Bipolar disorder in a gendered perspective : D Y Patil Journal of Health Sciences

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Bipolar disorder in a gendered perspective

Dar, Danishwar Rasool; Paul, Fayaz Ahmad

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D Y Patil Journal of Health Sciences 11(1):p 1, January-March 2023. | DOI: 10.4103/DYPJ.DYPJ_73_22
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In the world, almost 2.4% of people suffer from bipolar disorder (BD). Bipolar individuals experience changes in their functionality, mood, and energy levels. In India, 197.3 million people in 2017 have mental health disorders.[1] The National Mental Health Survey of India reported that 10.7% of adults and 7.3% of adolescents have mental health disorders in 2016.[2] Currently, 1 in 150 (0.3%) have BD and 0.5% have lifetime morbidity in India. The treatment gap ranged from 70% to 92% in many mental health disorders with 70.4% in BD.[3] Gender specificity may have an impact on a variety of variables, including incidence, prevalence, rapid cycling, suicidal behavior, comorbidities, and treatment response. Onset is often earlier in men than women; bipolar I with more manic symptoms as well as high substance use, while as women are more likely to have bipolar II, depressive episodes, and mixed mania.

Men and women have fairly similar incidence and lifetime prevalence rates for BD. However, women are more likely to be diagnosed with BD. In addition, hypomania is more frequently associated with the female gender. Although the age at which BD begins does not appear to differ between the genders, males are more likely than women to experience their first manic episode in their early childhood. Men experience their first manic episode more frequently than women, while women seem to be more likely to have a depressive episode. Furthermore, a woman is linked to higher lifetime rates of psychotic depression, depressive predominant polarity, and recurrent depression.

The contribution to disability-adjusted life years caused by mental health disorders increased from 5% in 1990 to 47% in 2017 with 6.9% from BD.[1] Throughout the menstrual cycle, women report despair and regular mood swings frequently and have an impact on the illness and its management. It significantly brings hurdles to treating BD and affects 1%–2% of women in childbearing years.[4]

In Indian BD patients, a higher prevalence of obsessive–compulsive disorder in men and anxiety-spectrum disorders in women occurs. Organic illnesses including hypothyroidism and migraines appear to be more frequently linked to the feminine gender in BD. The psychosocial functioning of the two genders differs, with women reporting greater social and professional standing than men with BD. Usually, women receive a combination of treatments, whereas men have more regularly reported taking lithium. Females with BD were more likely to adhere to medications but worried about side effects like excessive sleep and weight gain.

Females experience ovarian hormonal fluctuations, such as consistent oscillations of progesterone. BD may be affected by these hormones. The challenging postpartum period, however, is marked by a great deal of biological, physical, social, and emotional upheaval. The clinical symptoms may worsen when gonadal hormone levels are low, both at postpartum and during the premenstrual portion of the cycle. During this time, a suitable risk of BD onset and relapse may be present, and 81% of Indian women under the age of 25 experienced postpartum mental health issues.[5]

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2. Murthy RS. National Mental Health Survey of India 2015–2016. Indian J Psychiatry 2017;59:21-6
3. Gautham MS, Gururaj G, Varghese M, Benegal V, Rao GN, Kokane A, et al. The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity. Int J Soc Psychiatry 2020;66:361-72
4. Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry 2000;157:179-84
5. Rai S, Pathak A, Sharma I. Postpartum psychiatric disorders: Early diagnosis and management. Indian J Psychiatry 2015;57:S216-21
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