Bipolar disorder does not discriminate. Of the 2-4% of people that have the disorder, it affects men and women equally and there is no significant difference in the rate across race or ethnicity. Yet, treatment rates are discriminatory. Overall, treatment and quality of life are worse for anyone who isn’t white. This isn’t something you hear about often. I suspect that has something to do with the fact that most people writing from the perspective of someone who has the disorder look a lot like me. Race is a hard topic. On the one hand, I recognize that I have advantages others do not and cannot presume to know what it’s like without them. On the other, the facts need to be shared so we can fix the problem.
Everyone with bipolar disorder experiences high moods and low moods. Those moods present themselves differently in different people. People with bipolar II never experience full mania. Some people experience psychotic episodes while others don’t. With very few exceptions, we all experience varying degrees of depression.
We tend to have lower socioeconomic status, high unemployment and a high suicide rate. Those in adequate, regular treatment fare far better, and treatment seems to be equally effective across race and ethnicities.
Despite treatment being equally effective, there are still disparities between how people of different races experience symptoms and treatment of bipolar disorder:
- Report seeking help from a mental health specialist at half the rate of whites.
- Are more likely to receive a misdiagnosis of depression.
- Report higher levels of psychotic symptoms.
- Experience higher levels of impairment.
- 30% less likely to be prescribed medication than non-hispanics.
- Have a higher rate of bipolar I vs. bipolar II than whites.
- Are more likely to be misdiagnosed with schizophrenia.
- Receive even less adequate treatment than whites.
- Are less likely than whites to receive treatment for psychosis.
- Are more likely than whites to have received inpatient mental health services.
- Have more common manic symptoms than depressive symptoms.
- Report more incidences of unfair treatment.
- Asian women have the highest suicide rate of all U.S. women.
- Are 20% more likely to be diagnosed with bipolar disorder I than whites.
- Have the lowest rate of use of mental health services.
- Have family members that are more likely to participate in treatment decisions.
- Are least likely to use psychiatric medication.
- Have a higher rate of depression than whites, but lower than blacks or Latinos.
Despite these differences, treatment and research specific to minorities remain horribly inadequate. The first step to fixing the problem is acknowledging that it exists. Then we need to educate ourselves on how bipolar disorder itself interacts with race and ethnicity, cultural, social and political forces so that people get the care they need.
Image credit: flickr user Z S