The most expensive psychiatric illness in the U.S. is bipolar disorder, according to a carefully documented study by Pamela Peele and colleagues in the American Journal of Psychiatry in 2003. Patients with bipolar disorder cost in 1996-dollars $2,470 per patient per year, which was almost 400% more than it cost to treat other psychiatric disorders. One important reason for the increased cost of treating patients with bipolar disorder was their increased rates of psychiatric hospitalization relative to other disorders. Adolescents diagnosed with bipolar disorder were hospitalized at about twice the rates of adults diagnosed with bipolar disorder. Almost 40% of the adolescents with bipolar disorder were hospitalized once during the year under study, and half of these were hospitalized a second time.
David T. Feinberg, M.D., Medical Director the UCLA Neuropsychiatric and Behavioral Health Sciences Center, in an article in the Journal of Child and Adolescent Psychopharmacology in 2003, estimated the cost of care for a typical adolescent with bipolar disorder during the first year of treatment at over $27,000. This included the cost of two psychiatric hospitalizations ($14,500.00), medications ($6,000.00), outpatient care ($6,000.00), and two visits to the emergency room ($1,100.00).
In 1994, the diagnosis and treatment of bipolar disorder in children and adolescents began to increase dramatically. Before 1994, the diagnosis of bipolar disorder in children under 12 years of age was rare. Moreno and colleagues from Columbia University and NIMH reported that outpatient visits for the treatment of bipolar disorder in children and adolescents increased 40-fold from 20,000 in the year 1994-1995 to 800,000 in the year 2002-2003. Similarly, Blader and Carlson (2007) reported that the number of children and adolescents psychiatrically hospitalized with bipolar disorder increased four-fold between the years 1996 and 2004.
David Pogge and colleagues reported in Psychiatry Research (2001) that about 50% of adolescents given the diagnosis of bipolar disorder on a psychiatric inpatient unit, on more careful evaluation, did not have the disorder.
Despite the dramatic surge in the rates of diagnosis of bipolar disorder in children, the number of children under 12 who actually have the disorder is rare, according to a recent (2010) report of the highly influential American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-V) Child and Adolescent Disorder Work Group.
An unusual combination of circumstances led to the creation of a childhood version of this well established adult disorder and its immediate acceptance by child mental health professionals and the public. NIMH began in 1995 to fund a large number of research grants at prestigious universities to study this previously unknown disorder. This led to numerous papers in professional journals, and frequent presentations at professional meetings assuring practitioners that the disorder was frequent, unrecognized, and pharmacologically treatable. Many books for the lay public were written urging distraught parents to believe that their difficult-to-manage children had the disorder and needed treatment. Television featured proponents of child bipolar disorder on programs such as Oprah and 20/20. Magazines and web sites lent their support to the diagnosis as well. The pharmaceutical industry found new markets for their medications. The FDA lent solidity to the illusory diagnosis by approving medications for its treatment.
How can the cost of this fad diagnosis begin to be calculated? First is the direct treatment cost for the increasing numbers of children and adolescents receiving the diagnosis. Second is the financial cost of the many research studies funded by NIMH for the study of bipolar disorder in children and adolescents. Third is the cost of the medication studies pharmaceutical companies conducted for the treatment of this disorder. Fourth is the harm to the children for receiving dangerous largely ineffective medications for a disorder they did not have and the frequent withholding of medications that might have better treated the disorders the children actually did have. Fifth is the cost of future health care for the known side effects of the medications provided such as weight gain and masculinization in females. Sixth is the more elusive psychological cost to the children and their families of believing the children had a serious psychiatric diagnosis that in fact the children did not have.
The total yearly cost of psychiatric treatment for youth aged one to 24 years was estimated at 18 billion dollars per year in 2007, according to work jointly sponsored by the National Research Council and the Institute of Medicine. What have we received for the money we have spent studying and treating bipolar disorder in children and adolescents? How much does the misdiagnosis of child bipolar really cost?
Copyright Stuart L. Kaplan, M.D. 2011
Stuart L. Kaplan, M.D., is the author of Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created The Diagnosis, available at www.Amazon.com