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Rowe AL, Perich T, Meade T. Bipolar disorder and cumulative trauma: A systematic review of prevalence and illness outcomes. J Clin Psychol 2024; 80:692-713. [PMID: 38277425 DOI: 10.1002/jclp.23650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/24/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND The experience of cumulative trauma may be common in bipolar disorder (BD). However, it is not frequently reported as most studies focus on childhood trauma without examining differences in the amount of trauma experienced. This systematic review aimed to determine the prevalence of lifetime cumulative trauma in BD as well as explore associated illness outcomes. METHODS A systematic review was completed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Both the prevalence and outcomes of cumulative trauma in BD were assessed. Five electronic databases were searched (Embase, MEDLINE, PsycINFO, Web of Science, and PTSD Pubs) for records from January 2010 until December 2022. RESULTS A total of 20 studies, with 9304 participants were included in the narrative synthesis. At least one-third of BD participants had experienced cumulative trauma, with a prevalence range from 29% to 82%. The main outcomes associated with a history of cumulative trauma were earlier age of onset, longer episode duration, more lifetime mood episodes, greater likelihood of experiencing psychotic features, and higher likelihood of past suicide attempts. LIMITATIONS This review has been limited by the lack of studies directly assessing cumulative trauma in BD. CONCLUSIONS Cumulative trauma is prevalent in BD. Preliminary evidence indicates an association with a range of adverse outcomes, emphasizing the need for clinicians to obtain a detailed trauma history and to consider these risks in the management of the disorder. Future studies should report on the prevalence of cumulative trauma, particularly in adulthood as this area remains unexplored.
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Affiliation(s)
- Amy-Leigh Rowe
- School of Psychology, Western Sydney University, Penrith, Australia
| | - Tania Perich
- School of Psychology, Western Sydney University, Penrith, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, Penrith, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
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Cumulative trauma in bipolar disorder: An examination of prevalence and outcomes across the lifespan. J Affect Disord 2023; 327:254-261. [PMID: 36566941 DOI: 10.1016/j.jad.2022.12.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/08/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Trauma is highly prevalent in bipolar disorder, and while considerable research has been undertaken in relation to childhood trauma, little is known about the experience and the impact of exposure to multiple trauma types across the lifespan, otherwise known as cumulative trauma. This study aimed to examine the prevalence of cumulative trauma in bipolar disorder and explore its association with illness and other outcomes. METHODS Participants were recruited online globally and comprised 114 adults aged 23 to 73 years with BD-I (41.2 %) or BD-II (58.8 %). Participants completed an online questionnaire containing items regarding symptoms and trauma history followed by a diagnostic interview to confirm their BD diagnosis and assess BD symptoms. RESULTS Cumulative trauma accounted for most of the trauma exposure across both childhood (n = 89; 78.1 %) and adulthood (n = 72; 63.2 %). Those with lifetime cumulative trauma (n = 64; 56 %) were more likely to experience at least one other co-morbid mental health condition in addition to their BD diagnosis (88 %) and report significantly lower ratings of perceived social support compared to those who did not experience any cumulative trauma (N = 15; 13 %). LIMITATIONS This study has been limited by the cross-sectional retrospective design as well as the use of self-selection to participate. CONCLUSIONS Cumulative trauma is highly prevalent in bipolar disorder and is associated with greater likelihood of experiencing a psychiatric comorbidity and decreased levels of social support. More research is needed to explore the nature of this relationship and determine whether increasing social support may be of benefit.
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Hosang GM, Manoli A, Shakoor S, Fisher HL, Parker C. Reliability and convergent validity of retrospective reports of childhood maltreatment by individuals with bipolar disorder. Psychiatry Res 2023; 321:115105. [PMID: 36796256 DOI: 10.1016/j.psychres.2023.115105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/28/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
Childhood maltreatment is associated with the etiology and clinical course of bipolar disorder. Most studies employ retrospective maltreatment self-reports which are vulnerable to bias, raising questions about their validity and reliability. This study examined the test-retest reliability over 10 years, the convergent validity and the impact of current mood on retrospective reports of childhood maltreatment in a bipolar sample. 85 participants with bipolar I disorder completed the Childhood Trauma Questionnaire [CTQ] and the Parental Bonding Instrument [PBI] at baseline. Beck Depression Inventory and Self Report Mania Inventory assessed depressive and manic symptoms, respectively. 53 participants completed the CTQ at baseline and 10-year follow-up. Good levels of convergent validity were observed between the CTQ and PBI. Correlations ranged from rs= -0.35 (CTQ emotional abuse and PBI paternal care) to rs= -0.65 (CTQ emotional neglect and PBI maternal care). Good agreement between CTQ reports at baseline and 10-year follow-up were found (range: κ=0.41 for physical neglect to κ=0.83 for sexual abuse). Higher depression and mania scores were recorded among participants who reported abuse (but not neglect) compared to those without such reports. These findings support using this method in research and clinical practice, though current mood should be taken into account.
