Appendix table 1. Gender differences in lifetime prevalence, inter-quartile range. and ageof-onset of DSM-IV/CIDI bipolar disorder (BPD)

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Appendix table 1. Gender differences in lifetime prevalence, inter-quartile range. and ageof-onset of DSM-IV/CIDI bipolar disorder (BPD) Any BPD BP-I BP-II Sub-threshold BPD % (se) % (se) % (se) % (se) χ 2 Lifetime prevalence Male 4.3 (0.4) 0.8 (0.1) 0.9 (0.2) 2.6 (0.4) Female 4.5 (0.3) 1.1 (0.2) 1.3 (0.2) 2.1 (0.2) Total 4.4 (0.2) 1.0 (0.1) 1.1 (0.1) 2.4 (0.2) χ 2 1 0.1 3.7 3.9** 3.1 Age of onset 1 Male 0.1 Mean 20.8 (0.7) 20.4 (2.2) 20.5 (2.0) 21.0 (1.1) IQR 12.5-26.4 11.5-23.3 12.7-23.6 12.7-27.5 Female 16.8* Mean 20.8 (0.9) 16.7 (1.1) 20.1 (1.2) 23.5 (1.4) IQR 12.6-24.5 12.7-18.5 11.4-24.0 13.4-29.0 Total 7.8* Mean 20.8 (0.6) 18.2 (1.2) 20.3 (0.9) 22.2 (0.9) IQR 12.6-24.9 12.3-21.2 12.1-24.0 13.0-28.3 χ 2 1 0.0 2.5 0.0 2.0 *Significant difference across the three BPD subgroups at the.05 level, two-sided test. **Significant gender difference at the.05 level, two-sided test 1 Age of onset of first manic/hypomanic or depressive episode

Appendix table 2. Gender differences in twelve-month prevalence and persistence of DSM-IV/CIDI bipolar disorder (BPD) Any BPD BP-I BP-II Sub-threshold BPD % (se) % (se) % (se) % (se) 12-month prevalence Male 2.9 (0.3) 0.6 (0.1) 0.7 (0.1) 1.6 (0.3) Female 2.8 (0.2) 0.7 (0.1) 0.9 (0.1) 1.3 (0.1) Total 2.8 (0.2) 0.6 (0.1) 0.8 (0.1) 1.4 (0.2) χ 2 1 0.0 1.1 0.4 1.3 12-month/LT prevalence Male 65.7 (4.2) 68.1 (6.9) 83.9 (5.8) 58.8 (4.9) Female 62.1 (2.7) 60.2 (6.6) 66.5 (5.0) 60.4 (4.8) Total 63.8 (2.5) 63.3 (5.2) 73.2 (3.8) 59.5 (3.2) χ 2 1 0.5 0.8 5.0** 0.0 Mean (se) Mean (se) Mean (se) Mean (se) χ 2 2 Years in episode Male 8.3 (0.8) 11.2 (2.7) 10.9 (2.0) 6.5 (0.8) 7.4* Female 9.2 (0.6) 9.6 (0.8) 12.0 (1.5) 7.1 (0.8) 10.3* Total 8.8 (0.5) 10.3 (1.2) 11.6 (1.2) 6.8 (0.6) 18.1* χ 2 1 0.7 0.4 0.2 0.3 Number of episodes Male 45.6 (9.2) 84.6 (29.2) 47.1 (9.6) 33.1 (11.0) 3.5 Female 53.5 (8.0) 72.9 (18.6) 74.0 (15.1) 30.2 (6.1) 12.3* Total 49.8 (6.0) 77.6 (16.2) 63.6 (11.4) 31.8 (6.9) 10.7* χ 2 1 0.4 0.1 2.9 0.1 *Significant difference across the three BPD subgroups at the.05 level, two-sided test ** Significant gender difference at the.05 level, two-sided test

