Preliminary Analysis of the UK Mental Health Research Funding Landscape: Bipolar Disorder Research By Anne Kirtley Ph.D.

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1 Preliminary Analysis of the UK Mental Health Research Funding Landscape: Bipolar Disorder Research By Anne Kirtley Ph.D. Table of Contents 1 Introduction Major UK Funders of Bipolar Disorder Research Overview of Total Amount Awarded: by Funding Body Overview of Total Amount Awarded: by Year and Funding Body Overview of Total Amount Awarded: by Research Activity Detailed Analysis of Bipolar Disorder Research Grants UK Funding for Bipolar Disorder Co-morbidity Research Other Perspectives of UK Funded Bipolar Disorder Research Demographics of UK Funded Bipolar Disorder Research The Driving Hubs of Bipolar Disorder Research Funded by UK Funding Bodies Discussion Acknowledgements References Introduction The term bipolar disorder refers to a group of affective disorders characterized by depressive and manic or hypomanic episodes 1. While the term bipolar was first used in 1957, it was not until 1980 that it replaced the term manic depression in the diagnostic and statistical manual for mental disorders (DSM) 1. According to the DSM-IV there are four bipolar disorder subtypes: bipolar disorder type I, bipolar disorder type II, cyclothymic disorder and bipolar disorder not otherwise specified 1. However, in reality, patients often present with a range of symptoms and co-morbid disorders preventing an exact fit into these subtypes. From our UK mental health funding landscape analysis we found that only 24 grants related to bipolar disorder have been awarded between 2008 and 2013 and, in total, bipolar disorder research received only 1.5% of the total UK mental health research expenditure over these last six years, equating to 7.7 million. The investment in bipolar disorder research is low considering its prevalence and socioeconomic burden. For comparison, schizophrenia research received 5.1% of the total UK mental health research funding within the same time window despite having a lower prevalence; in the USA approximately 2% of the population are affected by bipolar disorder and 1% of the population are affected by schizophrenia 2, 3. While bipolar disorder research is underfunded, it is worth pointing out that research conducted in other more general mental health related categories will no doubt influence the progress of bipolar disorder research, in the same way that it will other mental health disorders. These general categories include brain function, brain dysfunction and psychiatric population and services research. Research in related categories that may have a stronger bearing on bipolar disorder research include depression and psychosis research. However, the applicability of depression and psychosis research to bipolar disorder research should be carefully considered. For example, research has shown that individuals with bipolar disorder and depression often have different responses to antidepressants 4. There is also evidence to suggest that

2 psychotic behavior in individuals with schizophrenia and bipolar disorder differ in that the episodes of psychosis are more mood congruent in individuals with bipolar disorder 5. Another category which could yield findings directly relevant to bipolar disorder research is the affective/ mood disorders research category but, as defining information was unavailable at the time of the analysis, it is not known whether these studies relate to depression and anxiety or depression and bipolar disorder research. 2 Major UK Funders of Bipolar Disorder Research Of the 11 funding bodies searched in our UK mental health research funding landscape analysis only 8 funding bodies awarded any grants towards bipolar disorder research. These funding bodies included the National Institute for Health Research (NIHR), Medical Research Council (MRC), Biotechnology and Biological Sciences Research Council (BBSRC), Economic and Social Research Council (ESRC), Chief Scientists Office (CSO), Public Health Agency Health and Social Care (PHA HSC), National Institute for Social Care and Health Research (NISCHR) and the Wellcome Trust (WT). 2.1 Overview of Total Amount Awarded: by Funding Body Just under half of the bipolar disorder research in the UK between 2008 and 2013 was funded by the NIHR, which spent 4.9 million. Investment by the MRC and WT combined approximately matched that by the NIHR. The other UK funding bodies that made minor investments in bipolar disorder research included the BBSRC, ESRC, CSO and NISCHR, all contributing somewhere between CSO, 0.2 BBSRC, 0.3 ESRC, 0.2 NISCHR, 0.1 WT, 2.3 NIHR, 4.9 MRC, 2.8 Figure 1. Funding awarded ( millions) to bipolar disorder research by the different research funding bodies between Overview of Total Amount Awarded: by Year and Funding Body In addition to bipolar disorder research appearing to be massively underfunded, the distribution of funding over the last six years has been considerably variable (Figure 2). This does not bode well for the field of research because unstable funding leads to difficulties in recruiting and retaining the expert capacity necessary for an improved future of bipolar disorder research. Of particular concern is the decrease in NIHR investment across the six years, ranging from 2.1 million investment in 2008 to no investment in As for the other main funders of bipolar disorder research, the MRC invested significant funds in five of the six years and the WT invested a sizable amount in two of the six years. The awards from the other funding bodies were small, with none of these funding bodies investing in the field for more than two years. 2

3 Amount Awarded ( m) NISCHR ESRC CSO BBSRC WT MRC NIHR Year Figure 2. Total funding awarded to mental health research each year between by the different UK funding bodies. 2.3 Overview of Total Amount Awarded: by Research Activity The majority of bipolar disorder research funding has focused on aetiology and health and social care services research activities, each of which received investment totaling approximately 3 million (Figure 3). The other research activities received between 0.6 and 1.2 million each, with the exception of underpinning research that received no funds. Despite there being no investment in underpinning research specific to bipolar disorder research, investment in related mental health research such as brain function and dysfunction, will no doubt yield findings that will inform bipolar disorder research. Amount Awarded ( m) Underpinning Research Aetiology Prevention of Disease & Conditions, & Promotion of Well-Being Detection, Screening & Diagnosis Development of Treatments & Therapeutic Interventions Evaluation of Treatments & Therapeutic Interventions Management of Disease & Conditions Health & Social Care Services Research Research Activity Figure 3. Total amount awarded to different research activities between

