Diagnostic progression to bipolar disorder in 17,285 adolescents and young adults with attention deficit hyperactivity disorder: A longitudinal follow-up study

Abstract Objective: We investigated the diagnostic progression to bipolar disorder (BD) among adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD). Methods: Using the Taiwan National Health Insurance Research Database, we enrolled adolescents and young adults aged 10–29 years with ADHD between January 1, 2001, and December 31, 2010, who were followed up until December 31, 2011, to determine progression to BD. Cox regression analysis was used to examine candidate risk and protective factors. Results: At the 11-year follow-up, the progression rate from ADHD to BD was 5.12%. Of the participants who progressed, 62.16% (322/518) progressed within the first 3 years. Risk factors for progression were as follows: older age (hazard ratio [HR], 1.058; 95% confidence interval [CI], 1.033–1.084), comorbidity with autistic spectrum disorder (HR, 1.839; 95% CI, 1.415–2.391), disruptive behavior disorder (HR, 1.434; 95% CI, 1.132–1.816), intelligence disability (HR, 1.744; 95% CI, 1.399–2.176), depressive disorder (HR, 1.978; 95% CI, 1.577–2.482), alcohol use disorder (HR, 1.705; 95% CI, 1.057–2.751), cluster A (HR, 2.508; 95% CI, 1.167–5.391) or B (HR, 2.718; 95% CI, 1.974–3.741) personality disorder, and a family history of BD (HR, 2.618; 95% CI, 1.823–3.758) Identified protective factors were male sex (HR, 0.771; 95% CI, 0.630–0.943) and cluster C personality disorder (HR, 0.278; 95% CI, 0.086–0.898). Conclusion: The study demonstrated the specific risk and protective factors for BD progression among adolescents and young adults with ADHD. It is important for clinician and mental health care providers to recognize identified factors to focus on early detection and prompt intervention.