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Gender-related differences in patients with bipolar disorder: a nationwide study

Published online by Cambridge University Press:  25 March 2019

Massimiliano Buoli
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
Bruno Mario Cesana
Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics “Giulio A. Maccacaro”, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
Bernardo Dell’Osso
Department of Biomedical and Clinical Sciences “Luigi Sacco”, Psychiatry Unit 2, ASST-Fatebenefratelli-Sacco, via G.B.Grassi 74, 20157 Milan, Italy Department of Psychiatry and Behavioral Sciences, Stanford University, CA, USA CRC “Aldo Ravelli” for Neurotechnology and Experimental Brain Therapeutics, University of Milan
Andrea Fagiolini
Department of Mental Health and Department of Molecular Medicine, University of Siena Medical Center, Siena, Italy
Andrea de Bartolomeis
Section of Psychiatry and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine, University “Federico II”, Naples, Italy
Emi Bondi
Department of Psychiatry, Hospital Papa Giovanni XXIII, Bergamo, Italy
Giuseppe Maina
Department of Mental Health, “San Luigi-Gonzaga” Hospital, University of Turin, Orbassano, Turin, Italy
Antonello Bellomo
Psychiatry Unit, Department of Medical Sciences, University of Foggia, Italy
A. Carlo Altamura
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy



The possible presence of gender-related differences in patients with bipolar disorder (BD) may have diagnostic and therapeutic implications. This multicenter study aimed to investigate gender differences in BD in the largest Italian database collected to date, on behalf of the Italian Chapter of the International Society of Bipolar Disorders.


A total of 1674 patients (males: n = 714; females: n = 960) from different psychiatric departments were compared according to gender on demographic/clinical variables. Owing to the large number of variables statistically related to the dependent variable (gender) at the univariate analyses, preliminary multiple logistic regression analyses were performed. A final multivariable logistic regression was then performed, considering gender as the dependent variable and statistically significant demographic/clinical characteristics as independent variables.


The results of the final multivariable logistic regression analysis with previous statistically significant demographic and clinical variables were the following: female gender was less frequently associated with employment (odds ratio [OR] = 0.7, P < 0.01), lifetime single marital status (OR = 0.45, P < 0.01), and substance abuse in the last year (OR = 0.35, P < 0.01), whereas it was more frequently associated with a major number of lifetime major depressive episodes (OR = 1.78, P < 0.01) and psychiatric visits in the last year (OR = 1.38, P = 0.01).


Few significant differences were found between genders in BD, particularly for those clinical features that are associated with poor prognosis (substance abuse for males and number of depressive episodes for females). Transcultural studies are needed to identify cultural versus illness-related variables possibly explaining the different clinical presentation of BD in relation to gender.