4 3 Detailed Analysis of Bipolar Disorder Research Grants 3.1 UK Funding for Bipolar Disorder Co-morbidity Research There have been only two grants funded that investigate bipolar disorder with another co-morbid disorder. In both cases the co-morbid disorder is another mental health disorder. The grant project titles are: Variation and specificity of eye movement dysfunction in schizophrenia, schizoaffective and bipolar disorders. Bipolar affective disorder or borderline personality disorder? An exploration of patient and clinician experience. This very limited UK investment in bipolar disorder co-morbidity research is particularly surprising as the disorder is often compared with depression and psychosis (see section 1). 3.2 Other Perspectives of UK Funded Bipolar Disorder Research As discussed in the main overview report, there are many different mental health related research approaches taken in addition to the disorder, co-morbid disorders or general based approaches. Themes that are of particular interest to MQ include research related to psychological treatments, suicide and selfharm, and mental health in the workplace. Of the 24 grants awarded to bipolar disorder research there are two studies that have been funded to investigate the effectiveness of psychological treatments: A Pilot Randomised Controlled Trial of CBT for People with Bipolar Disorders and Current Symptoms: Think Effectively About Mood Swings (TEAMS). A Pilot Study to Assess the Feasibility of a Web-based Intervention for Prevention of Relapse in Bipolar Disorder (ERP-Online). While none of the 24 bipolar disorder research grants pertain to mental health in the workplace, there is one study that investigates suicide in bipolar disorder: Reducing relapse and suicide in bipolar disorder: Practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care. All three of these perspectives are relevant to bipolar disorder research, and further investment in these avenues of research has the potential to improve or indeed save the lives of many individuals with bipolar disorder. 3.3 Demographics of UK Funded Bipolar Disorder Research Most UK funded bipolar disorder research has been conducted on adults but there have been two studies focused on adolescents or children with bipolar disorder. Other demographics of note amongst the funded research include two studies that between them cover pregnancy, postpartum and parenting in individuals with bipolar disorder. 4

5 4 The Driving Hubs of Bipolar Disorder Research Funded by UK Funding Bodies Funding for bipolar disorder research in the UK has been awarded to just 18 different universities, institutes and National Health Service (NHS) Trusts across the country. The distribution of these funds are not, however, evenly distributed and a large proportion of the total funding has been awarded to just several key hubs. The geographical location of the key UK driving hubs for bipolar disorder research include London, Oxford and Sheffield (figure 4). Figure 4. Geographical location within the UK of the awardee institutions. The size of the markers represent the relative amount awarded to that institute for psychological treatments research between Discussion This report highlights that the UK investment in bipolar disorder research is disproportionately low compared to that of some other mental health disorders. It also highlights that the little funding that has been awarded over the last six years spans many research activities, research perspectives and different demographics. There appear to be multiple avenues within the field of bipolar disorder research ripe for investment. The fact that government funding in this field of research is at an all time low alerts us to the need for an injection of funding, not only to yield discoveries to improve the lives of individuals with bipolar disorder, but also to secure the future of bipolar disorder research by providing funds to retain and foster high quality capacity within the field. There appear to be three key hubs of bipolar disorder research in the UK. It may be worth consulting with the investigators working within these hubs as a starting point to find out more about what factors have made their success possible and what difficulties they are still struggling to overcome. The results gleaned from this preliminary study, as presented in this report, have illuminated how greatly the development of a research programme could benefit from a greater understanding of the mental health 5

6 research funding history. However, as this report has only covered grants funded by UK mental health research funding bodies, it is worth considering that mental health research is a truly global enterprise. Therefore, to be confident of identifying underfunded areas of research, a study following the approach taken in this preliminary study would need to be conducted at a worldwide level and, if possible, should also include research conducted by industry. 6 Acknowledgements I would like to thank Cynthia Joyce, Alison Cranage, Sarah Shennow and Olivia Birkby for their valuable advice, discussions and comments throughout the process of conducting and writing up this UK mental health research funding landscape. I would also like to thank the following individuals for their assistance in providing extra information where it was not publically available or for directing me to additional publically available sources of data: David Kryl from the NIHR, Linda Wheeler from RCUK, Anne Sanderson from the Wellcome Trust, Angela Caldwell and Margaret Blakley from PHA HSC and Andrew Privett from NISCHR. I would also like to thank Steve Wooding and Alex Pollitt from RAND Europe for their comments on the methodology that I employed in order to conduct this UK funding landscape analysis. 7 References 1. Phillips, M. L. and Kupfer, D. J. Bipolar disorder diagnosis: challenges and future directions Lancet 381: Kessler, R.C., Chiu, W.T., Demler, O., Walters, E.E. (2005) Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry 62(6): Regier, D.A., Narrow, W.E., Rae, D.S., Manderscheid, R.W., Locke, B.Z., Goodwin, F.K. (1993) The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 50(2): Geddes, J. R. and Miklowitz, D. J. (2013) Treatment of bipolar disorder Lancet 381: Carpenter, W.T., Bustillo, J.R., Thaker, G.K., van Os, J., Krueger, R.F., Green, M.J. (2009) The psychoses: cluster 3 of the proposed meta-structure for DSM-V and ICD-11. Psychol Med (12):