BACKGROUND Bipolar disorder if untreated, has severe consequences: severe role impairment, higher health care costs, mortality and morbidity. Although effective treatment is available, the delay in diagnosis might be as long as 10-15 years. In this study, we aim at documenting the length of the diagnostic delay in Hungary and identifying factors associated with it. METHODS Kaplan-Meier survival analysis and Cox proportional hazards model was employed to examine factors associated with the time to diagnosis of bipolar disorder measured from the date of the first presentation to any specialist mental healthcare institution. We investigated three types of factors associated with delays to diagnosis: demographic characteristics, clinical predictors and patient pathways (temporal sequence of key clinical milestones). Administrative data were retrieved from specialist care; the population-based cohort includes 8935 patients from Hungary. RESULTS In the sample, diagnostic delay was 6.46 years on average. The mean age of patients at the time of the first bipolar diagnosis was 43.59 years. 11.85% of patients were diagnosed with bipolar disorder without any delay, and slightly more than one-third of the patients (35.10%) were never hospitalized with mental health problems. 88.80% of the patients contacted psychiatric care for the first time in outpatient settings, while 11% in inpatient care. Diagnostic delay was shorter, if patients were diagnosed with bipolar disorder by non-specialist mental health professionals before. In contrast, diagnoses of many psychiatric disorders received after the first contact were coupled with a delayed bipolar diagnosis. We found empirical evidence that in both outpatient and inpatient care prior diagnoses of schizophrenia, unipolar depression without psychotic symptoms, and several disorders of adult personality were associated with increased diagnostic delay. Patient pathways played an important role as well: the hazard of delayed diagnosis increased if patients consulted mental healthcare specialists in outpatient care first or they were hospitalized. CONCLUSIONS We systematically described and analysed the diagnosis of bipolar patients in Hungary controlling for possible confounders. Our focus was more on clinical variables as opposed to factors controllable by policy-makers. To formulate policy-relevant recommendations, a more detailed analysis of care pathways and continuity is needed.

中文翻译：

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探索双相情感障碍患者诊断延迟的因素：一项基于人群的队列研究。

背景技术躁郁症如果不加以治疗，将产生严重后果：严重的角色障碍，更高的医疗费用，死亡率和发病率。尽管有有效的治疗方法，但诊断延迟可能长达10-15年。在这项研究中，我们旨在记录匈牙利诊断延迟的时间，并确定与之相关的因素。方法采用Kaplan-Meier生存分析和Cox比例风险模型检查从首次向任何专业精神保健机构就诊之日起测量的双相情感障碍诊断时间相关的因素。我们调查了与诊断延迟相关的三种类型的因素：人口统计学特征，临床预测因素和患者通路（关键临床里程碑的时间顺序）。行政数据来自专科医疗；基于人群的队列包括来自匈牙利的8935名患者。结果在样本中，诊断延迟平均为6。46年。首次双极诊断时患者的平均年龄为43.59岁。11.85％的患者被诊断出患有双相情感障碍，没有任何延误，略微超过三分之一的患者（35.10％）从未因精神健康问题而住院。在门诊患者中，有88.80％的患者是首次接受精神科护理，而在住院患者中是11％。如果之前由非专科精神卫生专业人员诊断出患有躁郁症，则诊断延迟会更短。相反，首次接触后接受的许多精神疾病的诊断与延迟的双相性诊断相结合。我们发现经验证据表明，在门诊和住院治疗中，精神分裂症的先前诊断，无精神病性症状的单相抑郁症和几种成人人格障碍均与诊断延迟增加有关。患者的途径也起着重要的作用：如果患者首先在门诊咨询精神保健专家或住院，则延迟诊断的危险会增加。结论我们系统地描述和分析了在匈牙利控制可能混杂因素的躁郁症患者的诊断。我们的重点更多地放在临床变量上，而不是政策制定者可以控制的因素。为了制定与政策相关的建议，需要对护理途径和连续性进行更详细的分析。