Original Research
© Cambridge University Press 2019 

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Schaffer, A, Isometsä, ET, Tondo, L, et al. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry. 2015; 49(9): 785802.CrossRefGoogle ScholarPubMed
Bandelow, B, Michaelis, S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015; 17(3): 327335.Google ScholarPubMed
Salk, RH, Hyde, JS, Abramson, LY. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull. 2017; 143(8): 783822.CrossRefGoogle Scholar
Diflorio, A, Jones, I. Is sex important? Gender differences in bipolar disorder. Int Rev Psychiatry. 2010; 22(5): 437452.CrossRefGoogle ScholarPubMed
Hendrick, V, Altshuler, LL, Gitlin, MJ, et al. Gender and bipolar illness. J Clin Psychiatry. 2000; 61(5): 393396.CrossRefGoogle ScholarPubMed
Arnold, LM. Gender differences in bipolar disorder. Psychiatr Clin North Am. 2003; 26(5): 595620.CrossRefGoogle ScholarPubMed
Kawa, I, Carter, JD, Joyce, PR, et al. Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation. Bipolar Disord. 2005; 7(2): 119125.CrossRefGoogle ScholarPubMed
Merikangas, KR, Jin, R, He, JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011; 68(3): 241251.CrossRefGoogle ScholarPubMed
Fellinger, M, Waldhör, T, Blüml, V, et al. Influence of gender on inpatient treatment for bipolar disorder: an analysis of 60, 607 hospitalisations. J Affect Disord. 2018; 225: 104107.CrossRefGoogle ScholarPubMed
Karanti, A, Bobeck, C, Osterman, M, et al. Gender differences in the treatment of patients with bipolar disorder: a study of 7354 patients. J Affect Disord. 2015; 174: 303309.CrossRefGoogle Scholar
Kessing, LV. Gender differences in the phenomenology of bipolar disorder. Bipolar Disord. 2004; 6(5): 421425.CrossRefGoogle ScholarPubMed
Nivoli, AM, Pacchiarotti, I, Rosa, AR, et al. Gender differences in a cohort study of 604 bipolar patients: the role of predominant polarity. J Affect Disord. 2011; 133(3): 443449.CrossRefGoogle Scholar
Erol, A, Winham, SJ, McElroy, SL, et al. Sex differences in the risk of rapid cycling and other indicators of adverse illness course in patients with bipolar I and II disorder. Bipolar Disord. 2015; 17(6): 670676.CrossRefGoogle ScholarPubMed
Lewis, KS, Gordon-Smith, K, Forty, L, et al. Sleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender. Br J Psychiatry. 2017; 211(3): 169174.CrossRefGoogle ScholarPubMed
McElroy, SL. Bipolar disorders: special diagnostic and treatment considerations in women. CNS Spectr. 2004; 9(8): 518.CrossRefGoogle ScholarPubMed
Scott, J, Brichant-Petitjean, C, Etain, B, et al. A re-examination of antidepressant treatment-emergent mania in bipolar disorders: evidence of gender differences. Acta Psychiatr Scand. 2017; 135(5): 479488.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998; 59(20): 2233.Google ScholarPubMed
Vieta, E, Pacchiarotti, I, Valentí, M, et al. A critical update on psychological interventions for bipolar disorders. Curr Psychiatry Rep. 2009; 11(6): 494502.CrossRefGoogle ScholarPubMed
Colom, F, Vieta, E, Suppes, T. Predominant polarity in bipolar disorders: refining or redefining diagnosis? Acta Psychiatr Scand. 2015; 132(5): 324326.CrossRefGoogle ScholarPubMed
Kar, N, Arun, M, Mohanty, MK, et al. Scale for assessment of lethality of suicide attempt. Indian J Psychiatry. 2014; 56(4): 337343.Google ScholarPubMed
Messer, T, Lammers, G, Müller-Siecheneder, F, et al. Substance abuse in patients with bipolar disorder: a systematic review and meta-analysis. Psychiatry Res. 2017; 253: 338350.CrossRefGoogle ScholarPubMed
Strakowski, SM, DelBello, MP, Fleck, DE, et al. Effects of co-occurring cannabis use disorders on the course of bipolar disorder after a first hospitalization for mania. Arch Gen Psychiatry. 2007; 64(1): 5764.CrossRefGoogle ScholarPubMed
Carvalho, AF, Dimellis, D, Gonda, X, et al. Rapid cycling in bipolar disorder: a systematic review. J Clin Psychiatry. 2014; 75(6): e578586.CrossRefGoogle ScholarPubMed
Buoli, M, Dell’Osso, B, Caldiroli, A, et al. Obesity and obstetric complications are associated with rapid-cycling in Italian patients with bipolar disorder. J Affect Disord. 2017; 208: 278283.CrossRefGoogle ScholarPubMed
