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Preliminary Analysis of the UK Mental Health Research Funding Landscape:
Bipolar Disorder Research 2008 – 2013
By Anne Kirtley Ph.D.
Table of Contents
1
Introduction ................................................................................................ 1
2
Major UK Funders of Bipolar Disorder Research .................................................. 2
3
Detailed Analysis of Bipolar Disorder Research Grants ......................................... 4
4
The ‘Driving Hubs’ of Bipolar Disorder Research Funded by UK Funding Bodies .......... 5
5
Discussion .................................................................................................. 5
2.1
2.2
2.3
3.1
3.2
3.3
Overview of Total Amount Awarded: by Funding Body ................................................................................. 2
Overview of Total Amount Awarded: by Year and Funding Body .................................................................... 2
Overview of Total Amount Awarded: by Research Activity ........................................................................... 3
UK Funding for Bipolar Disorder Co-morbidity Research .............................................................................. 4
Other Perspectives of UK Funded Bipolar Disorder Research ....................................................................... 4
Demographics of UK Funded Bipolar Disorder Research .............................................................................. 4
6 Acknowledgements ....................................................................................... 6
7
References ................................................................................................. 6
1
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
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 £100 000 - £300 000.
CSO, 0.2 ESRC, 0.2 BBSRC, 0.3 WT, 2.3 NISCHR, 0.1 NIHR, 4.9 MRC, 2.8 Figure 1. Funding awarded (£ millions) to bipolar disorder research by the different research funding bodies
between 2008-2013.
2.2 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
2013. 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 4.0
Amount Awarded (£m)
3.5
3.0
NISCHR
2.5
ESRC
2.0
CSO
BBSRC
1.5
WT
1.0
MRC
0.5
0.0
NIHR
2008
2009
2010
2011
2012
2013
Year
Figure 2. Total funding awarded to mental health research each year between 2008-2013 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)
3.5
3
2.5
2
1.5
1
0.5
0
Underpinning
Research
Aetiology
Prevention of
Disease &
Conditions, &
Promotion of
Well-Being
Detection, Development of Evaluation of Management of Health & Social
Screening & Treatments & Treatments &
Disease &
Care Services
Diagnosis
Therapeutic
Therapeutic
Conditions
Research
Interventions Interventions
Research Activity
Figure 3. Total amount awarded to different research activities between 2008-2013.
3 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 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 2008-2013.
5 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 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: 1663-71
2. 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): 617-27
3. 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): 85–94
4. Geddes, J. R. and Miklowitz, D. J. (2013) ‘Treatment of bipolar disorder’ Lancet 381: 1672-82
5. 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. 200939(12):2025-42
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