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112 patients a first-time diagnosis of mania
or hypomania
42% diagnosed with bipolar I disorder,
13% diagnosed with bipolar II disorder
45% there were not sufficient data to
distinguish between the two types.

112 incident cases,

70 cases had bipolar I disorder,
31 cases had bipolar II disorder
11 cases had no sub-classification could be
made due to insufficient data.

48%, 15/31 cases

suffered recurrent hypomanic episodes
94%, 29/31 cases
preceded by 1/ >1 depressive episodes
6,5%, 2/32 cases
were not preceded by a depressive episode
suffered recurrent depressive episodes after
the primary hypomanic episode.

 63% (44 cases) with a first manic episode,

bipolar disorder started with a depressive
episode
64% (7 cases) of not otherwise specified
bipolar disorder started with a depressive
episode.
71% the (hypo)manic episodes were preceded
by a depressive episode.

95%, 106/ 112 cases

had their diagnosis confirmed by a specialists
letter.
4/112 cases
confirmations based on the description of the
episode, of which one was based on
documentation of psychiatric consultation by
telephone followed by referral to treatment.

2/112 cases
diagnosis was acquired from a foreign
colleague after admittance to a psychiatric
hospital abroad
was based on a diagnosis by a GP (ICPC)
combined with an accurate description of the
episode followed by referral and treatment.

Variation over time

The total IR during the period 19962007
varied between 0.17 and 1.10 /10000 PY.
There was no marked increase or decrease of
average incidence over the years covered.

Gender and age

Overall IRs of hypomania and mania were
similar for men and women .
Men (0.70/10000 PY; 95% CI: 0.530.91)
Woman (0.68/10000 PY; 95% CI: 0.520.90)

no significant differences in (Fig. 1).

 The source population was >15 years, divided

into age categories by ten years up to 75 years
age category.
(1524, 2534, 3544, 4554, 5564, 65-74, >75)
The incidence of (hypo)mania showed a trend
toward two peaks in age of onset:
one in early adulthood (1524 years; 0.68/10000 PY)
larger one in later life (4554 years; 1.2/10000 PY)

(Fig. 2)

 In the distribution of the total incidence of

(hypo)mania according to age categories, CI
overlapped except for the 4554 years age
category versus the 2534 and the 6574
categories.

The distribution over the different age groups for

bipolar I and II disorders separately showed that
bipolar I disorder tends to follow the age
distribution of the total incidence of
(hypo)mania.
The age distribution of the incidence of bipolar II
disorder showed only one peak in the 4554
years age category (IR 0.42/10000 PY).

Month or season of birth

No significant differences were found between
month or season of onset of first (hypo)manic
episode and month or season of birth.

Urbanization
The incidence of bipolar disorder was not different in
urban compared to non-urban areas,
0.74/10000 PY in the urban areas
(95% CI: 0.560.95) and
0.65/10000 PY in the non-urban areas
(95% CI: 0.420.97)
The difference between the two urbanization
categories was not statistically significant when
bipolar I and II disorder were considered separately
(Fig. 3).

Deprivation
The overall incidence of (hypo)mania was
statistically significant higher (p = 0.0012) in
deprived areas
[1.52/10000 PY (95% CI: 0.852.51)] (Fig. 4A)
compared to non-deprived areas
[0.64/10000 PY (95% CI: 0.520.78)],
which was mainly due to a higher incidence of
bipolar I disorder in deprived areas (Fig. 4B).

Discussion
The present study shows that the IR of bipolar
disorder in the general population of the
Netherlands is 0.7/10000 PY,
with a peak incidence in early adulthood (ages
1524 years) and a larger peak at ages 4554
years.
The results also suggest that the IR of bipolar I
disorder is higher in deprived areas compared
to non-deprived areas.

 The incidence of bipolar disorder is not related

to urbanization, gender, or month/season of
birth.

The overall IR for bipolar disorder in the

present study is in line with that in the
literature, suggesting the validity of the
sample and method of ascertainment (27).

 The relationship with age shows a peak

incidence at 4554 years and a smaller peak in
early adulthood.

Although the majority of studies on this

subject report the average age at onset to be
in early adulthood, there are also conflicting
reports, consistent with our study, describing
a peak in .. BERSAMBUNG