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Affiliation(s)
- Georgina M Hosang
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary, University of London, London, UK.
| | - Athina Manoli
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary, University of London, London, UK
| | - Sania Shakoor
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary, University of London, London, UK
| | - Helen L Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Camilla Parker
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary, University of London, London, UK
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Gilmoor AR, Vallath S, Peters RMH, van der Ben D, Ng L. Adapting the Trauma History Questionnaire for use in a population of homeless people with severe mental illness in Tamil Nadu, India: qualitative study. BJPsych Open 2021; 7:e122. [PMID: 34218840 PMCID: PMC8280791 DOI: 10.1192/bjo.2021.952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Trauma History Questionnaire (THQ) is one of the most widely used traumatic event inventories, but its lack of validation makes it unsuitable for the millions of homeless people with severe mental illness in India, who are particularly vulnerable to trauma exposure. AIMS To translate and culturally adapt the THQ for use in a population of homeless people with severe mental illness in Tamil Nadu, India. METHOD We used Herdman et al's model of cultural equivalence to conduct an in-depth qualitative assessment of the cultural validity of the THQ. Following several translations, conceptual, item, semantic and operational equivalence of the THQ was assessed through four focus groups with user-survivors (n = 20) and two focus groups with mental health professionals (n = 11). RESULTS Several adaptations, including the addition of 18 items about relationships, homelessness and mental illness, were necessary to improve cultural validity. Three items, such as rape, were removed for reasons of irrelevance or cultural insensitivity. Items like 'adultery' and 'mental illness' were reworded to 'extramarital affair' and 'mental health problem', respectively, to capture the cultural nuances of the Tamil language. Findings revealed a divergence in views on tool acceptability between user-survivors, who felt empowered to voice their experiences, and mental health professionals, who were concerned for patient well-being. Providing a sense of pride and autonomy, user-survivors preferred self-administration, whereas mental health professionals preferred rater administration. CONCLUSIONS Culture significantly affects what types of events are considered traumatic, highlighting the importance of cultural validation of instruments for use in novel populations and settings.
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Affiliation(s)
- Andrew R Gilmoor
- Department of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Smriti Vallath
- Department of Science, Vrije Universiteit Amsterdam, The Netherlands; Department of Psychology, Banyan Academy of Leadership in Mental Health, India; and The Banyan, India
| | - Ruth M H Peters
- Department of Science, Vrije Universiteit Amsterdam, The Netherlands; and Department of Global Health and Social Medicine, Harvard Medical School, USA
| | | | - Lauren Ng
- Department of Psychiatry, Boston University School of Medicine, USA; and Department of Psychology, University of California Los Angeles, USA
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Zhang S, Lin X, Yang T, Zhang S, Pan Y, Lu J, Liu J. Prevalence of childhood trauma among adults with affective disorder using the Childhood Trauma Questionnaire: A meta-analysis. J Affect Disord 2020; 276:546-554. [PMID: 32871685 DOI: 10.1016/j.jad.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Childhood trauma is associated with major depressive disorder (MDD) and bipolar disorder (BD) in adults. However, no meta-analysis was performed on the prevalence of different types of childhood trauma in adults with affective disorders, using the Childhood Trauma Questionnaire (CTQ). METHODS Four databases were used to search articles regarding the prevalence of childhood emotional abuse (CEA), childhood physical abuse (CPA), childhood sexual abuse (CSA), childhood physical neglect (CPN), and childhood emotional neglect (CEN) in patients with MDD and BD using the CTQ. RESULTS A total of 17 and 11 articles were found analyzing patients with MDD and BD, respectively. A pooled prevalence rate of 33.0% and 30.0% for CEA, 17.0% and 18.0% for CPA, 19.0% and 22.0% for CSA, 37.0% and 31.0% for CEN, and 31% and 30.0% for CPN was found in patients with MDD and BD respectively. A difference in 95% confidence interval in the CSA rate between men and women was found in patients with MDD in the gender subgroup and in the rate of some types of childhood trauma in the continent subgroup in both patient types. LIMITATIONS A limited number of articles were included in some continents, thus, the heterogeneity in the meta-analysis was generally high. CONCLUSION The prevalence of CEA, CEN, and CPN in patients with affective disorders was relatively high, whereas that of CPA and CSA was relatively low. These childhood traumas might be affected by continent and gender.
