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Résumé (français)

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Résumé (anglais)

Objective: The original aim of this thesis was to estimate the prevalence of bipolar disorder (BD) including bipolar I (BDI) and bipolar II (BDII) disorder subtypes, in Canada in 2012 and to characterize persons with BD in terms of demographic features, health status, and mental health service utilization. During the course of this thesis, a third objective emerged which was to examine some indicators of validity of the World Mental Health version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) classifications of BD. Methods: Data were from the Canadian Community Health Survey-Mental Health (CCHS-MH; n=25,113) Interviews were based on the WMH-CIDI. The WMH-CIDI uses algorithms to determine the presence or absence of BD. Alternative classification methods were also considered. Using proportions and generalized linear modeling, I estimated prevalence of BD, examined agreement among different methods for classifying BD and described the epidemiology of BD according to the different classifications in terms of demographic features, health status and impact, and mental health service utilization. Results: According the WMH-CIDI algorithm, the prevalence of BDI and BDII in Canada in 2012 was 0.87% (95% CI 0.67% to 1.07%) and 0.57% (95% CI 0.44% to 0.71%), respectively. I observed a lack of congruence between WMH-CIDI defined and self-reported BD, and few people taking lithium were positive for BD on the WMH-CIDI, which raises concern about the validity of the WMH-CIDI’s assessment of BD. Conclusion: Prevalence estimates using the WMH-CIDI align with those reported in prior literature. However, existing algorithms used to diagnose BD in the WMH-CIDI appear to result in a large proportion of misclassification. Fully structured interviews may be inaccurate for assessing BD. Future research should aim to develop and evaluate new methods of identifying BD in the general population.