The Compelling and Persistent Problem of Bipolar Disorder Disguised as Major Depression Disorder: An Integrative Review [Formula: see text]

J Am Psychiatr Nurses Assoc. 2018 Sep/Oct;24(5):415-425. doi: 10.1177/1078390318784360. Epub 2018 Jun 28.


Background: Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder.

Objective: The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening.

Design: An integrative review was conducted using standard criteria for evaluating research articles.

Results: Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed.

Conclusions: Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.

Keywords: bipolar disorder; mental illness; misdiagnosis.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Bipolar Disorder / diagnosis*
  • Depressive Disorder, Major / diagnosis*
  • Diagnostic Errors*
  • Humans