauer et al., 1994, Coryell et al., 1992, Leibenluft, 1996); (2) more episodes of depression or dysphoric mania (Leibenluft, 1996, Dilsaver et al., 1994, McElroy et al., 1992); (3) a later age of onset of BD (Leibenluft, 1996); (4) more episodes of depression than mania (Angst et al., 1978); and (5) longer duration of individual episodes of depression (Kessler et al., 1993). Although these studies suggest substantial gender differences in BD, conclusions are limited by the small number of studies and their methodologic limitations; particularly, small sample sizes.
The aim of the present study was to investigate gender differences in a clinic sample of patients with BD. Furthermore, a measure of well-being and functioning was obtained from a subset of the larger group to provide a subjective appraisal of the participant's experience with the illness.
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Methods
Subjects were outpatients attending the Mood Disorders Program at the Clarke Institute of Psychiatry, University of Toronto. All participants gave informed written consent to participate in an ongoing study of the course and outcome of BD. Each met Research Diagnostic Criteria (Endicott and Spitzer, 1978) for BD as determined by clinical assessment and by the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-LV) (Spitzer et al., 1978) administered by a nurse clinician.
Results
Sixty nine subjects completed the outcome measure and this group consisted of 27 men and 42 women, BP type I, n=54;type II n=15 and a mean age 36.0±1.2 years (eight patients 1M/7F were rapid cycling). Results are presented in Table 1. There were no significant differences between gender groups with respect to age or type of BD. Women appear to experience episodes of both depression (27.2 yrs±1.3 vs 22.4 yrs±1.2) and mania (25.9±1.0 vs 21.8±1.0) at a significantly later age than men. Women had
Discussion
Our findings suggest specific clinical differences experienced by women compared with men who have the diagnosis of BD. The present data further acknowledge that rapid cyclers are female (88%) and this finding is comparable to those of Bauer et al. (1994)and Coryell et al. (1992)who found 70% of the rapid cycling patients were women. In a similar fashion women tended to more commonly have mixed episodes (20% vs 3%) consistent with earlier studies (Dilsaver et al., 1994McElroy et al., 1992).
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