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Kamali M, Stapp EK, Fullerton JM, Ghaziuddin N, Hulvershorn L, McInnis MG, Mitchell PB, Roberts G, Wilcox HC, Nurnberger JI. Examining the association of familial and social stress, trauma, and support on mood, anxiety, and behavioral symptoms and diagnoses in youth at risk for bipolar disorder and controls. J Affect Disord 2024; 363:79-89. [PMID: 39038624 DOI: 10.1016/j.jad.2024.07.125] [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: 03/25/2024] [Revised: 06/23/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Youth with a family history of bipolar disorder (At-Risk) have a higher risk of developing psychiatric disorders and experiencing environmental stressors than youth without such family history (Control). We studied the differential associations of familial and environmental factors on developing psychiatric diagnoses and symptoms, in At-Risk and Control youth. METHODS At-Risk and Control youth (N = 466, ages 9-22) were systematically assessed for severity of symptoms, psychiatric diagnoses, and self-reported measures of stress and social support. We tested the association of family history and measures of stress or support with symptom severity and diagnoses. RESULTS At-Risk youth had higher symptom severity scores and were more frequently diagnosed with psychiatric disorders (all p values < 0.001). When predicting mood symptom severity, family history had an interaction effect with stressful life events (p < 0.001) and number of distinct traumatic events (p = 0.001). In multivariate models, At-Risk status predicted anxiety disorders (OR = 2.7, CI 1.3-5.4, p = 0.005) and anxiety severity (Coefficient = 0.4, CI 0.2-0.7, p < 0.001) but not mood or behavioral disorder diagnoses or severity. LIMITATIONS Measures of stress and social support were based on self-report. Not all participants had passed through the period of risk for developing the outcomes under study and the follow up period was variable. We could not fully study the differential impact of physical or sexual abuse due to low frequency of occurrence in controls. CONCLUSION At-Risk youth exhibit more severe mood symptoms compared to Controls when exposed to similar levels of stress or trauma. At-Risk youth are also more prone to develop anxiety which may be a precursor for bipolar disorder.
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Affiliation(s)
- Masoud Kamali
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Emma K Stapp
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, NSW, Australia & School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Neera Ghaziuddin
- Department of Psychiatry, Child and Adolescent Psychiatry Section, University of Michigan, Ann Arbor, MI, USA
| | | | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Philip B Mitchell
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Gloria Roberts
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Holly C Wilcox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John I Nurnberger
- Indiana University School of Medicine, Indianapolis, IN, USA; Stark Neurosciences Research Institute, Departments of Psychiatry and Medical and Molecular Genetics, Indianapolis, IN, USA
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Gruber J, Van Meter A, Gilbert KE, Youngstrom EA, Youngstrom JK, Feeny NC, Findling RL. Positive Emotion Specificity and Mood Symptoms in an Adolescent Outpatient Sample. COGNITIVE THERAPY AND RESEARCH 2016; 41:393-405. [PMID: 28529394 DOI: 10.1007/s10608-016-9796-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research on positive emotion disturbance has gained increasing attention, yet it is not clear which specific positive emotions are affected by mood symptoms, particularly during the critical period of adolescence. This is especially pertinent for identifying potential endophenotypic markers associated with mood disorder onset and course. The present study examined self-reported discrete positive and negative emotions in association with clinician-rated manic and depressive mood symptoms in a clinically and demographically diverse group of 401 outpatient adolescents between 11-18 years of age. Results indicated that higher self reported joy and contempt were associated with increased symptoms of mania, after controlling for symptoms of depression. Low levels of joy and high sadness uniquely predicted symptoms of depression, after controlling for symptoms of mania. Results were independent of age, ethnicity, gender and bipolar diagnosis. These findings extend work on specific emotions implicated in mood pathology in adulthood, and provide insights into associations between emotions associated with goal driven behavior with manic and depressive mood symptom severity in adolescence. In particular, joy was the only emotion associated with both depressive and manic symptoms across adolescent psychopathology, highlighting the importance of understanding positive emotion disturbance during adolescent development.
