Impact of childhood trauma and affective temperament on resilience in bipolar disorder

Resilience and Attachment in Patients with Major Depressive Disorder and Bipolar Disorder

BACKGROUND

Resilience represents one of the fundamental elements of attachment and has often been investigated in mood disorders. This study aims to investigate possible correlations between attachment and resilience in patients with major depressive disorder (MDD) and bipolar disorder (BD).

METHODS

106 patients (51 MDD, 55 BD) and 60 healthy controls (HCs) were administered the 21-item Hamilton Depression Rating Scale (HAM-D-21), the Hamilton Anxiety Rating Scale (HAM-A), the Young Mania Rating Scale (YMRS), the Snaith-Hamilton Pleasure Scale (SHAPS), the Barratt Impulsiveness Scale-11 (BIS-11), the Toronto Alexithymia Scale (TAS), the Connor-Davidson Resilience Scale (CD-RISC), and Experiences in Close Relationship (ECR).

RESULTS

MDD and BD patients did not significantly differ from each other according to the HAM-D-21, HAM-A, YMRS, SHAPS, and TAS, while they scored higher than HCs on all these scales. Patients in the clinical group scored significantly lower on CD-RISC resilience than HCs (p < 0.01). A lower proportion of secure attachment was found among patients with MDD (27.4%) and BD (18.2%) compared to HCs (90%). In both clinical groups, fearful attachment prevailed (39.2% patients with MDD; 60% BD).

CONCLUSIONS

Our results highlight the central role played by early life experiences and attachment in participants with mood disorders. Our study confirms the data from previous research showing a significant positive correlation between the quality of attachment and the development of resilience capacity, and supports the hypothesis that attachment constitutes a fundamental aspect of resilience capacity.

Affective temperaments mediate the effect of childhood maltreatment on bipolar depression severity

Aim

Bipolar disorder is a leading disorder contributing to global disease burden, and bipolar depression often becomes severe and refractory. Therefore, clarifying the pathophysiology of bipolar disorder is an urgent issue. Previous reports suggested that factors, such as affective temperaments and childhood maltreatment, aggravate bipolar depression severity. However, to our knowledge, no reports to date have clarified the interrelationship between the above factors and bipolar depression severity. We here hypothesized that childhood maltreatment worsens bipolar depression severity via increasing affective temperaments. To test this hypothesis, a covariance structural analysis was conducted.

Methods

The following information was evaluated for a total of 75 people with bipolar disorder using self-administered questionnaires: demographic characteristics, depressive symptoms (Patient Health Questionnaire-9), history of childhood maltreatment (Child Abuse and Trauma Scale), and affective temperaments (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire). The results were analyzed using covariance structure analysis.

Results

A significant indirect effect of childhood maltreatment on bipolar depression severity via increasing affective temperaments was identified, whereas the direct effect of childhood maltreatment was not significant.

Conclusion

Our results reveal that affective temperaments can mediate the adverse effects of childhood maltreatment on the severity of bipolar depression.

Relationship between childhood trauma and resilience in patients with mood disorders

BACKGROUND

Childhood trauma has lasting negative impacts on individuals' psychological functioning. However, there is limited empirical evidence on the association between childhood trauma and resilience and none examining such relationship among diverse clinical populations. This study aimed to investigate the relationship in patients with major depressive disorder, bipolar I disorder, bipolar II disorder, and a comparison group.

METHODS

In total, 787 psychiatric patients and 734 people from the general population participated in the study. The Childhood Trauma Questionnaire-Short Form and Connor-Davidson Resilience Scale were used to assess childhood trauma and resilience, respectively.

RESULTS

Individuals with childhood trauma showed lower levels of resilience in all subjects; among them, those who experienced emotional abuse and emotional neglect exhibited even stronger associations than other types of childhood trauma. There was a significant difference in the negative relationship between childhood trauma and resilience by group, where the association was more prominent in the comparison group than in MDD and BD II patient groups.

LIMITATIONS

The generalizability of our results may be limited due to unproportionate patient sample size. Also, we could not examine the causal relationship between childhood trauma and resilience.

