Gender differences in bipolar disorder- a cross-sectional study in central Kerala


  • Bettina Sara Mathew Junior Resident, Department of Psychiatry, Pushpagiri Institute of Medical Sciences & Research Centre, Thiruvalla
  • Soumya P Thomas Senior Resident, Department of Psychiatry, Pushpagiri Institute of Medical Sciences & Research Centre, Thiruvalla
  • Roy Abraham Kallivayalil Professor and HOD, Department of Psychiatry, Pushpagiri Institute of Medical Sciences & Research Centre, Thiruvalla



Gender differences, Bipolar disorder, Cross-sectional study


Introduction: There is a need for better recognition of the nature and course of bipolar disorder among both genders as it may improve the quality of care. The objective of the study was to identify gender differences in sociodemographic characteristics and illness characteristics among patients with bipolar disorder presenting to a tertiary care centre. Methods: This was a cross-sectional descriptive study comparing 50 males and 50 females with a diagnosis of bipolar disorder, current episode manic according to DSM 5 criteria. The sociodemographic and illness-related data were collected from a reliable informant, and the Young Mania Rating Scale (YMRS) was applied. Results: The total number of episodes was similar between genders; however, the number of depressive episodes (p<0.000) was more in females. The majority of males had the first episode of mania, whereas the first episode in females was mostly depressive (p=0.009). Comorbid medical illnesses especially, hypothyroidism and obesity, were seen more often in women and substance use was higher in men. Conclusion: It was found that women often had depressive episodes, whereas a manic picture was commonly seen in men. Endocrine and metabolic abnormalities were more often seen in women with bipolar disorder, while substance abuse was prevalent among men. A substantial difference was noticed in the course, polarity and severity of illness between the genders. This knowledge may provide better insight into adequate treatment strategies for improving the quality of life in persons with Bipolar disorder.


Grunze H. Bipolar disorder. In Neurobiology of brain disorders 2015 Jan 1 (pp. 655-673). Academic Press.

Sadock BJ, Sadock VA. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Lippincott Williams & Wilkins; 2011 Dec 26.

Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, Maj M, et al. Innovations and changes in the ICD?11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019 Feb;18(1):3-19.

Bebbington P, Ramana R. The epidemiology of bipolar affective disorder. Soc Psychiatry Psychiatr Epidemiol 1995;30:279-92.

Taylor MA, Abrams R. Gender differences in bipolar affective disorder. Journal of affective disorders. 1981 Sep 1;3(3):261-71.

Angst J. The course of affective disorders. II. Typology of bipolar manic-depressive illness. Arch Psychiatr Nervenkr. 1978;226:65–74.

Robb JC, Young LT, Cooke RG, Joffe RT. Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores. J Affect Disord 1998; 49: 189–193.

Pillai M, Munoli RN, Praharaj SK, Bhat SM. Gender Differences in Clinical Characteristics and Comorbidities in Bipolar Disorder: a Study from South India. Psychiatric Quarterly. 2020 Sep 5:1-0.

Leibenluft E. Issues in the treatment of women with bipolar illness. Journal of Clinical Psychiatry. 1997 Jan 1;58(15):5-11.

Azorin JM, Belzeaux R, Kaladjian A, Adida M, Hantouche E, Lancrenon S, et al. Risks associated with gender differences in bipolar I disorder. Journal of affective disorders. 2013 Dec 1;151(3):1033-40.

Faedda GL, Tondo L, Teicher MH, Baldessarini RJ, Gelbard HA, Floris GF. Seasonal mood disorders: patterns of seasonal recurrence in mania and depression. Archives of general psychiatry. 1993 Jan 1;50(1):17-23.

Yildiz A, Sachs GS. Age onset of psychotic versus nonpsychotic bipolar illness in men and in women. J Affect Disord 2003; 74: 197–201.

Hendrick V, Altshuler LL, Gitlin MJ, Delrahim S, Hammen C. Gender and bipolar illness. J Clin Psychiatry 2000; 61: 393–396.

Arnold LM. Gender differences in bipolar disorder. Psychiatr Clin North Am. 2003;26:595–620.

Subramanian K, Sarkar S, Kattimani S. Bipolar disorder in Asia: illness course and contributing factors. Asian J Psychiatr. 2017;29:16–29.