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Affiliation(s)
- June Gruber
- University of Colorado Boulder, Department of Psychology and Neuroscience
| | | | | | - Eric A Youngstrom
- University of North Carolina at Chapel Hill, Department of Psychology
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Contributions of the social environment to first-onset and recurrent mania. Mol Psychiatry 2015; 20:329-36. [PMID: 24751965 PMCID: PMC4206672 DOI: 10.1038/mp.2014.36] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/27/2014] [Accepted: 03/10/2014] [Indexed: 12/02/2022]
Abstract
In treated cohorts, individuals with bipolar disorder are more likely to report childhood adversities and recent stressors than individuals without bipolar disorder; similarly, in registry-based studies, childhood adversities are more common among individuals who later become hospitalized for bipolar disorder. Because these types of studies rely on treatment-seeking samples or hospital diagnoses, they leave unresolved the question of whether or not social experiences are involved in the etiology of bipolar disorder. We investigated the role of childhood adversities and adulthood stressors in liability for bipolar disorder using data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=33 375). We analyzed risk for initial-onset and recurrent DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) manic episodes during the study's 3-year follow-up period. Childhood physical abuse and sexual maltreatment were associated with significantly higher risks of both first-onset mania (odds ratio (OR) for abuse: 2.23; 95% confidence interval (CI)=1.71, 2.91; OR for maltreatment: 2.10; CI=1.55, 2.83) and recurrent mania (OR for abuse: 1.55; CI=1.00, 2.40; OR for maltreatment: 1.60; CI=1.00, 2.55). In addition, past-year stressors in the domains of interpersonal instability and financial hardship were associated with a significantly higher risk of incident and recurrent mania. Exposure to childhood adversity potentiated the effects of recent stressors on adult mania. Our findings demonstrate a role of social experiences in the initial onset of bipolar disorder, as well as in its prospective course, and are consistent with etiologic models of bipolar disorder that implicate deficits in developmentally established stress-response pathways.
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Reward dysregulation and mood symptoms in an adolescent outpatient sample. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 41:1053-65. [PMID: 23783771 DOI: 10.1007/s10802-013-9746-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research on bipolar spectrum disorders (BPSD) in adolescence has burgeoned in the last decade, but continued work is needed to identify endophenotypic markers associated with illness onset and course. The present study examined reward dysregulation--measured via the behavioral activation system (BAS)--as one putative marker of BPSD in adolescence. A diverse group of 425 outpatient adolescents between 11 and 17 years of age (52 % male) completed the Behavioral Inhibition and Activation Scale (BIS-BAS) scale to measure reward dysregulation. Semi-structured interviews determined diagnoses and severity of mood symptoms. Parent-reported BAS was associated with increased symptoms of mania, and parent and adolescent-reported BAS were associated with symptoms of depression. Parent-reported BIS scores were associated with increased symptoms of mania. Results held independent of diagnostic status. Furthermore, parent BIS/BAS reports were stronger predictors for manic symptoms compared to adolescent-reports. Results extend work in adults with BPSD, suggesting a transdiagnostic association between reward dysregulation and mood symptom severity in adolescence.
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Levenson JC, Nusslock R, Frank E. Life events, sleep disturbance, and mania: An integrated model. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/cpsp.12034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fristad MA, Frazier TW, Youngstrom EA, Mount K, Fields BW, Demeter C, Birmaher B, Kowatch RA, Arnold LE, Axelson D, Gill MK, Horwitz SM, Findling RL. What differentiates children visiting outpatient mental health services with bipolar spectrum disorder from children with other psychiatric diagnoses? Bipolar Disord 2012; 14:497-506. [PMID: 22788253 PMCID: PMC3407300 DOI: 10.1111/j.1399-5618.2012.01034.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the contribution of parent-reported manic symptoms, family history, stressful life events, and family environment in predicting diagnosis of bipolar spectrum disorders (BPSD) in youth presenting to an outpatient psychiatric clinic. METHODS A total of 707 6- to 12-year-old children [621 with elevated symptoms of mania (ESM+) based on screening via the Parent General Behavior Inventory 10-item Mania Scale (PGBI-10M) and 86 without ESM (ESM-)] received a comprehensive assessment. RESULTS Of the 629 with complete data, 24% (n = 148) had BPSD. Compared to those without BPSD (n = 481), children with BPSD: were older (Cohen's d = 0.44) and more likely to be female (Cohen's d = 0.26); had higher parent-endorsed manic symptom scores at screening (Cohen's d = 0.36) and baseline (Cohen's d = 0.76), more biological parents with a history of manic symptoms (Cohen's d = 0.48), and greater parenting stress (Cohen's d = 0.19). Discriminating variables, in order, were: baseline PGBI-10M scores, biological parent history of mania, parenting stress, and screening PGBI-10M scores. Absence of all these factors reduced risk of BPSD from 24% to 2%. CONCLUSIONS History of parental manic symptoms remains a robust predictor of BPSD in youth seeking outpatient care, even after accounting for parent report of manic symptoms in the child at screening. However, the risk factors identified as associated with BPSD, together had limited value in accurately identifying individual participants with BPSD, highlighting the need for careful clinical assessment.
