Title: Mapping Opportunities for earlier detection of Bipolar Disorder – Linking Big Data to Improve Patient Outcomes (MOBILISE)
Funder: Department of Health and Social Care

Abstract: Bipolar disorder (BD) is a chronic and disabling mental illness. There are usually delays of many years between illness onset and diagnosis, meaning that individuals suffer from untreated symptoms. Additionally, prolonged delay is associated with increased disability. However, there is no strategy for improving the early identification and treatment of BD in the NHS. In this project we aim to use large electronic health record databases to identify signs of unrecognised BD and develop a profile of signs of prodromal BD. Work Package (WP) 1 will examine signs of undiagnosed BD and risk factors for, and consequences of, long duration of undiagnosed illness. We will start by identifying all individuals with a diagnosis of BD in the 5 year period between 1/1/2010 and 31/12/2014. Defining onset of BD as first diagnosis of depression or first prescription of antidepressants, we will examine the health records of these individuals after the onset but before diagnosis of BD. This phase of undiagnosed illness is called the &ldquo;latency period&rdquo;. We will compare health &ldquo;events&rdquo; (eg prescriptions, diagnoses) during this latency period with a control group matched for age, gender general practice and time period but without a diagnosis of BD. Thus we will build a picture of features indicative of unrecognised illness. We will then examine risk factors for long latency and health events in people with long versus short latency periods. WP2 will use information from WP1 to create a health informatics model of how timely diagnosis of BD could alter patient outcomes. This Early Opportunities Mapping will identify different actions that could be taken to close the gap between the optimal and actual care pathways. We can examine, for example, how outcomes might be improved if BD were identified at first opportunity, second opportunity and so on. In WP3 we will examine health events for the year prior to onset of BD (as defined above) to develop a profile of prodromal BD. This group will need to be followed up longitudinally using the electronic health record databases to assess their risk of being diagnosed with BD. This WP therefore lays the groundwork for a future prospective study examining putative signs of undiagnosed and prodromal BD. An Advisory Board, which will include service users, carers, primary and specialist care clinicians, and professionals involved in curriculum development and training of health care professionals, will consider our findings and make recommendations to improve practice, and advise on dissemination. Impact on clinical practice Our research will create a profile of common features indicative of unrecognised BD and adverse outcomes of prolonged duration of untreated illness. This information can be used in the education and training of medical students, GPs, psychiatrists, and other health professionals involved in the provision of MH care. The trajectory to changing medical practice will be accelerated by the inclusion of professionals involved in training GPs and medical students on our Advisory Board. Benefits to patients There are several thousand patients in the UK currently suffering from unrecognised BD. Our research will improve the ability of GPs and other clinicians to identify the illness earlier in its course, thereby reducing the suffering from untreated symptoms, incorrect diagnoses and inappropriate treatment. Earlier recognition and treatment also potentially improve outcomes. Our dissemination strategy could make the public more aware of potential signs of unrecognised BD, enhancing the ability of individuals to seek help earlier. Potential impact on policy Our research can influence policy for improving the early identification and treatment of BD in the NHS, for example by providing evidence for NICE guidelines. The findings may indicate optimal care pathways through Early Opportunities Mapping .

Lay abstract: Bipolar disorder is a serious mental illness in which individuals fluctuate between high and low moods. They usually suffer for years before being correctly diagnosed and during this time are at elevated risk of suicide, self-harm and other potentially harmful behaviours. This project aims to improve the recognition of BD in primary and specialist care. We also aim to explore early &ldquo;prodromal&rdquo; signs of BD that could indicate that someone is at high risk for developing the disorder. We will address these issues through three Work Packages (WPs) that will use anonymised routinely collected healthcare data. WP1: Aims to identify signs of undiagnosed BD. We will compare pathways through the healthcare system of those with and without BD. For example we might find high rates of incorrect diagnoses of anxiety in those with an eventual diagnosis of BD. We will also assess which people are most at risk of delayed diagnosis and examine the link between delay in diagnosis and poor outcomes such as self-harm, suicide and physical illnesses. WP2 will use findings from the WP1 for &ldquo;Early Opportunities Mapping&rdquo; (EOM), indicating what would have happened if improved practice were followed. For example, we can examine how many suicides may have been avoided if BD had been diagnosed at first opportunity, at second opportunity and so on. WP3: We will create a profile of early, emerging &ldquo;prodromal&rdquo; BD and identify These data can be analysed in a future study to see if these individuals were eventually diagnosed with BD. If so, the signs might be used for early intervention and possibly prevention of illness in the future. We will discuss our findings with an Advisory Board that will make recommendations for changing practice to improve recognition of BD.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH