Clinical, psychosocial, and treatment differences in minority patients with bipolar disorder

Objectives:  The clinical profile of minorities with bipolar disorder has been largely unexplored. We compared the clinical (e.g. psychiatric and substance use comorbidity), psychosocial, and treatment characteristics between white and minority patients with bipolar disorder (minorities were defined as black or other minority, which included Hispanic, Asian-American, or Native-Americans). Methods:  We collected demographic, diagnosis, and treatment information using the Structured Clinical Interview for DSM-IV (SCID) from 330 inpatients with a current major affective episode across 11 Veterans Affairs (VA) Medical Centers enrolled in the VA Cooperative Study (Reducing the Efficacy–Effectiveness Gap in Bipolar Disorder). Results:  Twenty-four percent (n = 80) were minority; 9% (n = 30) were women, 4% (n = 20) were ≥65 years old; and the majority (87%, n = 286) had bipolar type I. Minorities compared with whites were no more likely to have a current episode of psychosis (30% versus 37%, respectively; p = 0.28). However, minorities were more likely than whites to have a cocaine use disorder (adjusted odd's ratio, OR = 2.2; 95% CI: 1.4–3.5; p < 0.01) or current alcohol abuse disorder (adjusted OR = 1.8; 95% CI: 1.1–3.9;p < 0.05). Further breakdown by race/ethnicity revealed that cocaine use disorder was most prevalent among blacks (n = 14, 29%), compared with all other minorities (n = 2, 6%) or whites (n = 10, 4%; p < 0.001). Other minorities compared with blacks or whites were more likely involuntarily committed during some part of their index hospitalization (adjusted OR = 2.47; 95% CI: 1.1–5.7; p = 0.04). Conclusions:  Minorities with bipolar disorder may be a more vulnerable population because of higher rates of substance use disorder and higher rates of involuntary psychiatric commitment. Moreover, the specific profile of vulnerability may differ across minority groups.