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Bipolar Disord. 2017 Aug;19(5):396-400. doi: 10.1111/bdi.12499. Epub 2017 May 22.

Is a delay in the diagnosis of bipolar disorder inevitable?

Author information

Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
School of Health, Medical and Applied Sciences, CQUniversity, Sydney, NSW, Australia.
Klinikum Rechts der Isar, München, Germany.



A diagnosis of bipolar disorder (BD) is often preceded by an initial diagnosis of depression, creating a delay in the accurate diagnosis and treatment of BD. Although previous research has focused on predictors of a diagnosis change from depression to BD, the research on this delay in diagnosis is sparse. Therefore, the present study examined the time taken to make a BD diagnosis following an initial diagnosis of major depressive disorder in order to further understand the patient characteristics and psychological factors that may explain this delay.


A total of 382 patients underwent a clinical evaluation by a psychiatrist and completed a series of questionnaires.


Ninety patients were initially diagnosed with depression with a later diagnosis of BD, with a mean delay in diagnostic conversion of 8.74 years. These patients who were later diagnosed with BD were, on average, diagnosed with depression at a younger age, experienced more manic symptoms, and had a more open personality style and better coping skills. Cox regressions showed that depressed patients with diagnoses that eventually converted to BD had been diagnosed with depression earlier and that this was related to a longer delay to conversion and greater likelihood of dysfunctional attitudes.


The findings from the present study suggested that an earlier diagnosis of depression is related to experiencing a longer delay in conversion to BD. The clinical implications of this are briefly discussed, with a view to reducing the seemingly inevitable delay in the diagnosis of BD.


bipolar disorder; delay in diagnosis; depression; diagnosis

[Indexed for MEDLINE]

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