Gender differences in a cohort study of 604 bipolar patients: the role of predominant polarity

J Affect Disord. 2011 Oct;133(3):443-9. doi: 10.1016/j.jad.2011.04.055. Epub 2011 May 26.


Background: Some clinical differences between gender regarding the course and outcome of bipolar disorders have already been described and some others remain still controversial.

Aims: To explore gender differences regarding clinical and socio-demographic characteristics amongst bipolar patients with particular attention to predominant polarity and depressive symptoms.

Method: Data were collected from DSM-IV type I and II bipolar patients (n=604), resulting from the systematic follow-up of the Bipolar Disorders Program, Hospital Clinic of Barcelona, over an average follow-up of 10 years. Socio-demographic and clinical variables were collected in order to detect gender-related differences.

Results: Bipolar women are more likely than men to show a predominance of depressive polarity as well as a depressive onset whilst men would be more likely to suffer from comorbid substance use disorders. Women significantly have a higher lifetime prevalence of psychotic depression and a higher prevalence of axis II comorbid disorders. Bipolar women are also more likely to have a family history of suicide and a lifetime history of attempted suicide. Suicide attempts are more often violent amongst bipolar men. In a backward logistic regression model, two variables were responsible for most gender-related clinical differences: type of predominant polarity - more likely to be depressive amongst women - (B=-0.794, p=0.027, Exp(B)=0.452; CI= 0.223-0.915), alcohol abuse (B=-1.095, p=0.000, Exp(B)=2990; CI= 1.817-4.919) and cocaine abuse (B=0.784, p=0.033, Exp(B)=2.189; CI= 1.066-4.496) - more prevalent amongst men.

Conclusion: The main characteristic featuring bipolar women is depression, both at illness onset and as a predominant polarity all along the illness course. This may have important diagnostic and therapeutic implications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alcoholism / epidemiology
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / drug therapy
  • Bipolar Disorder / epidemiology
  • Bipolar Disorder / psychology*
  • Cohort Studies
  • Comorbidity
  • Depression / psychology*
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Depressive Disorder, Major / epidemiology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Sex Factors*
  • Substance-Related Disorders / epidemiology
  • Suicide / statistics & numerical data
  • Suicide, Attempted / statistics & numerical data