Specific clinical presentations and demographic factors contribute to delayed diagnosis of bipolar disorderFactors linked to late diagnosis in bipolar disorder patients

Purpose There are widespread concerns about adverse consequences of persistent five-to-ten-year delays in diagnosing and treating bipolar disorder. Previous evidence synthesis focuses primarily on quantifying scale. This systematic review aimed to identify the complex and broad precursors, outcomes, and suggested pathways to improve diagnostic delay. Method A complex intervention approach, using co-produced narrative synthesis of quantitative and qualitative studies, is used to identify associated precursors, outcomes, and suggested avenues for improvement. Results A total of 49 generally high-quality studies from high or middle-income countries were included. This review reinforces certain findings from previous reviews regarding scale of delayed diagnosis and key associated precursors, including: history of depression, suicide attempts, earlier onset, female sex, BD-II presentation. However, we also identify a wider range of associated factors including: mixed, hypomanic, atypical, and rapid cycling presentations; suicidality in bipolar and interrelationship with diagnosis, acknowledging persistence of suicide risk following diagnosis; interrelationship with diverse mental and physical health conditions; attitudes and management of bipolar; diagnostic process in lower-and-middle income countries; clinical pathways associated with diagnosis and the complex interplay of socio-economic, cultural, and demographic factors. Suggested avenues for improvement were diverse, but highlighted screening, and the need for increased collaboration and broader research. Conclusions Our findings suggest that future research and interventions should examine delayed diagnosis in terms of its breadth and complex interrelationships with aspects of bipolar disorder which remain insufficiently understood. We also highlight the need for deeper insight into stakeholder experiences and attitudes toward bipolar management and diagnosis, particularly through qualitative, mixed-methods, and co-produced research.