We know that it can take many years for people with bipolar disorder to be accurately diagnosed, following an initial episode of mental illness.
This cohort study carried out by researchers from Denmark, the US and Wales, set out to study to what extent psychiatric disorders with postpartum onset (following childbirth) are early manifestations of an underlying bipolar affective disorder.
The study involved 120,378 women with a mental health disorder (excluding bipolar disorder) and a first-time psychiatric inpatient or outpatient experience.
The participants were followed up after discharge from hospital and the outcome of interest was a first-time diagnosis of bipolar affective disorder during the follow-up period.
Here’s what they found:
- 3,062 women were readmitted or had an outpatient contact with bipolar affective disorder diagnoses
- Women who experienced mental health symptoms within 14 days of giving birth had a predicted subsequent conversion to bipolar disorder (relative risk = 4.26; 95% CI =3.11-5.85)
- 14% of women who experienced mental health symptoms within 1 month of giving birth converted to a bipolar diagnosis within the 15-year follow-up period
- 4% of women with a first psychiatric contact not related to childbirth converted to a bipolar diagnosis within the 15-year follow-up period
- Postpartum inpatient admissions were also associated with higher conversion rates to bipolar disorder than outpatient contacts (relative risk = 2.16; 95% CI = 1.27-3.66)
The authors concluded:
A psychiatric episode in the immediate postpartum period significantly predicted conversion to bipolar affective disorder during the follow-up period. Results indicate that the presentation of mental illness in the early postpartum period is a marker of possible underlying bipolarity.
Munk-Olsen T, Laursen TM, Meltzer-Brody S, Mortensen PB, Jones I. Psychiatric Disorders With Postpartum Onset: Possible Early Manifestations of Bipolar Affective Disorders. Arch Gen Psychiatry. 2011 Dec 5. [Epub ahead of print] [PubMed abstract]
Could that be me? I fit the bracket – I first was assessed by a psychiatrist/entered specialist mental health servises post-natally but had been experiencing different symptoms and light interventions a long while before. I think applying this to oneself is a natural thing to do: but having recently been reading Crazy Like Us (Ethan Watters) I question if this is healthy to publish this study here and if the study could’ve been reported in a less leading way (Watters presents a case that in Sri Lanka post-tsunami for instance a crisis-counselling movement told people to expect classic ptsd responses but evidence of cultural differences and ways of dealing with other recent past trauma there shows perhaps they would not have; he argues PTSD was exported by this psychologically leading mass intervention) but also I find it interesting!? I wonder if there are effects within our own population we build? Have I been been bush-whacked by a different perspective? But could reading this affect the incidence of longer-range diagnosis of bipolar? What is the validity of diagnoses anyway: it sould be noted within sector how confusing and distressing changing diagnoses can be: patients see authoraties en loco parentis who ought to be always right not tentative scientific theoretical search for useful categorisation subject to revision; the professionals rarely talk-up this aspect of the nature of their work in general outlets or school syllabus committees perhaps so the British popular notion of the job of expert/doctor doesn’t change fast! Language is a big issue; reporting on and searching for truth is subjective and not a self-contained process and words and nuances for the general or service-user readership are differently received than perhaps the standard academic paradigms/mores allow anticipation of!? The write-up above evokes larger risk on a first light read than the study found: of 14% re-diagnosed to bi-polar vs 4% new diagnosis of bi-polar in the postnatal clinical illness group and the no-post-natal-illness group respectively: this study doesn’t predict Bi-polar in those who have post-natal depression or psychosis it suggests elevated risks. I would say ‘significant’ as in ‘statistically significant’ risk/elevation is less subjective and I would say requires a lower threshold of evidence than ‘significant’ in Standard English. Personal illustrations of the real world of service users now (hard figures are not self-contained inert truths): I was convinced before that I had bi-polar but that has fallen away for ages; has been discussion about ocd and personality disorder adhd dyspraxia asd/aspergers: there has been controversy and I thank God I have one brain that copes with this a bit but not totally! I can lose days and weeks to the identity/world-view crises that result/trigger just out of questions of identity and diagnosis! Not alone either! Personally I had a post-natal service entry diagnosis of depression with obsessional and borderline traits; but recently the ADHD clicician I was referred to