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Affiliation(s)
- Mary A Fristad
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH 43210, USA.
| | - Thomas W Frazier
- Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic, Cleveland, OH
| | - Eric A Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine Mount
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH
| | - Benjamin W Fields
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH
| | - Christine Demeter
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Robert A Kowatch
- Division of Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - L Eugene Arnold
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Ohio State University, Columbus, OH
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Sarah McCue Horwitz
- Department of Pediatrics and Stanford Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert L Findling
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Case Western Reserve University, Cleveland, OH
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Horesh N, Iancu I. A comparison of life events in patients with unipolar disorder or bipolar disorder and controls. Compr Psychiatry 2010; 51:157-64. [PMID: 20152296 DOI: 10.1016/j.comppsych.2009.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 04/29/2009] [Accepted: 05/19/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The present study aimed to explore the association between stressful life events (LEs) and the development of affective psychopathology. METHOD Thirty patients with unipolar disorder and 30 patients with bipolar disorder were compared to 60 matched healthy controls in regard to the rate of stressful LEs. Assessment measures included the Beck Depression Inventory, the Adult Life Events Questionnaire, and the Childhood Life Events List. RESULTS The entire sample of affective patients had more LEs in general, more negative LEs, and more loss-related LEs in the year preceding their first depressive episode as compared with normal controls. Subjects with unipolar disorder had more positive LEs and more achievement LEs, whereas subjects with bipolar disorder had more uncontrollable LEs in the year preceding the first depressive episode. The relationship between LEs and manic episodes was prominent in the year preceding the first manic episode, with subjects with bipolar disorder reporting more LEs in general and more ambiguous events in that year. Almost no significant differences on LE frequency were observed in the year before the last depressive and manic episodes in the patient groups with unipolar and bipolar disorder. A significant relationship was found between childhood LEs and the development of affective disorders in adulthood, with patients with unipolar disorder exhibiting less positive and achievement LEs. CONCLUSIONS In both the unipolar and the bipolar groups, the major impact of LEs on the onset of affective disorders was found in the year before the first depressive or manic episodes. This suggests that the accumulation of stressful LEs at this crucial period contributes to the precipitation of a pathological response mechanism. Once established, this mechanism would be reactivated in the future by even less numerous and less severe stressors, compatible with the kindling hypothesis.
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Affiliation(s)
- Netta Horesh
- Department of Psychology, Bar Ilan University, Ramat Gan 52900, Israel
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Is the increase of hypomanic stages during adolescence related to gender and developmental tasks? World J Biol Psychiatry 2010. [DOI: 10.3109/15622970903521149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Romero S, Birmaher B, Axelson DA, Iosif AM, Williamson DE, Gill MK, Goldstein BI, Strober MA, Hunt J, Goldstein TR, Esposito-Smythers C, Iyengar S, Ryan ND, Keller M. Negative life events in children and adolescents with bipolar disorder. J Clin Psychiatry 2009; 70:1452-60. [PMID: 19906349 PMCID: PMC2921940 DOI: 10.4088/jcp.08m04948gre] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 04/24/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study the relationship between negative life events and demographic and clinical variables in youth with bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified (NOS), as well as to compare the rates of life events in youth with bipolar disorder, depressive and/or anxiety disorders (DEP-ANX), and healthy controls. METHOD Subjects included 446 youth, aged 7 to 17 years, meeting DSM-IV criteria for bipolar I, bipolar II, or an operationalized definition of bipolar disorder NOS, and were enrolled in the Course and Outcome of Bipolar Illness in Youth study. Subjects completed the Life Events Checklist. Sixty-five DEP-ANX and 65 healthy youth were obtained from previous studies using similar methodology. The study was conducted from October 2000 to July 2006. RESULTS Older age, lower socioeconomic status, living with nonintact family, non-Caucasian race, anxiety, and disruptive disorders were associated with greater number of total negative life events. Specifically, increased independent, dependent, and uncertain negative life events were associated with lower socioeconomic status, nonintact family, and comorbid disruptive disorders. Increased independent negative life events were additionally associated with non-Caucasian race and comorbid anxiety disorders. Increased dependent and uncertain negative life events were also associated with older age. DEP-ANX youth reported a similar rate of negative life events as bipolar youth, and both groups had more negative life events than the healthy controls. Bipolar youth reported fewer total and dependent positive life events compared to DEP-ANX and healthy youths. CONCLUSIONS Similar to DEP-ANX youth, bipolar youth are exposed to excessive negative independent and dependent life events, which may have implications in the long-term outcome and negative consequences associated with this disorder.