Chatterjee S, Kulhara P. Symptom resolution and short

term course in mania. Indian J Psychiatry. 1989;31:213–8.

Sylvia LG, Montana RE, Deckersbach T, Thase ME, Tohen M, Harrington NR, et al. Poor quality of life and functioning in bipolar disorder. Int J Bipolar Disord. 2017;5:10.

Bhattacharya A, Khess CR, Munda SK, Bakhla AK, Praharaj SK, Kumar M. Sex difference in symptomatology of manic episode. Comprehensive psychiatry. 2011 May 1;52(3):288-92.

Saraf AS. Age and Gender Differences in Phenomenology of Major Depression in A Tertiary Mental Health Institute in Northeast of India. Indian J Psychiatry 2016 Jan 1 (Vol. 58, No. 5, pp. S63-S63).

Thomas SP, Nisha A, Varghese PJ. Disability and Quality of Life of Subjects with Bipolar Affective Disorder in Remission. Indian J Psychol Med. 2016 Jul-Aug;38(4):336-40. doi: 10.4103/0253-7176.185941. PMID: 27570346; PMCID: PMC4980902.

Chaudhury S, Bakhla AK, Vijay SK, Mujawar S, Dewan C. Gender Differences in Mania. Indian Journal of Medical Psychiatry. 2019;2(1):19-24.

Martinez-Aran A, Scott J, Colom F, Torrent C, Tabares-Seisdedos R, Daban C, et al. Treatment nonadherence and neurocognitive impairment in bipolar disorder. Journal of Clinical Psychiatry. 2009 Jul 7;70(7):1017.

Grover S, Sahoo S, Chaudhary S, Chakrabarti S, Nehra R, Avasthi A. Gender differences, family size and fertility rate among patients with bipolar disorder: A study from India. Psychiatry research. 2019 Feb 1;272:562-8.

McMahon FJ, Stine OC, Chase GA, Meyers DA, Simpson SG, DePaulo JR Jr. Influence of clinical subtype, sex, and linearity on age at onset of major affective disorder in a family sample. Am J Psychiatry 1994; 151: 210–215.

Viguera A, Baldessarini R, Tondo L. Response to lithium maintenance treatment in bipolar disorders: comparison of women and men. Bipolar Disord 2001;3:245–52.

Kawa I, Carter JD, Joyce PR, Doughty CJ, Frampton CM, Wells JE, et al. Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation. Bipolar Disord. 2005;7:119–25.

Kessing LV. Gender differences in the phenomenology of bipolar disorder. Bipolar Disord. 2004;6:421–5.

Leboyer M, Henry C, Paillere?Martinot ML, Bellivier F. Age at onset in bipolar affective disorders: a review. Bipolar disorders. 2005 Apr;7(2):111-8.

Chopra HD, Bhaskaran K, Verma IP. Socioeconomic status and manic depressive psychosis. Indian J Psychiatry. 1970;12:40–7.

Khess CR, Das J, Akhtar S. Four year follow-up of first episode manic patients. Indian J Psychiatry. 1997;39:160–5.

McElroy SL, Arnold LM, Altshuler LL. Bipolarity in women: therapeutic. In: Akiskal HS, Tohen M, editors. Bipolar psychopharmacotherapy: caring for the patient. 1st ed. West Sussex: Wiley; 2006. p. 235–78.

Mortensen PB, Pedersen CB, Melbye M, Mors O, Ewald H. Individual and familial risk factors for bipolar affective disorders in Denmark. Arch Gen Psychiatry. 2003;60:1209–15.

Kirgaval RS, Revanakar S, Srirangapattna C. Prevalence of Extrapyramidal Side Effects in Patients on Antipsychotics Drugs at a Tertiary Care Center5. Journal of Psychiatry. 2017 Jul;20(5):1-5.

Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB. Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity and recurrence. Journal of affective disorders. 1993 Oct 1;29(2-3):85-96.

Kallivayalil RA, Chadda RK, Mezzich JE. Indian psychiatry: Research and international perspectives. Indian journal of psychiatry. 2010 Jan;52(Suppl1): S38.




How to Cite

Mathew, B. S. ., Thomas, S. P. ., & Kallivayalil, R. A. . (2022). Gender differences in bipolar disorder- a cross-sectional study in central Kerala. Kerala Journal of Psychiatry, 35(1), 1–8.



Research Report