Sex Differences Among Older Adults With Bipolar Disorder: Results From the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project

• Published in: The American journal of geriatric psychiatry 2024-03, Vol.32 (3), p.326-338
• Main Authors: Blanken, Machteld A.J.T., Oudega, Mardien L., Almeida, Osvaldo P., Schouws, Sigfried N.T.M., Orhan, Melis, Beunders, Alexandra J.M., Klumpers, Ursula M.H., Sonnenberg, Caroline, Blumberg, Hilary P., Eyler, Lisa T., Forester, Brent P., Forlenza, Orestes V., Gildengers, Ariel, Mulsant, Benoit H., Rajji, Tarek, Rej, Soham, Sarna, Kaylee, Sutherland, Ashley, Yala, Joy, Vieta, Eduard, Tsai, Shangying, Briggs, Farren B.S., Sajatovic, Martha, Dols, Annemiek
• Format: Article
• Language: English
• Subjects: Affect; Aged; Aging - psychology; bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - epidemiology; Comorbidity; Female; gender; geriatrics; Humans; Male; men; Middle Aged; older age bipolar disorder (OABD); sex; Sex Characteristics; Sex differences; women
• ISSN: 1064-7481; 1545-7214; 1545-7214
• DOI: 10.1016/j.jagp.2023.10.008

•What is the primary question addressed by this study?Are there sex differences in clinical presentation, general functioning and mood symptoms among older adults with bipolar disorder?•What is the main finding of this study?Female sex was associated with psychiatric hospitalization and male sex with higher rates of lifetime substance abuse disorders.•What is the meaning of the finding?Older aged women with bipolar disorder experience a more severe course of illness, emphasizing the importance of addressing sex-specific disparities in healthcare. Sex-specific research in adult bipolar disorder (BD) is sparse and even more so among those with older age bipolar disorder (OABD). Knowledge about sex differences across the bipolar lifespan is urgently needed to target and improve treatment. To address this gap, the current study examined sex differences in the domains of clinical presentation, general functioning, and mood symptoms among individuals with OABD. This Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) study used data from 19 international studies including BD patients aged ≥50 years (N = 1,185: 645 women, 540 men).A comparison of mood symptoms between women and men was conducted initially using two-tailed t tests and then accounting for systematic differences between the contributing cohorts by performing generalized linear mixed models (GLMMs). Associations between sex and other clinical characteristics were examined using GLMM including: age, BD subtype, rapid cycling, psychiatric hospitalization, lifetime psychiatric comorbidity, and physical health comorbidity, with study cohort as a random intercept. Regarding depressive mood symptoms, women had higher scores on anxiety and hypochondriasis items. Female sex was associated with more psychiatric hospitalizations and male sex with lifetime substance abuse disorders. Our findings show important clinical sex differences and provide support that older age women experience a more severe course of BD, with higher rates of psychiatric hospitalization. The reasons for this may be biological, psychological, or social. These differences as well as underlying mechanisms should be a focus for healthcare professionals and need to be studied further.