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The BRIDGE Study

Jules Angst, MD; Jean-Michel Azorin, MD; Charles L. Bowden, MD; Giulio Perugi, MD; Eduard Vieta, MD, PhD; Alex Gamma, PhD; Allan H. Young, MD, PhD; for the BRIDGE Study Group

Arch Gen Psychiatry. 2011;68(8):791-799. doi:10.1001/archgenpsychiatry.2011.87

Context  Major depressive disorder, the most common psychiatric illness, is often chronic and a major cause of disability. Many patients with major depressive episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers.

Objective  To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a major depressive episode.

Design  Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE).

Setting  Community and hospital psychiatry departments.

Patients  Participants included 5635 adults with an ongoing major depressive episode.

Main Outcome Measures  The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression.

Results  A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P < .001) with bipolarity were observed for family history of mania/hypomania and multiple past mood episodes. The bipolarity specifier additionally identified significant associations for manic/hypomanic states during antidepressant therapy, current mixed mood symptoms, and comorbid substance use disorder.

Conclusions  The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with major depressive episodes. Such an assessment is recommended before deciding on treatment.

Author Affiliations: Division of Psychiatric Research, Zürich University Psychiatric Hospital, Zürich, Switzerland (Drs Angst and Gamma); Division of Psychiatry, Hôpital de Sainte-Marguerite, Marseille, France (Dr Azorin); Departments of Psychiatry, The University of Texas Health Science Center, San Antonio (Dr Bowden) and University of Pisa, Italy (Dr Perugi); Hospital Clinic, University of Barcelona, Institut d’Investigació Biomèdica August Pi i Sunyer–Centro de Investigación Biomédica En Red de Salud Mental, Barcelona, Spain (Dr Vieta); and Division of Psychiatry, Centre for Mental Health, Imperial College, London, England (Dr Young).
Group Information: The BRIDGE Study Group members are listed at https://delta.uthscsa.edu/BRIDGEstudyInvestigatorlist.

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RAPID RESPONSES TO THIS ARTICLE

Angst, et al May Have Overlooked a Common Confounding Factor
Stefan P. Kruszewski, et al.
Arch Gen Psychiatry Online, 6 Oct 2011.
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