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Affiliation(s)
- Simei Zhang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China
| | - Xiujin Lin
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080
| | - Tingyu Yang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Shengjie Zhang
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning 530000, China
| | - Yuli Pan
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning 530000, China
| | - Jianping Lu
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China.
| | - Jianbo Liu
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China.
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Ventimiglia I, Van der Watt ASJ, Kidd M, Seedat S. Association between trauma exposure and mood trajectories in patients with mood disorders. J Affect Disord 2020; 262:237-246. [PMID: 31718804 DOI: 10.1016/j.jad.2019.10.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/06/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Trauma exposure is associated with the development of mood disorders and their phenotypic presentation. Cross-sectional associations between trauma exposure and mood disorders are well documented. Data on the association of trauma with longitudinal mood trajectories are lacking. We investigated the association between trauma exposure and weekly mood trajectories. METHOD Mood disorder patients (N = 107; female = 81; mean age = 37.04 years), assessed for trauma exposure at baseline using the Childhood Trauma Questionnaire (CTQ) and Life Events Checklist (LEC), completed weekly telephonic mood assessments using the Quick Inventory of Depressive Symptomatology (QIDS) and Altman Self-Rating Mania scale (ASRM) over a 16 week period commencing at one week post-discharge from hospital. Associations between trauma exposure, severity of mood symptoms and mood trajectories were analysed using Pearson's correlations, LS Mean scores, F-statistics, and RMANOVA. RESULTS Trauma exposure was persistently associated, albeit with some fluctuation in the strength of the association, with depressive symptomatology. Emotional abuse showed the most persistent association over time. Sexual abuse was minimally associated with depressive symptomatology. The severity of childhood trauma exposure was positively correlated with the severity of depressive symptoms. Lifetime traumatic events were significantly associated with mania scores, however there was no association between childhood trauma exposure and mania symptoms. CONCLUSION Identification of both a history of childhood abuse and neglect and lifetime traumatic event exposure is important in the assessment and management of patients with mood disorders, as trauma can exert a persistent impact on depression trajectories and on symptom severity.
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Affiliation(s)
- I Ventimiglia
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - A S J Van der Watt
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Kidd
- Department of Statistics and Actuarial Sciences, University of Stellenbosch, Stellenbosch, South Africa.
