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Dempsey RC, Dodd AL, Gooding PA, Jones SH. The Types of Psychosocial Factors Associated with Suicidality Outcomes for People Living with Bipolar Disorder: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:525. [PMID: 38791740 PMCID: PMC11120682 DOI: 10.3390/ijerph21050525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
Bipolar Disorder is associated with high rates of suicidal thoughts, behaviors, and outcomes, yet the lived experience of suicidality and Bipolar Disorder is not particularly well understood. Understanding the role of psychosocial aetiologies in suicidality outcomes for those living with Bipolar Disorder is key for developing appropriately targeted interventions focusing on factors that are amenable to change. In line with PRISMA guidance, we conducted a scoping review to identify the types of psychosocial factors studied in relation to the experience of suicidality for people living with Bipolar Disorder diagnoses. Systematic literature searches identified a sample of 166 articles from which key study data were extracted and charted. A narrative synthesis of the reviewed literature is presented ordered by the factors investigated across studies, a frequency count of the types of psychological/social aetiologies studied, and a brief overview of the key findings for each aetiology. Most of the identified literature took the form of quantitative cross-sectional studies, with only one qualitative study and 18 quantitative prospective studies. The most studied aetiologies were trauma (specifically early adverse experiences and childhood traumas) and stressful life events, impulsivity (primarily subjective self-reported trait impulsivity), social support and functioning, and personality/temperament factors. Only six studies in the final sample reported basing their research questions and/or hypotheses on an explicit theoretical model of suicide. The literature was primarily focused on using self-report measurements of key aetiologies and on factors which lead to worsened suicidality rather than focusing on potentially protective or buffering factors. Future research needs to better justify the aetiologies investigated in relation to suicidality outcomes for people living with Bipolar Disorder, including a firmer basis in theory and hypothesis testing, more prospective designs, and the use of alternative assessments of psychosocial aetiologies in addition to self-report questionnaires.
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Affiliation(s)
- Robert C. Dempsey
- Department of Psychology, Faculty of Health and Education, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Alyson L. Dodd
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Patricia A. Gooding
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Steven H. Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
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Lin Y, Wei Q, Luo S, Ye X, Zheng F, Zheng L, Lu X, Li H, Wu S. The risk of suicidal intention in severe mental illness: An ecological perspective. Psychol Psychother 2023; 96:1044-1061. [PMID: 37668301 DOI: 10.1111/papt.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Guided by the ecosystem theory model framework, we aimed to explore the influence of three ecological dimensions (social, family and psychological factors) on suicidal intention in people with severe mental illness (SMI). We hypothesized that three factors influence suicidal intention, and that psychological factors may play a mediating role in the influence of social and family factors on suicidal intention. METHODS We collected 994 patients with SMI aged 18 and above from May 2021 to March 2022 in the Fourth Hospital of Fuzhou City. We used logistic regression to analyse the association between social, family, psychological factors and suicidal intention. Furthermore, we explored the mediating effects among the influencing factors. RESULTS Younger male patients with schizophrenia were more likely to have suicidal intention due to psychosocial family factors (p < .05). Social factors (poor interpersonal relations, social retreat, social activities outside the home), family factors (parental functions, activities within the family, family functions), psychological factors (anxiety, depression, interest in the outside world, overt aggression, lack of accountability and planning) were all independent risk factors for suicidal intention in patients. Mediation analysis showed anxiety and depression mediated the role of social and family factors on suicidal intention (p < .05). CONCLUSION Social, family and psychological factors were important risk factors for suicidal intention, with anxiety and depression being partial mediators for suicidal intention. Therefore, interventions that enhance family and social functioning and reduce anxiety and depression may be effective in reducing suicidal intention in SMI.
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Affiliation(s)
- Yawen Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Qinfei Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Suping Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaoying Ye
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Fuhao Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Department of Scientific Research Management, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Liuyan Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xinyue Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Huangyuan Li
- Department of Preventive Medicine, Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Siying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
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Stapp EK, Fullerton JM, Musci RJ, Zandi PP, McInnis MG, Mitchell PB, Hulvershorn LA, Ghaziuddin N, Roberts G, Ferrera AG, Nurnberger JI, Wilcox HC. Family environment and polygenic risk in the bipolar high-risk context. JCPP ADVANCES 2023; 3:e12143. [PMID: 37378048 PMCID: PMC10292829 DOI: 10.1002/jcv2.12143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 09/27/2023] Open
Abstract
Background The interaction of polygenic risk (PRS) and environmental effects on development of bipolar disorder (BD) is understudied, as are high-risk offspring perceptions of their family environment (FE). We tested the association of offspring-perceived FE in interaction with BD-PRS on liability for BD in offspring at high or low familial risk for BD. Methods Offspring of a parent with BD (oBD; n = 266) or no psychiatric disorders (n = 174), aged 12-21 at recruitment, participated in the US and Australia. Empirically-derived profiles of FE classified offspring by their perceived levels of familial cohesion, flexibility, and conflict. Offspring BD-PRS were derived from Psychiatric Genomics Consortium BD-GWAS. Lifetime DSM-IV bipolar disorders were derived from the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. We used a novel stepwise approach for latent class modeling with predictors and distal outcomes. Results Fifty-two offspring were diagnosed with BD. For those with well-functioning FE (two-thirds of the sample), higher BD-PRS tracked positively with liability for BD. However, for those with high-conflict FEs, the relationship between BD-PRS and liability to BD was negative, with highest risk for BD observed with lower BD-PRS. In exploratory analyses, European-ancestry offspring with BD had elevated history of suicidal ideation in high-conflict FE compared to well-functioning-FE, and of suicide attempt with low-BD-PRS and high-conflict FE. Conclusions The data suggest that the relationship of BD-PRS and offspring liability for BD differed between well-functioning versus high-conflict FE, potentially in line with a multifactorial liability threshold model and supporting future study of and interventions improving family dynamics.