CONCLUSION

Childhood trauma and resilience had a significantly negative association. Our results suggest that people who have experienced emotional abuse and emotional neglect should be closely assisted to develop resilience. Interventions that promote resilience should be provided to individuals predisposed to psychological risks as a result of childhood trauma.

Cyclothymic Temperament, Physical Neglect, and Earlier Age of Onset Predict Poor Medication Adherence in Patients With Bipolar Disorder

ABSTRACT

Individual-level risk factors may predict poor medication adherence (PMA) in bipolar disorder (BD). This study aimed to evaluate the association between affective temperament, childhood trauma, age of first onset, and PMA in patients with BD in China. A total of 168 patients completed the eight-item Morisky Medication Adherence Scale; the Short Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire; and the Childhood Trauma Questionnaire-Short Form. Scores were then compared between PMA and non-PMA groups. Binary logistic regression showed that age of first onset was negatively correlated with PMA ( β = -0.106, p = 0.002), whereas physical neglect and cyclothymic temperament were positively correlated with PMA ( β = 0.143, p = 0.029; β = 0.19, p = 0.001, respectively). These findings indicate that cyclothymic temperament, physical neglect, and earlier onset are predictors of PMA in patients with BD and that such patients may require further attention to improve medical compliance.

Low resilience in severe obesity: marker of adverse childhood experiences and current psychological disorders

PURPOSE

Psychological disorders, early-age psychological traumas and eating disorders may contribute to the development of severe obesity in vulnerable individuals. Resilience may serve a protective role against binge eating disorder or depression. The current study aimed to investigate the relationship between adverse childhood experiences (ACE), resilience, and current psychological disorders. It also examined whether resilience plays a protective role in this pathway in a cohort of patients seeking bariatric surgery.

METHODS

Two hundred patients (153 women, 47 men) with severe obesity scheduled for bariatric surgery at the CHRU Nancy were included between September 2016 and April 2017. Participants completed the Resilience Scale for Adults (RSA) questionnaire and underwent a structured interview on ACE and current psychological disorders.

RESULTS

Mean total RSA score was 5.16 ± 0.87. The most frequent ACE were emotional neglect (90.5%) and emotional abuse (61%); 96% reported at least one ACE; 67% presented at least one current psychological disorder, the most frequent being anxiety (36%) and BED (35%). The number of psychological disorders, cumulative ACE and age explained 19.5% of the variance in total RSA score (p < 0.0001; adjusted R² = 0.19). The association of cumulative ACE and number of psychological disorders was mediated by resilience.

CONCLUSION

Our findings suggest that resilience is a relevant component of the psychosocial phenotype of severe obesity in bariatric surgery candidates. Resilience seems to play a partly mediation role in the relationship between ACE and psychological disorders. Low resilience becomes a marker that underscores the necessity to examine in greater depth ACE and psychological disorders.

LEVEL OF EVIDENCE

Level III, cohort analytic study.

Coping Style and Resilience Mediate the Effect of Childhood Maltreatment on Mental Health Symptomology

Background: A well-known distal risk factor for mental health symptomology is childhood maltreatment. Previous research revealed that several mediators, such as coping style and resilience, might be connected to the psychological mechanism of childhood maltreatment on mental health symptomology. Objective: The purpose of this study was to assess how coping style and resilience affect the relationship between childhood maltreatment and mental health symptomology of college students. Methods: With the method of cross-sectional survey, 740 college students from China (Gansu Province) completed the Childhood Trauma Questionnaire (CTQ), the Simplified Coping Style Questionnaire (SCSQ), the Connor–Davidson Resilience Scale (CD-RISC), and the Symptom Checklist 90 (SCL-90). Structural equation modeling (SEM) was used to reveal the link between childhood maltreatment, coping style, resilience, and mental health symptomology. Results: The results showe that childhood maltreatment was significantly positively correlated with mental health symptomology and significantly negatively correlated with coping style and resilience. Coping style was significantly negatively correlated with mental health symptomology and significantly positively correlated with resilience. Resilience was significantly negatively correlated with mental health symptomology. Coping style and resilience played a partially mediating role in the relationship between childhood maltreatment and college students’ mental health symptomology. Through a chain of intermediary effects on coping style and resilience, childhood maltreatment not only had a direct impact on mental health symptomology but also had an indirect impact. Conclusion: Childhood maltreatment could affect college students’ mental health symptomology through the chain mediating effect of coping style and resilience. Therefore, it is an effective way to reduce the influence of childhood maltreatment on mental health symptomology through some intervention measures to cultivate positive coping style and improve resilience.