| | - S Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Read J, Harper D, Tucker I, Kennedy A. Do adult mental health services identify child abuse and neglect? A systematic review. Int J Ment Health Nurs 2018; 27:7-19. [PMID: 28815844 DOI: 10.1111/inm.12369] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 11/26/2022]
Abstract
Child abuse and neglect play a causal role in many mental health problems. Knowing whether users of mental health services were abused or neglected as children could be considered essential for developing comprehensive formulations and effective treatment plans. In the present study we report the findings of a systematic review, using independent searches of three databases designed to discover how often mental health staff find out whether their clients were abused or neglected as children. Twenty-one relevant studies were identified. Most people who use mental health services are never asked about child abuse or neglect. The majority of cases of child abuse or neglect are not identified by mental health services. Only 28% of abuse or neglect cases identified by researchers are found in the clients' files: emotional abuse, 44%; physical abuse, 33%; sexual abuse, 30%; emotional neglect, 17%; and physical neglect, 10%. Between 0% and 22% of mental health service users report being asked about child abuse. Men and people diagnosed with psychotic disorders are asked less than other people. Male staff ask less often than female staff. Some improvement over time was found. Policies compelling routine enquiry, training, and trauma-informed services are required.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
| | - David Harper
- School of Psychology, University of East London, London, UK
| | - Ian Tucker
- School of Psychology, University of East London, London, UK
| | - Angela Kennedy
- Tees, Esk and Wear Valleys National Health Service Foundation Trust, Darlington, UK
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The association between childhood trauma, parental bonding and depressive symptoms and interpersonal functioning in depression and bipolar disorder. Ir J Psychol Med 2017; 35:23-32. [DOI: 10.1017/ipm.2016.43] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ObjectivesThis study explores rates of a history of childhood trauma in adult patients with bipolar disorder and depression and the impact of such trauma and parental bonding patterns on depressive mood and interpersonal functioning at the time of assessment.MethodsA cross-sectional design was used and a sample of 49 participants was recruited from a mental health outpatient service in Northern Ireland. Data were subject to correlations, one-way analysis of variance and hierarchal regression analyses. A cut-off point of r=±0.25 was used to select variables for inclusion in the hierarchal regression analyses.ResultsHigh rates of childhood trauma were present in both samples: 74% in bipolar disorder and 82% in depression. Childhood trauma and poor parental bonding (with mother) were significant predictors of higher rates of current inter-episode depressive mood and interpersonal difficulties.ConclusionsThis finding adds to the evidence that routine assessment of early childhood experience is likely to prove helpful in clinical care.
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Shannon C, Hanna D, Tumelty L, Waldron D, Maguire C, Mowlds W, Meenagh C, Mulholland C. Reliability of reports of childhood trauma in bipolar disorder: A test-retest study over 18 months. J Trauma Dissociation 2016; 17:511-9. [PMID: 26835747 DOI: 10.1080/15299732.2016.1141147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to explore the reliability of self-reported trauma histories in a population with a diagnosis of bipolar disorder using the Childhood Trauma Questionnaire. Previous studies in other populations suggest high reliability of trauma histories over time, and it was postulated that a similar high reliability would be demonstrated in this population. A total of 39 patients with a confirmed diagnosis (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria) were followed up and readministered the Childhood Trauma Questionnaire after 18 months. Cohen's kappa scores and intraclass correlations suggested reasonable test-retest reliability over the 18-month time period of the study for all types of childhood abuse, namely, emotional, physical, and sexual abuse and physical and emotional neglect. Intraclass correlations ranged from r = .50 (sexual abuse) to r = .96 (physical abuse). Cohen's kappas ranged from .44 (sexual abuse) to .76 (physical abuse). Retrospective reports of childhood trauma can be seen as reliable and are in keeping with results found with other mental health populations.
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Affiliation(s)
- Ciaran Shannon
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - Donncha Hanna
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - Leo Tumelty
- b Department of Psychiatry , Western Health and Social Care Trust , Derry , Northern Ireland
| | - Daniel Waldron
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - Chrissie Maguire
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - William Mowlds
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - Ciaran Meenagh
- c Department of Psychiatry , Northern Health and Social Care Trust , Newtownabbey , Northern Ireland
| | - Ciaran Mulholland
- d School of Medicine , Queen's University Belfast , Belfast , Northern Ireland
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Cunningham T, Shannon C, Crothers I, Hoy K, Fitzsimmons C, McCann R, O’Hare J, Mulholland C. Enquiring about traumatic experiences in psychosis: A comparison of case notes and self-report questionnaires. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2016. [DOI: 10.1080/17522439.2015.1115542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bosqui TJ, Shannon C, Tiernan B, Beattie N, Ferguson J, Mulholland C. Childhood trauma and the risk of violence in adulthood in a population with a psychotic illness. J Psychiatr Res 2014; 54:121-5. [PMID: 24694670 DOI: 10.1016/j.jpsychires.2014.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
Abstract
There are strong links between childhood trauma and the risk of violence (Ford et al., 2007). Despite evidence that people with psychotic disorders are at a higher risk of violence than the general population (Witt et al., 2013) there have been few studies that have examined the trauma-violence link in this population (Spidel et al., 2010). This study explored the association between a history of childhood trauma (abuse, neglect and conflict-related trauma) and the risk of violence in adults with psychotic disorders. The strongest associations with the risk of violence were found for sexual abuse (r = .32, p < .05) and the impact of community conflict (r = .32, p < .05). An accumulative effect of trauma was found using a hierarchical regression (adjusted R(2) = .14, F(2,37) = 4.23, p < .05). There are implications for applying models of violence to psychosis, risk assessment and treatment of people with psychotic disorders as well as informing trauma models and protective factors for children in conflict-affected regions.
