Global diversity in bipolar disorder: the role of cultural and social differences with a view to genomics.

Abstract

As global gene discovery efforts turn away from a historic Eurocentric focus and advance towards embracing more diverse populations, consideration of sociocultural aspects of bipolar disorder become critical to their success. Diversity can be leveraged to accelerate gene discovery, via different patterns of linkage disequilibrium that lead to greater resolution of mapping association signals, and convergence of genes and pathways implicated within and across diverse ancestral groups improving our understanding of the molecular underpinnings of disease. However it is not just the differences in linkage disequilibrium structure and allele frequency that drive differences in genomic signals between populations. This review focuses on the role of social, cultural and societal factors on bipolar disorder, and their potential impact on disease prevalence, clinical course and outcome, and disease burden. Social, cultural, and geographical differences in expression of symptoms, and frequency of clinical subtypes in bipolar disorder present both opportunities and challenges to the field. In this era of global multi-ancestry research, resources that facilitate the collection and harmonization of data from culturally and ancestrally-diverse population groups will enhance our ability to gain true biological understanding. Such resources are essential to disambiguate the genetic and environmental components of disease risk, as well as inform effective lifestyle interventions to improve outcome for global citizens living with bipolar disorder.