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Table 3 Factors associated with diagnostic delay in patients with bipolar disorder (N = 7876)

From: Exploring factors of diagnostic delay for patients with bipolar disorder: a population-based cohort study

FactorsNumber of patientsPercentageModel 1Model 2
Adjusted hazard ratio95% confidence intervalSig.Adjusted hazard ratio95% confidence intervalSig.
Age categories18–27106113.47%ReferenceReference
28–37143418.21%0.650.60–0.710.000 ***0.630.58–0.690.000 ***
38–47193024.50%0.510.47–0.560.000 ***0.500.46–0.550.000 ***
48–57199425.32%0.470.43–0.510.000 ***0.460.42–0.500.000 ***
58–65145718.50%0.460.42–0.500.000 ***0.440.41–0.490.000 ***
GenderFemale466359.21%ReferenceReference
Male321340.79%1.030.98–1.080.2421.020.97–1.070.366
First mental health visitInpatient115714.69%ReferenceReference
Outpatient671985.31%0.620.58–0.670.000 ***0.650.61–0.700.000 ***
First diagnosis with bipolar disorderInpatient595575.61%ReferenceReference
Outpatient192124.39%1.010.96–1.070.6781.010.95–1.060.806
Prior F31 diagnosis, assigned mostly as additional diagnosis (proportion of patients)273734.75%1.011.01–1.010.000 ***1.011.01–1.010.000 ***
Time between prior F31 diagnosis (mostly additional diagnosis) and first F31 diagnosis as defined in this study (years)281435.73%1.001.00–1.000.000 ***1.001.00–1.000.000 ***
Patient was hospitalized with mental problemsNo301238.24%ReferenceReference
Yes486461.76%0.920.87–0.980.006 *0.910.86–0.970.002 *
Mania at first presentationNo278235.32%ReferenceReference
Yes509464.68%0.980.93–1.030.3910.960.92–1.010.132
Inpatient carealcohol misuse/dependence7339.31%0.930.90–0.960.000 ***0.950.92–0.980.000 ***
illicit drug misuse/dependence3474.41%0.980.92–1.050.5631.010.95–1.080.721
schizophrenia and related disorders167221.23%0.970.96–0.980.000 ***0.970.96–0.980.000 ***
anxiety disorder142218.05%0.990.97–1.020.6961.010.98–1.040.498
specific, mixed and other personality disorders other than borderline personality disorder, and enduring personality changes3454.38%0.900.83–0.980.014 *0.950.88–1.030.248
borderline personality disorder1732.20%0.880.75–1.040.1280.980.83–1.160.832
psychotic depression3123.96%1.070.98–1.170.1291.131.03–1.230.008 *
unipolar depression without psychotic symptoms183323.27%0.980.97–1.000.042 *0.990.97–1.000.065 †
mood affective disorders other than the ones listed above6077.71%0.990.94–1.040.5941.000.95–1.050.931
organic, including symptomatic, mental disorders2232.83%1.020.91–1.140.7061.020.91–1.140.728
neurotic, stress-related and somatoform disorders1191.51%0.770.64–0.940.008 *0.770.63–0.930.008 *
behavioural syndromes associated with physiological disturbances and physical factors290.37%0.810.71–0.930.003 *0.820.72–0.930.002 *
disorders of adult personality and behavior other than the ones listed above250.32%1.010.82–1.250.9371.010.83–1.240.903
mental and behavioural disorders other than the ones listed above3624.60%0.930.87–0.990.026 *0.940.88–1.010.087 †
poisoning and toxic substances175322.26%0.980.94–1.020.3661.000.96–1.040.818
intentional self-harm120815.34%1.040.99–1.090.1291.030.98–1.080.256
Outpatient carealcohol misuse/dependence179022.73%1.001.00–1.000.088 †0.990.98–0.990.000 ***
illicit drug misuse/dependence137117.41%1.000.99–1.000.025 *0.980.98–0.990.000 ***
schizophrenia and related disorders269334.19%0.990.99–1.000.000 ***0.990.99–0.990.000 ***
anxiety disorder653082.91%1.000.99–1.000.000 ***0.990.99–0.990.000 ***
specific, mixed and other personality disorders other than borderline personality disorder, and enduring personality changes185723.58%1.000.99–1.000.005 *0.970.95–0.990.005 *
borderline personality disorder85810.89%0.990.99–1.000.003 *0.960.94–0.990.002 *
psychotic depression5506.98%1.000.99–1.010.7020.980.97–0.990.006 *
unipolar depression without psychotic symptoms508764.59%0.990.99–0.990.000 ***0.990.99–0.990.000 ***
mood affective disorders other than the ones listed above168921.44%0.990.98–0.990.000 ***0.980.97–0.980.000 ***
organic, including symptomatic, mental disorders120015.24%1.000.99–1.000.3150.980.97–0.990.000 ***
neurotic, stress-related and somatoform disorders111714.18%1.011.00–1.010.001 *0.970.95–0.980.000 ***
behavioural syndromes associated with physiological disturbances and physical factors140017.78%1.000.99–1.000.071 †1.010.97–1.050.592
disorders of adult personality and behavior other than the ones listed above2172.76%1.000.95–1.060.9281.000.99–1.010.897
mental and behavioural disorders other than the ones listed above134317.05%0.980.98–0.990.000 ***0.970.96–0.970.000 ***
intentional self-harm82110.42%0.980.95–1.020.3620.980.94–1.020.331
  1. In inpatient care, in both model 1 and model 2 principal diagnosis alone was considered. In outpatient care, in model 1 all diagnoses in patient’s medical history were counted, while in model 2 we tested the effect of considering only the principal diagnosis. Variables with Exp(β) smaller than one are associated with decreased hazard; the lower the variable, the lower the hazard of the event. For example, in model 1 for the variable alcohol misuse/dependence in inpatient care the interpterion of Exp(β) is as follows: the probability of being diagnosed early with bipolar disorder for the first time is by 7% lower (1–0.93 = 0.07) if a patient has received an additional diagnosis of alcohol misuse/dependence in inpatient care
  2. p < 0.1; * p < 0.05; *** p < 0.0001