Childhood abuse and borderline personality disorder features in Chinese undergraduates: the role of self-esteem and resilience

BACKGROUND

Although childhood abuse is considered to be related to borderline personality disorder (BPD), few studies have elaborated on the mediating role of self-esteem and resilience in it. Thus, the present study aimed to explore the potential mediating role of resilience and self-esteem between childhood abuse and BPD.

METHODS

This cross-sectional study was conducted with 4034 college students in Anhui Province, China. Participants were asked to complete Chinese versions of the following instruments: Childhood Trauma Questionnaire-Short Form (CTQ-SF), Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Connor-Davidson Resilience Scale (CD-RISC), and Rosenberg Self-Esteem Scale (RSES). Structural equation modeling (SEM) was used to test the mediation effects.

RESULTS

Resilience and self-esteem were found to be mediators of all three types of childhood abuse (emotional abuse, physical abuse and sexual abuse) when the types were examined separately; however, when all three types of childhood abuse were entered into the model simultaneously, neither the indirect effects nor direct effects of physical abuse or sexual abuse were found to be significant, only the association between emotional abuse and BPD features was partially mediated by resilience and self-esteem.

CONCLUSIONS

Self-esteem and resilience mediate the links between childhood abuse and BPD features, and emotional abuse is uniquely associated with BPD features.

Resilience in severe mental disorders: correlations to clinical measures and quality of life in hospitalized patients with major depression, bipolar disorder, and schizophrenia

PURPOSE

To evaluate resilience in severe mental disorders and correlate it with clinical measures and quality of life.

METHODS

Resilience (Resilience Scale, RS) and quality of life (WHOQOL-BREF questionnaire) were prospectively evaluated in a sample of 384 hospitalized patients diagnosed with severe mental disorders (depression, bipolar disorder and schizophrenia). Clinical outcomes were measured using the Global Assessment of Functioning Scale (GAF), Clinical Global Impression (CGI), Cumulative Illness Rating Scale (CIRS), Hamilton Scale-Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS).

RESULTS

Resilience measure showed a difference between the three clinical groups analyzed in the study, with lower scores in depressed patients than in bipolar disorder or schizophrenia patients. There was a trend toward a correlation between resilience and depressive symptoms (Hamilton Scale-Depression; P = 0.052; r_s = - 0.163). The scores in the resilience scale's personal competence domain presented a tendency of association with general psychiatric symptoms (Brief Psychiatric Rating Scale; P = 0.058; r = - 0.138). There was a significantly positive association between resilience and all domains of quality of life (r = 0.306-0.545; P < 0.05). Sociodemographic data like age, education, intelligence quotient, sex, and marital status were associated with resilience.

CONCLUSION

Depressive patients had low scores on the resilience scale compared to patients with other disorders. Resilience was positively associated with quality of life. Therefore, it deserves special attention, as it promotes more positive outcomes and improves patients' quality of life with severe mental disorders.

The association of childhood trauma, lifetime stressful events and general psychopathological symptoms in euthymic bipolar patients and healthy subjects

BACKGROUND

Psychopathological symptoms during euthymia in Bipolar Disorder (BD) affect quality of life and predispose to the occurrence of new acute episodes, however only few studies investigated potential risk-factors. This study aims to explore the association between childhood trauma (CT), lifetime stressful events (SLEs) and psychopathological symptoms in BD patients during euthymia and controls (HC).