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Affiliation(s)
- Emma K. Stapp
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Genetic Epidemiology BranchNational Institute of Mental HealthBethesdaMarylandUSA
| | - Janice M. Fullerton
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rashelle J. Musci
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Peter P. Zandi
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Philip B. Mitchell
- School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Neera Ghaziuddin
- Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
| | - Gloria Roberts
- School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - John I. Nurnberger
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
- Stark Neurosciences Research InstituteIndiana University School of MedicineIndianapolisIndianaUSA
| | - Holly C. Wilcox
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Polat N, Beyaztas H, Aktas S, Maden O, Metin Guler E. Comparison of oxidative stress parameters, thiol-disulfide homeostasis, and pro-inflammatory cytokines levels in patients with bipolar disorder and their first-degree relatives. J Psychiatr Res 2023; 162:103-112. [PMID: 37148601 DOI: 10.1016/j.jpsychires.2023.05.022] [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: 07/03/2022] [Revised: 04/04/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND In this study, we aimed to compare the oxidative stress parameters, thiol-disulfide homeostasis, and plasma pro-inflammatory cytokines levels of patients with bipolar disorder (BD), BD patients' first-degree relatives (FDRs), and the healthy controls (HCs). METHODS Thirty-five patients with BD, 35 FDRs of BD, and 35 healthy controls (HCs) were included. The individuals' ages varied from 28 to 58, and the groups were well-matched in terms of age and gender. The total thiol (TT), native thiol (NT), disulfide (DIS), total oxidant status (TOS), total antioxidant status (TAS), IL-1β, IL-6, and TNF-α concentrations were measured from serum samples. The oxidative stress index (OSI) was calculated using mathematical formulas. RESULTS TOS was significantly higher in both patients and FDRs than HCs (p < 0.01 for all pairwise comparisons). OSI, DIS, oxidized thiol, and the ratio of thiol oxidation-reduction levels were significantly higher in both patients with BD and FDRs than HCs (p < 0.01 for all pairwise comparisons). TAS, TT, NT, and reduced thiol levels were significantly lower in both patients with BD and FDRs than HCs (p < 0.01 for all pairwise comparisons). IL-1β, IL-6, and TNF-α were significantly higher in both patients and FDRs than HCs (p < 0.01 for all pairwise comparisons). LIMITATIONS Small sample size. CONCLUSIONS Early diagnosis is important for treating of bipolar disorder. TT, NT, DIS, TOS, TAS, OSI, IL1-β, IL-6, and TNF-α can be used as potential biomarkers in the early diagnosis and intervention of BD. Furthermore, oxidative/antioxidative markers and plasma pro-inflammatory cytokine parameters may guide the determination of the disease's activity and response to treatment.
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Affiliation(s)
- Naci Polat
- Department of Pathophysiology, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Hakan Beyaztas
- Department of Medical Biochemistry, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Istanbul, Turkey
| | - Selman Aktas
- Department of Biostatistics, Haydarpasa University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Istanbul, Turkey; Department of Biostatistics, Istanbul University-Cerrahpasa, Institue of Health Sciences, Istanbul, Turkey
| | - Ozgur Maden
- Department of Mental Health and Diseases, University of Health Sciences Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Eray Metin Guler
- Department of Medical Biochemistry, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Istanbul, Turkey; Department of Medical Biochemistry, University of Health Sciences Turkey, Haydarpasa Numune Health Application and Research Center, Istanbul, Turkey
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Cirone C, Secci I, Favole I, Ricci F, Amianto F, Davico C, Vitiello B. What Do We Know about the Long-Term Course of Early Onset Bipolar Disorder? A Review of the Current Evidence. Brain Sci 2021; 11:brainsci11030341. [PMID: 33800274 PMCID: PMC8001096 DOI: 10.3390/brainsci11030341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
Abstract
Aim: Early onset of psychopathology is often an index of a more severe clinical course and worse prognosis. This review examined the course of bipolar disorder (BD) with onset in childhood and adolescence, with a focus on persistence of symptoms, severity of illness, comorbidity, and functional impairment. Methods: The databases of PubMed, Embase, and PsycInfo were systematically searched for publications since 1990 reporting on long-term (12 months or longer) assessments of patients with early onset BD. Results: Forty-two relevant publications were identified, which reported on data derived from 15 different patient cohorts, including 7 prospective research psychopathology studies, 4 medical record reviews, 2 follow-ups of clinical trial samples, 1 managed care database, and 1 nationwide registry, for a total of 10,187 patients. The length of follow-ups ranged from 1.0 to 15 years. Diagnostic stability of BD ranged from 73% to 100% over ten years. Recovery rate from an index episode was 81.5–100% and recurrence rate was 35–67%. Suicide attempt cumulative prevalence in five years was 18–20%. Earlier age at the first episode predicted a more severe clinical course. Conclusions: Early onset BD persists over time through adolescence, with homotypic diagnostic continuity over the years, but heterogeneity in the severity of the clinical course. Whether early identification and treatment improves distal prognosis remains to be further investigated.
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Affiliation(s)
- Carlotta Cirone
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
| | - Ilaria Secci
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
| | - Irene Favole
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
| | - Federica Ricci
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
| | - Federico Amianto
- Child and Adolescent Neuropsychiatry—Department of Neurosciences, Universita’ degli Studi di Torino, 10126 Turin, Italy;
| | - Chiara Davico
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
- Correspondence:
| | - Benedetto Vitiello
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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