Appendix table 3. Socio-demographic correlates of DSM-IV/CIDI bipolar disorder (BPD) in the total sample (n = 9282) Any BPD BP-I BP-II Sub-threshold BPD OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Age 18 29 1.0 -- 1.0 -- 1.0 -- 1.0 -- 30 44 0.7* (0.5-1.0) 0.9 (0.4-2.0) 1.1 (0.7-1.7) 0.6* (0.4-0.9) 45 59 0.5* (0.3-0.7) 0.5* (0.2-1.0) 0.8 (0.4-1.8) 0.3* (0.2-0.6) 60+ 0.1* (0.1-0.2) 0.1* (0.0-0.2) 0.1* (0.0-0.6) 0.2* (0.1-0.4) χ 2 3 43.9* 28.3* 7.2 28.0* Sex Male 1.0 -- 1.0 -- 1.0 -- 1.0 -- Female 1.0 (0.8-1.3) 1.3 (0.8-2.0) 1.4 (0.9-2.2) 0.8 (0.6-1.1) χ 2 1 0.1 1.1 1.8 2.2 Race Hispanic 0.8 (0.5-1.2) 1.0 (0.6-1.6) 0.6 (0.3-1.5) 0.7 (0.4-1.5) Black 0.9 (0.7-1.2) 0.8 (0.5-1.6) 0.7 (0.4-1.4) 1.0 (0.7-1.5) Other 1.1 (0.6-1.9) 0.7 (0.3-2.2) 0.9 (0.3-2.5) 1.3 (0.7-2.6) White 1.0 -- 1.0 -- 1.0 -- 1.0 -- χ 2 3 1.7 0.7 1.9 1.2 Education 0-11 years 1.0 -- 1.0 -- 1.0 -- 1.0 -- 12 years 0.9 (0.6-1.3) 0.9 (0.5-1.9) 0.9 (0.5-1.7) 0.9 (0.6-1.4) 13-15 years 0.8 (0.5-1.2) 1.1 (0.5-2.3) 0.8 (0.3-1.9) 0.7 (0.5-1.0) 16+ years 0.6* (0.3-0.9) 0.4 (0.1-1.2) 0.5* (0.3-0.9) 0.7 (0.4-1.1) χ 2 3 7.8* 7.3 6.5 4.0 Marital Status Married/Cohabiting 1.0 -- 1.0 -- 1.0 -- 1.0 -- Sep./Widowed/Divorced 1.7* (1.4-2.3) 1.4 (0.8-2.7) 1.6 (0.8-3.1) 2.1* (1.4-3.0) Never Married 1.1 (0.8-1.6) 1.1 (0.6-2.4) 0.7 (0.3-1.6) 1.4 (0.9-2.2) χ 2 2 20.7* 1.3 3.6 16.4* Employment Status Working 1.0 -- 1.0 -- 1.0 -- 1.0 -- Student 0.6 (0.3-1.2) 0.9 (0.3-2.6) 1.3 (0.6-2.5) 0.3* (0.1-1.0) Homemaker 0.8 (0.5-1.3) 1.2 (0.5-2.8) 0.7 (0.2-2.2) 0.6 (0.2-1.5) Retired 1.3 (0.6-2.5) 2.1 (0.9-5.2) 2.5 (0.6-11.3) 0.8 (0.3-2.0) Other 2.1* (1.6-2.9) 2.0* (1.1-3.8) 3.7* (2.1-6.4) 1.6* (1.1-2.3) χ 2 4 32.2* 10.7* 26.5* 14.9* Family Income Low 1.0 (0.7-1.4) 1.5 (0.7-3.3) 1.0 (0.5-2.0) 0.8 (0.5-1.4) Low-Average 1.1 (0.8-1.4) 1.1 (0.5-2.4) 1.6 (0.9-2.8) 0.9 (0.5-1.4) High-Average 1.0 (0.7-1.4) 0.9 (0.4-2.1) 1.0 (0.5-1.9) 1.1 (0.6-1.8) High 1.0 -- 1.0 -- 1.0 -- 1.0 -- χ 2 3 0.5 5.0 6.8 2.2 *Significant at the.05 level, two-sided test

Appendix Table 4. Estimated lifetime prevalence and age-of-onset of three subtypes of DSM-IV/CIDI bipolar disorder (BPD) with MDE % (se) % (se) % (se) Lifetime prevalence Total 0.8 (0.1) 1.0 (0.2) 0.5 (0.1) Age of onset 1 Mean (se) 20.8 (1.3) 23.3 (1.0) 22.2 (2.0) IQR 12.0-26.0 13.6-33.4 13.1-27.3 (n) (77) (88) (45) 1 Age of onset of first hypomanic or depressive episode

Appendix Table 5. Estimated 12-month prevalence and persistence of three subtypes of DSM-IV/CIDI bipolar disorder (BPD) with MDE % (se) % (se) % (se) 12-month prevalence 0.6 (0.1) 0.6 (0.1) 0.2 (0.1) 12-month/LT prevalence 68.9 (5.0) 65.4 (5.0) 34.5 (9.5) Mean (se) Mean (se) Mean (se) χ 2 2 Years in episode 9.1 (0.8) 5.7 (0.7) 5.3 (1.3) 9.7* Number of episodes 58.3 (17.1) 19.3 (4.9) 15.3 (4.0) 6.0* (n) (52) (56) (15) *Significant difference across the three BPD subgroups at the.05 level, two-sided test

Appendix Table 6. Gender differences in the ratio of DSM-IV/CIDI manic/hypomanic to total number of lifetime and 12-month manic/hypomanic or depressive episodes 1 Any BPD BP-I BP-II Sub-threshold BPD % (se) % (se) % (se) % (se) χ 2 I. 12-month Male Mean.70 (.04).55 (.10).52 (.04).84 (.05) 20.2* IQR.40-1.00.15-.96.34-.67.78-1.00 (n) (111) (27) (28) (56) Female Mean.63 (.03).53 (.06).47 (.06).78 (.04) 37.9* IQR.33-1.00.19-.87.17-.78.55-1.00 (n) (151) (38) (46) (67) Total Mean.66 (.02).54 (.05).49 (.03).81 (.04) 57.9* IQR.37-1.00.15-.96.30-.71.67-1.00 (n) (262) (65) (74) (123) χ 2 1 3.5 0.0 0.4 0.8 II. Lifetime Male Mean.76 (.02).64 (.08).52 (.03).87 (.03) 54.3* IQR.50-1.00.23-1.00.34-.67.84-1.00 (n) (176) (38) (36) (102) Female Mean.69 (.02).64 (.05).52 (.05).83 (.03) 38.2* IQR.45-1.00.43-1.00.23-.80.75-1.00 (n) (240) (63) (69) (108) Total Mean.72 (.02).64 (.04).52 (.03).85 (.02) 94.2* IQR.50-1.00.32-1.00.33-.76.80-1.00 (n) (416) (101) (105) (210) χ 2 1 4.4** 0.0 0.0 1.3 *Significant difference across the three BPD subgroups at the.05 level, two-sided test ** Significant gender difference at the.05 level, two-sided test 1 Respondents were asked separately to report their numbers of lifetime manic/hypomanic and depressive episodes. The ratios reported here are the means of the within-person ratios of manic/hypomanic episodes divided by total episodes. No attempt was made to assess mixed episodes.

