Substance use among older adults with bipolar disorder varies according to age at first treatment contact

Almeida, Osvaldo P., Hankey, Graeme J., Yeap, Bu B., Golledge, Jonathan, and Flicker, Leon (2018) Substance use among older adults with bipolar disorder varies according to age at first treatment contact. Journal of Affective Disorders, 239. pp. 269-273.

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Abstract

Background: The use of alcohol and drugs is common among people with bipolar disorder, but it is unclear if age of onset modifies this association.

Aims: To determine the cross-sectional and longitudinal association between age of onset of bipolar disorder (BD) and disorders associated with the use of alcohol or other substances in later life, as well as their impact on mortality.

Methods: Cohort study of a community-representative sample of 38,173 men aged 65–85 years at the start of the follow up period of 18 years. We used the Western Australian Data Linkage System to ascertain the presence of BD and substance use disorders according to the International Classification of Diseases (ICD). We also collected information on concurrent morbidities: diabetes, hypertension, ischaemic heart disease and stroke.

Results: 175 men had BD onset < age 60 years and 75 ≥ 60 years. Compared with older men without BD, the adjusted odds of alcohol use disorders were 3.87 (95%CI = 2.52, 5.93) for men with BD onset < 60 years and 2.38 (95%CI = 1.08, 5.25) for those with onset ≥ 60 years. The adjusted hazard ratio of incident disorders associated with the use of alcohol and other substances was 3.23 (95%CI = 1.87, 5.58) and 2.38 (95%CI = 1.38, 4.11) respectively for men with BD onset < 60 years. BD with onset ≥ 60 years was not associated with substance use disorders. The mortality hazard was not affected by the interaction between BD and the use of substances.

Conclusions: Substance use disorders (alcohol or others) are more prevalent among older adults with than without BD, but new cases are only more frequent among men with BD onset < 60 years of age. Grouping BD into early and late onset is clinically informative and may affect approach to assessment and management.

Item ID: 58713
Item Type: Article (Research - C1)
ISSN: 1573-2517
Keywords: Age at onset, Alcohol, Bipolar disorder, Elderly, Men, Mortality, Substance use
Copyright Information: © 2018 Elsevier B.V.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC 279408, NHMRC 379600, NHMRC 403963, NHMRC 513823, NHMRC 540403, NHMRC 540504, NHMRC 540405, NHMRC 634492, NHMRC 1021416, NHMRC 1045710, NHMRC 1060557
Date Deposited: 19 Jun 2019 08:25
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110399 Clinical Sciences not elsewhere classified @ 100%
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