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Affiliation(s)
- Tania Josiane Bosqui
- School of Psychology, Queens University Belfast, Belfast, BT7 1NN, Northern Ireland, UK.
| | - Ciarán Shannon
- School of Psychology, Queens University Belfast, Belfast, BT7 1NN, Northern Ireland, UK
| | - Bridget Tiernan
- School of Psychology, Queens University Belfast, Belfast, BT7 1NN, Northern Ireland, UK
| | - Nicola Beattie
- Shannon Clinic, Regional Forensic Unit, Knockbracken Health Care Park, Belfast, Northern Ireland, UK
| | - John Ferguson
- Shannon Clinic, Regional Forensic Unit, Knockbracken Health Care Park, Belfast, Northern Ireland, UK
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Maniglio R. The impact of child sexual abuse on the course of bipolar disorder: a systematic review. Bipolar Disord 2013; 15:341-58. [PMID: 23346867 DOI: 10.1111/bdi.12050] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this review was to elucidate the impact of child sexual abuse on all clinical phenomena that occur after the onset of bipolar disorder, including associated clinical features that are not part of the diagnostic criteria for the disorder. METHODS Five databases were searched and supplemented with a hand search of reference lists from retrieved papers. Study quality was assessed using a validated quality assessment tool. Blind assessments of study eligibility and quality were conducted by two independent researchers to reduce bias, minimize errors, and enhance the reliability of findings. Disagreements were resolved by consensus. RESULTS Eighteen studies that included a total of 2996 adults and youths with bipolar disorder and met the minimum quality criteria necessary to ensure objectivity and not invalidate results were analyzed. Across studies, child sexual abuse was strongly (and perhaps directly) associated with posttraumatic stress disorder; whereas it was less strongly (and perhaps indirectly) related to suicide attempts, alcohol and/or drug abuse or dependence, psychotic symptoms, and an early age of illness onset. In regard to the association between child sexual abuse and other clinical variables concerning the course of bipolar disorder, evidence was scant or conflicting. CONCLUSIONS Child sexual abuse is associated (either directly or indirectly) with some clinical phenomena that represent a more severe form of bipolar disorder. Although such a traumatic experience may directly affect the development of posttraumatic stress disorder, the effects of early sexual abuse on later suicidal behavior, substance abuse, and psychotic symptoms may operate through the mediating influences of certain psychopathological or neurobiological variables.
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Affiliation(s)
- Roberto Maniglio
- Department of Pedagogic, Psychological, and Didactic Sciences, University of Salento, Lecce, Italy
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Maniglio R. Prevalence of child sexual abuse among adults and youths with bipolar disorder: a systematic review. Clin Psychol Rev 2013; 33:561-73. [PMID: 23563080 DOI: 10.1016/j.cpr.2013.03.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 03/05/2013] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Abstract
To estimate the prevalence and social and demographic correlates of child sexual abuse among people with bipolar disorder, the findings of all the pertinent studies were qualitatively and semi-quantitatively analyzed. Five databases were searched. Blind assessments of study eligibility and quality were conducted by two independent researchers. Twenty studies, meeting minimum quality standards and including 3407 adults and youths with bipolar disorder across 10 countries and 3 continents, were examined. The prevalence of child sexual abuse was 24% (23% without outliers); however, such prevalence rate might be underestimated, because many studies restricted definitions to the most severe forms of abuse. Child sexual abuse was a common experience for both males and females, while it was more frequent for adults than for youths. Compared to healthy individuals, patients with bipolar disorder reported higher rates of child sexual abuse; compared to populations with other mental disorders, participants with bipolar disorder reported similar or lower rates of such abuse. Individuals with bipolar disorder are at risk of having a history of child sexual abuse, although such risk seems to be neither more specific to nor stronger for these individuals, compared to people with other psychiatric disorders.
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Affiliation(s)
- Roberto Maniglio
- Department of Pedagogic, Psychological, and Didactic Sciences, University of Salento, Via Stampacchia 45/47, 73100 Lecce, Italy.
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