Appendix Table 7. Clinical severity of three subtypes of 12-month subthreshold DSM-IV/CIDI bipolar disorder (BPD) with MDE % (se) % (se) % (se) χ 2 1 2 Combined 2 Severe 56.2 (8.6) 34.2 (6.3) 17.6 (10.9) 5.8 Moderate 43.8 (8.6) 61.5 (6.8) 69.4 (15.4) 224.4 Mild 0.0 (0.0) 3.1 (2.9) 12.9 (11.9) 112.8 None 0.0 (0.0) 1.2 (1.2) 0.0 (0.0) (n) (52) (56) (15) - *Significant difference across the three BPD subgroups at the.05 level, twosided test 1 Significance tests were carried out for cumulative categories. In the case of moderate severity, the BPD subgroups were compared for prevalence of severe or moderate. In the case of mild severity, the BPD subgroups were compared for prevalence of any severity (i.e., severe, moderate or mild) versus none. No significance tests are presented for the final category (None) because of this cumulative coding. 2 Based on the Young Mania Rating Scale (YMRA) 22 and the Quick Inventory of depressive Symptoms Self-Report version (QIDS-SR). 23 Respondents who reported both manic/hypomanic and depressive episodes in the past year were assigned the more severe of their two severity scores.

Appendix Table 8. Role impairment of three subtypes of 12-month DSM-IV/CIDI bipolar disorder (BPD) 1 with MDE % (se) % (se) % (se) χ 2 1 2 Severity of impairment across role domains 4 Severe 67.6 (7.8) 59.4 (7.5) 7.6 (5.9) 12.9 Moderate 30.9 (7.9) 35.0 (7.2) 61.0 (11.6) 12.1 Mild 1.5 (1.5) 3.3 (2.4) 24.5 (13.0) 214.3 None 0.0 (0.0) 2.4 (2.4) 6.9 (5.4) (n) (52) (56) (15) *Significant difference across the three BPD subgroups at the.05 level, two-sided test 1 Based on the Sheehan Disability Scales (SDS). 24 Significance of differences across three BPD subgroups in Part II was evaluated for cumulative categories. In the case of moderate severity, the BPD subgroups were compared for prevalence of severe or moderate. In the case of mild severity, the BPD subgroups were compared for prevalence of any severity (i.e., severe, moderate or mild) versus none. 2 Significance of differences across three BPD subgroups 3 Cell entries are the percent of respondents who reported severe impairment in the role domain. 4 Cell entries are the distribution of maximum severity across the four role domains. Respondents with both mania/ and MDE were assigned the more severe score across the two disorders.

Appendix table 9. Twelve-month use of appropriate medication among respondents with DSM- IV/CIDI bipolar disorder (BPD) 1 Twelve-month cases Lifetime cases Mania/ MDE-only % (se) (n) % (se) (n) % (se) (n) I. Psychiatrist Appropriate medication 47.0 (7.5) 39.1 (14.3) 41.0 (13.1) Other medication 41.0 (7.7) 53.1 (15.8) 43.0 (12.9) No medication 12.0 (5.7) 8.6 (8.1) 16.0 (7.7) (n) (47) (12) (23) II. General medical (not including those treated by a psychiatrist) Appropriate medication 9.6 (4.9) 8.3 (8.8) 6.9 (6.7) Other medication 68.2 (7.2) 91.7 (8.8) 66.1 (12.7) No medication 22.2 (5.7) 0.0 (--) 27.0 (11.5) (n) (44) (6) (17) III. Total 2 Appropriate medication 13.0 (2.4) 21.0 (7.8) 8.8 (2.8) Other medication 29.0 (3.1) 43.0 (10.1) 25.1 (3.8) No medication 58.0 (3.9) 36.0 (9.0) 66.1 (3.6) (n) (219) (43) (154) 1 Cases of BP-I, BP-II, and BPD were collapsed because of sparse data. 2 The denominator for Part II includes cases not in treatment. The proportion with appropriate medication in Part III exceeds the sum of the weighted proportions in Parts I and II due to the fact that some respondents reported use of appropriate medications even though they said that they had not seen either a psychiatrist or a general medical professional at any time in the past 12 months.

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