METHODS

A total of 261 participants (93 euthymic patients with BD, 168 HC) were enrolled. Generalized linear models and multiple logistic models were used to assess the association among the Symptom Check List-90-R (SCL-90-R), the Infancy Trauma Interview, the Paykel Life Events Scale.

RESULTS

The rate of participants reporting CT was higher in BD (n=47; 53%) than HC (n=43; 30%) (p=0.001). The experience of neglect was strongly related to BD (OR 6.5; p=0.003). CT was associated to higher scores on the SCL-90-R subscales (all the subscales except Phobia). No effects of the interaction between CT and diagnosis were found on SCL-90-R. Finally, there was a main effect of CT on lifetime SLEs (p<.001), that was not associated with diagnosis (p=0.833), nor with the interaction between CT and diagnosis (p=0.624).

LIMITATIONS

The cross-sectional design does not allow causal inferences; the exclusion of subjects reporting medical or psychiatric comorbidity limits generalizability.

CONCLUSIONS

CT was associated both to psychopathological symptoms during euthymia and the lifetime SLEs, thus it may represent a vulnerability factor influencing the course of BD. Overall, these data contribute to overcome the limited evidences documenting the influence of environmental factors on euthymic phase in BD.

Relationship of childhood trauma, psychological resilience, and family resilience among undergraduate nursing students: A cross-sectional study

PURPOSE

To analyze how family resilience mediates the relationship between childhood trauma and psychological resilience in undergraduate nursing students.

DESIGN AND METHODS

A cross-sectional survey design was used to investigate 698 nursing undergraduate students (mean age: 18.77 ± 0.86 years) using the Childhood Trauma Questionnaire, Family Resilience Assessment Scale, and Connor-Davidson Resilience Scale. The mediating effect of family resilience was estimated using structural equation modeling and the bootstrap method.

FINDINGS

Both childhood trauma and family resilience were associated with psychological resilience. Family resilience showed a partial mediating effect between childhood trauma and psychological resilience, accounting for 21.5% of the total effect.

PRACTICE IMPLICATION

Our findings may help inform family interventions to improve the psychological resilience of nursing students, especially for those with childhood trauma experience.

Effects of the COVID-19 pandemic and lockdown in Spain: comparison between community controls and patients with a psychiatric disorder. Preliminary results from the BRIS-MHC STUDY

BACKGROUND

The aim of this study was to evaluate potential differences about the effects of the COVID-19 pandemic and lockdown between community controls (CC) and patients with a mental illness (MI) in a Spanish population during the state of emergency.

METHODS

Individuals with a psychiatric condition and the general population were invited to complete an anonymous online survey. Bivariate analyses were used to compare them in a broad range of measures: sociodemographic, clinical variables, behavioral changes related to the lockdown and coping strategies to face it. Two groups of different psychiatric disorders were compared: depression or anxiety disorders (D+A) versus bipolar disorder and schizophrenia related disorders (BD+SCZ).

RESULTS

413 CC and 206 MI were included in the study. CC reported to use more adaptive coping strategies as following a routine, talking to friends/relatives, practicing physical exercise and maintaining a balanced diet. MI reported significantly more anxiety and depression symptoms during the lockdown when compared to CC. Gaining weight, sleep changes, and tobacco consumption were more prevalent in the MI group. The D+A group showed significantly more psychological distress and negative expectations about the future, suffered more sleep disturbances when compared to BD+SCZ, whilst reported to practice more exercise.

LIMITATIONS

psychiatric disorders were self-reported.

CONCLUSIONS

Imposed restrictions and uncertainty during confinement had a higher psychological impact in individuals with a psychiatric illness, with less healthy behavior strategies to face the situation. Developing interventions to mitigate negative mental health outcomes among this vulnerable population will be essential in the coming months.

Impact of Childhood Trauma and Attachment on Resilience in Remitted Patients with Bipolar Disorder

BACKGROUND

Childhood trauma has been reported to be associated with severe course of illness, insecure attachment, and lower resilience in bipolar disorder. We aimed to examine the impact of childhood trauma on resilience and possible mediating role of attachment on this impact in bipolar disorder.