Dell’Osso, B, Camuri, G, Cremaschi, L, et al. Lifetime presence of psychotic symptoms in bipolar disorder is associated with less favorable socio-demographic and certain clinical features. Compr Psychiatry. 2017; 76: 169176.CrossRefGoogle ScholarPubMed
Dell’Osso, B, Vismara, M, Dobrea, C, et al. Clinical characterization of Italian suicide attempters with bipolar disorder. CNS Spectr. 2018; 23(4): 271277.CrossRefGoogle ScholarPubMed
Salloum, IM, Brown, ES. Management of comorbid bipolar disorder and substance use disorders. Am J Drug Alcohol Abuse. 2017; 43(4): 366376.CrossRefGoogle ScholarPubMed
Boerma, T, Hosseinpoor, AR, Verdes, E, et al. A global assessment of the gender gap in self-reported health with survey data from 59 countries. BMC Public Health. 2016; 16: 675.CrossRefGoogle ScholarPubMed
Tsai, SM, Chen, C, Kuo, C, et al. 15-Year outcome of treated bipolar disorder. J Affect Disord. 2001; 63(1–3): 215220.CrossRefGoogle ScholarPubMed
Chang, HC, Huang, KC, Chiu, WC, et al. Change in employment status in bipolar disorder: a longitudinal study using national claims data. J Clin Psychiatry. 2016; 77(4): e429435.CrossRefGoogle ScholarPubMed
Scott, J, Grunze, H, Meyer, TD, et al. A bipolar II cohort (ABC): the association of functional disability with gender and rapid cycling. J Affect Disord. 2015; 185: 204208.CrossRefGoogle ScholarPubMed
Kupka, R, Luckenbaugh, DA, Post, RM, et al. Rapid and non-rapid cycling bipolar disorder: a meta-analysis of clinical studies. J Clin Psychiatry. 2003; 64(12): 14831494.CrossRefGoogle ScholarPubMed
Kupka, RW, Luckenbaugh, DA, Post, RM, et al. Comparison of rapid-cycling and non-rapid-cycling bipolar disorder based on prospective mood ratings in 539 outpatients. Am J Psychiatry. 2005; 162(7): 12731280.CrossRefGoogle ScholarPubMed
Lieberman, DZ, Massey, SH, Goodwin, FK. The role of gender in single vs married individuals with bipolar disorder. Compr Psychiatry. 2010; 51(4): 380385.CrossRefGoogle ScholarPubMed
Azorin, JM, Belzeaux, R, Kaladjian, A, et al. Risks associated with gender differences in bipolar I disorder. J Affect Disord. 2013; 151(3): 10331040.CrossRefGoogle ScholarPubMed
Cremaschi, L, Dell’Osso, B, Vismara, M, et al. Onset polarity in bipolar disorder: a strong association between first depressive episode and suicide attempts. J Affect Disord. 2017; 209: 182187.CrossRefGoogle Scholar
Bonnín, CM, Reinares, M, Hidalgo-Mazzei, D, et al. Predictors of functional outcome after a manic episode. J Affect Disord. 2015; 182: 121125.CrossRefGoogle ScholarPubMed
Soni, A, Singh, P, Shah, R, et al. Impact of cognition and clinical factors on functional outcome in patients with bipolar disorder. East Asian Arch Psychiatry. 2017; 27(1): 2634.Google ScholarPubMed
Solomon, DA, Fiedorowicz, JG, Leon, AC, et al. Recovery from multiple episodes of bipolar I depression. J Clin Psychiatry. 2013; 74(3): e205211.CrossRefGoogle ScholarPubMed
Güçlü, O, Karaca, O, Yıldırım, B, et al. The relationship between insight and clinical features in bipolar disorder. Turk Psikiyatri Derg. 2011; 22(4): 230238.Google ScholarPubMed
de Assis da Silva, R, Mograbi, DC, Silveira, LA, et al. Insight across the different mood states of bipolar disorder. Psychiatr Q. 2015; 86(3): 395405.CrossRefGoogle ScholarPubMed
Benazzi, F. The relationship of major depressive disorder to bipolar disorder: continuous or discontinuous? Curr Psychiatry Rep. 2005; 7(6): 462470.CrossRefGoogle ScholarPubMed
Vega, P, Barbeito, S, Ruiz de Azúa S, et al. Bipolar disorder differences between genders: special considerations for women. Womens Health (Lond). 2011; 7(6): 663674.CrossRefGoogle Scholar
Serati, M, Buoli, M, Altamura, AC. Factors that affect duration of untreated illness in pregnant women with bipolar disorder. Am J Obstet Gynecol. 2015; 213(6): 876.CrossRefGoogle ScholarPubMed
Altamura, AC, Goikolea, JM. Differential diagnoses and management strategies in patients with schizophrenia and bipolar disorder. Neuropsychiatr Dis Treat. 2008; 4(1): 311317.CrossRefGoogle ScholarPubMed
Altamura, AC, Mundo, E, Bassetti, R, et al. Transcultural differences in suicide attempters: analysis on a high-risk population of patients with schizophrenia or schizoaffective disorder. Schizophr Res. 2007; 89(1–3): 140146.CrossRefGoogle ScholarPubMed

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