Research report The lifetime prevalence, health services utilization and risk of suicide of bipolar spectrum subjects, including subthreshold categories in the Sa ˜o Paulo ECA study Doris Hupfeld Moreno a, * , Laura Helena Andrade b a Mood Disorders Unit, Institute of Psychiatry, University of Sa ˜o Paulo School of Medicine, Brazil b Section of Psychiatric Epidemiology—LIM-23, Institute of Psychiatry, University of Sa ˜o Paulo School of Medicine, Brazil Received 4 November 2004; accepted 4 April 2005 Available online 11 July 2005 Abstract Background: Identifying the bipolar (BP) spectrum, including the classic Bipolar I subtype (BP-I), Bipolar II (BP-II) and subthreshold bipolar disorders not meeting DSM-IV diagnostic criteria has raised growing interest, as these softer expressions of bipolar spectrum have been underdiagnosed in spite of clinical consequences. Methods: Data are from the Sao Paulo Epidemiological Catchment Area Study (N = 1464). Non-affective controls were compared to BP spectrum groups, based on DSM-IIIR and on the bclinical significanceQ criteria: Subsyndromal Hypomania (SSH) and Manic Symptoms (MS). Results: The lifetime prevalence of BP subgroups was 8.3% (N = 122). All BP-I and -II and around 75% of SSH and MS subjects had a lifetime depressive syndrome. Compared to controls and MS subjects, BP-I, BP-II and SSH groups searched more medical help and mental health services. SSH group displayed higher rates of clinical significance than BP-I subjects, and suicidality was higher in BP groups compared to controls. Even the softer MS group had higher rate of suicide attempts than SSH subjects. Limitations: This is a cross-sectional study and interviews were conducted by lay personnel. Replication in bigger community samples using a mood spectrum approach is necessary to confirm these findings. However, our findings were very similar to those obtained by other authors. Conclusion: Softer expressions of BP disorders appear in 6.6% of this community sample and have serious clinical consequences, which supports the importance of including these categories in the BP spectrum. D 2005 Elsevier B.V. All rights reserved. Keywords: Bipolar disorders; Bipolar spectrum; Subthreshold bipolar disorders; Subsyndromal hypomania; Manic symptoms 1. Introduction An international consensus reviewing clinical evi- dence (Akiskal et al., 2000), and early epidemiologic studies using the Research Diagnostic Criteria (End- 0165-0327/$ - see front matter D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2005.04.010 * Corresponding author. Rua Capote Valente, 423-Conj 35, 05409-001-Sa ˜o Paulo-SP, Brazil. Tel.: +55 11 3068 0150; fax: +55 11 3063 3417. E-mail address: dorismoreno@uol.com.br (D.H. Moreno). Journal of Affective Disorders 87 (2005) 231 – 241 www.elsevier.com/locate/jad