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COLORADO SPRINGS, Colo. -- A fraction of people diagnosed as having major depressive disorder (MDD) may have misdiagnosed bipolar I disorder (BP-I), self-reported data suggested.

Among more than 75,000 people surveyed online, 302 people with MDD had potentially misdiagnosed BP-I, reported Larry Culpepper, MD, MPH, of Boston University, and co-authors in a poster presented at the .

Overall, 818 people self-reported a BP-I diagnosis, including 336 people with mild BP-I, 285 people with moderate BP-I, and 197 people with severe BP-I.

Mean depression scores assessed by the Patient Health Questionnaire-9 (PHQ-9) among potentially misdiagnosed people were 15.9, compared with 12.7 for people with moderate BP-I and 18.1 for severe BP-I (P<0.05). Mean anxiety scores assessed by the General Anxiety Disorder-7 (GAD-7) scale among potentially misdiagnosed people were 13.1, versus 10.8 for moderate BP-I and 15.2 for severe BP-I (P<0.05).

Higher PHQ-9 and GAD-7 scores indicate higher levels of depression and anxiety, respectively.

"The key takeaway from this study was that potentially misdiagnosed patients have considerable anxiety and depressive symptoms, report a quality of life that is similar to those with moderately severe BP-I, and have healthcare resource use similar to those with mild BP-I," noted co-investigator Mousam Parikh, director of health economics outcomes research strategy at AbbVie, which sponsored the study.

"Prior research suggests that many BP-I patients present to the clinician with depressive symptoms rather than manic symptoms," Parikh said. "Therefore, if a careful clinical evaluation to uncover a past manic episode is missed, it may result in an incorrect diagnosis of MDD since the major depressive episodes are clinically identical."

The study used data from the 2020 Cerner Enviza (NHWS). Participants were divided into four cohorts: those who were potentially misdiagnosed, and those with mild, moderate, or severe BP-I.

Participants were considered to have potentially misdiagnosed BP-I if they had a self-reported physician diagnosis of depression and had Mood Disorder Questionnaire scores suggesting probable BP-I. Participants with BP-1 were stratified by disease severity using Functioning Assessment Short Test (FAST) scores, with <20 considered mild, 21-40 considered moderate, and >40 considered severe BP-I.

scores showed that potentially misdiagnosed BP-I participants had significantly worse mental component scores with respect to health-related quality of life than people with mild BP-I and statistically similar scores as moderate BP-I participants. Physical component scores for the potentially misdiagnosed group were similar to those with mild BP-I.

The potentially misdiagnosed group had significantly worse scores on the compared with the mild BP-I group, and similar scores compared with the moderate group.

Participants with potentially misdiagnosed BP-I had similar rates of provider and emergency department visits as people with mild BP-I, but significantly fewer hospitalizations.

The study had several limitations, the authors acknowledged. Only people with internet access were included in the survey. NHWS data are cross-sectional and no causal relationships between diagnoses and health outcomes can be assumed.

In addition, the Mood Disorder Questionnaire is not 100% sensitive in identifying people with BP-I among patients with MDD, Culpepper and co-authors noted. The study relied on self-reported data, and other variables may have influenced outcomes.

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