suggested that and perhaps greater than ‘traits’ was correct and yet another friend with clinical experience thought ASD was the correct diagnosis and people/friends with ASD diagnosis tend to see that in the experiences and traits I show. It feels like either you clinicians have a brain we ordinary people fail to understand or otherwise there is just chaos; but actually you are just people in a systematic wisdom-base that is not quite all the mythology says it is!? I read Oliver James suggest celebrities diagnosed with bi-polar are generally actually personality disordered and his articles were upsetting by the edgy line he took without real acquiesence to a personal story and the role of people’s diagnosis in their lives; it was like an arrogant ‘expert’ on racing pigeons re-pigeon-holing whether the pigeon or the owner liked it and with a lot of brou-hahaa that frightened all the pigeons at the racing-coop! He listed facets of behaviour and feelings that would sit in a typical asd list without any such reference too. There is considerable recognised overlap in traits and a separating sub-culture in discussion support and research of neuro-psychiatric and other chronic pervasive or stress-related diagnoses apparent online within service-user forums plus a polarisation of viewpoints on the nature of diagnostic labels and what psychiatrists and other related clinicains are for and should be ding: there is quite a build-up of hostility and yet dependence/acceptance of a cooperation of finding the ‘right’ diagnosis being like a spirtual quest!? The idea that a diagnosis is a tentative construct is not well understood by a lot of people! Bi-polar disorder and personality dsorder (especially the other BPD) ASD ADHD specific learning and language disorders: I would tend to describe these as a fuzzy locus of associated/differetially/jointly diagnosed conditions but add chronic pain fatigue and digestive conditions into the edges of your concept too? A study is just a study on one hand but this inserts itself into a very densely controversial and personally significant battlefield! Would rather than have this identity attribution struggle before and whilst offering support alternatively attributing it all to the uniquely acting forces of sub-cultural zeitgeists/bio-psycho-social networks altogether help the individual better and serve our globalist western culture better – a compatible equivalent to the Sri Lankan and other native culture’s studied spirit-beliefs featured in Crazy like us; attribution of both acting-out behaviour and substantial malfunction to the passing influence of internal and external spirits; in Ethan Watter’s book this cultural difference is perhaps over-stated to clarify the transaction where it has gone wrong but psychiatric models are not the only tools and beliefs for coping with inherent and incoming difficulties; psychiatry is not – is not – the only strand and we could lead less into confusion perhaps with at least including those strands into our ropes; would that not be better?
We can’t stop different opinions and powers to rearrange the pigeon-holes for at least the people who read and interpret any particular study or article or find clinicians have different opinions – but we can articulate loudly and clearly a way of looking at all this complexity that works!? I think ideas can be pathogenic or health-saving in themselves; and the same idea can be expressed differently evoking different figurative basic concepts; and also each idea like a bacteria can be friendly or pathogenic depending on the ecology – place and means of entry and strength of force ie with words significant repetition of exposure to an idea and the appropriateness/word-skill/power/absorptive qualities it was delivered with and status of the writers/speakers and the medium of communication as well as the basic shape and content and what it what it evokes and how it will interact with people where they are all figure in the effect; with bacteria or viruses their pathogenic or friendly qualities depend on numbers and relative condition and dangerousness of the species and strain of bacteria or virus and the place and means of entry! What could powerful simple vaccinating words be? What change in basic concepts/assumptions demonstrated above would work? What ‘risks’ can properly be attached to an individual? Really? Usefully? Wellbeing and distress and social-place as both events and states-of-being are always present but perhaps the scale is tipped to far towards distress or deeper inner states/qualities/defects being revealed or triggered by events rather than seeing external events creating circustances that an externally-oriented inner-self deals with? Plus diagnosis suggests possession of an inherent quality and re-diagnosis a change in the opinion on those inherent qualities brought about by new evidence this is bound to drive insecurity and self-analysis that begets distress and could tip you over into other diagnostic catagories; a change in diagnosis is a social transaction following an event and a reaction to it too.