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Affiliation(s)
- Soledad Romero
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pennsylvania, USA.
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. Pittsburgh, PA.USA
| | - David A. Axelson
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. Pittsburgh, PA.USA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, CA
| | - Douglas E. Williamson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, TX
| | - Mary Kay Gill
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. Pittsburgh, PA.USA
| | - Benjamin I. Goldstein
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. Pittsburgh, PA.USA
| | - Michael A. Strober
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, CA
| | - Jeffrey Hunt
- Department of Psychiatry and Butler Hospital, Brown University School of Medicine, Providence, R.I
| | - Tina R. Goldstein
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. Pittsburgh, PA.USA
| | - Christianne Esposito-Smythers
- Department of Psychiatry and Butler Hospital, Brown University School of Medicine, Providence, R.I, George Mason University. Fairfax, VA
| | - Satish Iyengar
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. Pittsburgh, PA.USA
| | - Neal D. Ryan
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. Pittsburgh, PA.USA
| | - Martin Keller
- Department of Psychiatry and Butler Hospital, Brown University School of Medicine, Providence, R.I
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Abstract
BACKGROUND Pharmacological treatments are the principal intervention for bipolar disorder. Alone, however, they are not sufficient to control symptoms and maintain psychosocial functioning. Adjunctive psychosocial interventions may help to improve the patient's condition and the course of the illness. Family interventions are deserving of special attention, since they may help to relieve the burden of care borne by relatives and caregivers, which in turn may facilitate the task of supporting the patient. OBJECTIVES The objective of this review was to investigate the effectiveness of family interventions in the treatment of bipolar disorder compared with no intervention and other forms of intervention. SEARCH STRATEGY We searched the electronic databases CCDANRCT-Studies and CCDANCTR-References on 1/8/2007, CENTRAL (2006-3), MEDLINE (2006), EMBASE (2006) and LILACS (2006), and searched the reference lists of included studies. We also made personal contact with authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-randomised trials. Participants were people with bipolar disorder and their relatives or caregivers; family psychosocial interventions of any type were considered; primary outcomes were changes in the status of symptoms and relapse rates. DATA COLLECTION AND ANALYSIS Data were independently extracted by two review authors. Quality assessment of included studies was carried out. The findings were presented descriptively. Where there were sufficient studies, dichotomous data were combined using relative risk, and continuous data were combined using weighted mean difference, with their 95% CIs. MAIN RESULTS Seven RCTs were included in the review, involving a total of 393 participants. All of the included studies assessed psychoeducational methods, and one study also assessed a type of systems psychotherapy. In all trials, participants continued to receive pharmacotherapy treatment. Due to the diversity of interventions, outcome measures and endpoints used across studies, it was not possible to perform meta-analyses for primary outcomes. Five studies compared a variety of family interventions, involving carers, families or spouses, against no intervention, with individual findings indicating no significant added effect for family interventions. Three studies compared one type or modality of family intervention against another family intervention, with inconsistent findings. AUTHORS' CONCLUSIONS To date there is only a small and heterogeneous body of evidence on the effectiveness of family oriented approaches for bipolar disorder, and it is not yet possible to draw any definite conclusions to support their use as an adjunctive treatment for bipolar disorder. Further well designed RCTs should be a research priority.
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Affiliation(s)
- L P Justo
- Universidade Federal de Sao Paulo, Departmento de Psicobiologia, Rua Napoleao de Barros 925, Vila Clementino, Sao Paulo, Brazil, CEP 04024002.
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