Department of Psychiatry, Centro Hospitalar do Oeste, Caldas da Rainha, Portugal.
Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.
J Clin Psychiatry. 2017 Nov/Dec;78(9):e1259-e1269. doi: 10.4088/JCP.16r11165.
To test whether rates of bipolar disorder (BD) have changed over time or vary across geographic regions after adjusting for design features meta-analyzing epidemiologic studies reporting BD prevalence in adults worldwide.
Searches in PubMed and PsycINFO using the terms (epidemiology OR community OR prevalence) AND (mania OR "bipolar disorder" OR cyclothymi*) AND adult and backward searches from published reviews were conducted.
Eighty-five epidemiologic studies published in English from 1980 onward that reported prevalence rates for BD or mania for subjects ≥ 18 years old were included.
We coded BD prevalence, method of data collection, diagnostic criteria, year of study, country, and quality of study design and data reporting. Meta-regression tested whether sample characteristics influenced prevalence rates using the metafor package in R.
Eighty-five effect sizes, from 44 countries, from studies spanning the years 1980-2012, included 67,373 people with BD. Lifetime prevalence for BD spectrum was 1.02% (95% CI, 0.81%-1.29%). Prevalence was moderated by the inclusion of BD not otherwise specified (P = .009) and by geographic region; rates from Africa and Asia were less than half of those from North and South America. Rates did not change significantly over 3 decades after controlling for design features.
The overall prevalence rate is consistent with historical estimates, but rates vary significantly across studies. Differences in methodology contribute to the perception that rates of BD have increased over time. Rates varied markedly by geographic region, even after controlling for all other predictors. Research using consistent definitions and methods may expose specific factors that confer risk for BD.
通过对全球范围内成人双相障碍（BD）患病率进行元分析，以检验在调整设计特征后，BD 的发病率是否随时间变化或在地理区域上存在差异。
在 PubMed 和 PsycINFO 中使用术语（流行病学或社区或患病率）和（躁狂或“双相障碍”或环性心境障碍*）以及对已发表综述的回溯搜索进行了搜索。
纳入了 85 项发表于 1980 年以后、以≥18 岁患者为对象、报告 BD 或躁狂患病率的英文流行病学研究。
我们对 BD 患病率、数据收集方法、诊断标准、研究年份、国家以及研究设计和数据报告的质量进行了编码。使用 R 中的 metafor 包，元回归检验了样本特征是否影响患病率。
共有来自 44 个国家的 85 项效应量，研究时间跨度为 1980 年至 2012 年，共纳入 67373 例 BD 患者。BD 谱终生患病率为 1.02%（95%CI，0.81%-1.29%）。BD 未特定型别的纳入（P =.009）和地理区域调节了患病率；非洲和亚洲的发病率不到北美和南美发病率的一半。在控制设计特征后，30 年来发病率并未显著变化。
总体患病率与历史估计值一致，但不同研究间的发病率差异显著。方法学的差异导致人们认为 BD 的发病率随时间增加。即使在控制了所有其他预测因素后，发病率在地理区域上仍有明显差异。使用一致的定义和方法进行的研究可能会揭示出特定的风险因素。