METHODS

The study group comprised of 110 remitted patients with bipolar disorder. Hamilton Depression Rating Scale (HAM-D) and Young Mani Rating Scale (YMRS) are administered to verify remission. Childhood trauma questionnaire (CTQ-SF), Experiences in Close Relationships-revised (ECR-R), and Resilience Scale for Adults (RSA) scales administered to all patients.

RESULTS

More than half of patients in bipolar disorder group reported childhood trauma. HAM-D scores were positively associated with childhood trauma total scores and emotional abuse scores, negatively associated with resilience, with attachment-related anxiety. Total childhood trauma scores were associated with lower scores of resilience, higher scores of attachment-related anxiety and avoidance. Resilience scores were negatively associated with attachment-related anxiety and avoidance. Impact of childhood trauma on resilience was partly mediated by attachment-related anxiety and avoidance, respectively.

LIMITATIONS

The cross-sectional design of this study is a limitation in terms of determining causality of the identified relationships.

CONCLUSIONS

Childhood traumas are associated with lower resilience and higher attachment-related anxiety and avoidance. Attachment-related anxiety and avoidance partly mediated the negative effect of childhood trauma on resilience. Since resilience is associated with increased quality of life in bipolar disorder, it might be helpful to develop attachment-informed psychosocial interventions to ameliorate the detrimental effect of childhood trauma on resilience.

QEEG - spectral power density of brain regions in predicting risk, resistance and resilience for bipolar disorder: A comparison of first degree relatives and unrelated healthy subjects

BACKGROUND

Temperament stems from the brain circuitry. Genetic differences among people are attributable to differences in neurophysiological function. Affective temperament is proposed endophenotype for bipolar affective disorder. QEEG - spectral power density is thought to be an index of general affective and cognitive brain activity. The association of spectral power density with types of affective temperament may enlighten endophenotypes for bipolar affective disorder disposition.

METHOD

TEMPS-A scale and rest QEEG were done on 25 euthymic patients, their healthy first degree relatives (n = 25) and 25 unrelated healthy control subjects. All patients were on lithium maintenance therapy.

RESULTS

F4 and T4 delta wave activity were similar between patients and first degree relatives, while Pz alpha activity was similar in first degree relatives and unrelated healthy subjects (p = 0.025, p = 0.001, p = 0.010). Cyclothymic and hyperthymic temperament scores were similar between patients and first degree relatives but higher than unrelated healthy subjects (p = 0.015, p = 0.010). F7 beta and F7-O2 high beta power were correlated with hyperthymic and irritable temperaments respectively in bipolar subjects (r = 0.439, 0.387; 0.405, 0.364; 0.226, 0.351). T3-F4-T4 delta powers were correlated with cyclothymic temperament in patients and their first degree relatives (r = 0.443, 0.420, 505). Pz alpha power and hyperthymic temperament were inversely correlated in first degree relatives and unrelated healthy subjects (r = -0.256 and -0.311).

CONCLUSION

Medial temporal network may be associated with bipolar affective disorder heritability. On the other hand, left dorsolateral prefrontal beta and high beta activities may be a neural marker for disorder resistance together with right occipital high beta power.

Resilience and insight in euthymic patients with bipolar disorder

BACKGROUND

The relationship between resilience and insight may be of potential importance for coping with stress in bipolar disorder (BD). The aim of this study was to investigate if there was a relation between insight and resilience in euthymic patients with BD and also to analyze the associations between resilience, impulsivity, aggression, alcohol use and affective temperament.

METHODS

142 patients with BD type I in remission period were involved. Resilience Scale for Adults-Turkish version, Schedule for Assessment of Insight, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, Barratt Impulsiveness Scale, Buss-Perry Aggression Questionnaire, Michigan Alcoholism Screening Test were used.

RESULTS

Total insight scores were negatively correlated with the scores of perception of future. As distinct from other subscales of resilience, family cohesion had independent significant associations with insight in relabelling of psychotic experiences and attention impulsivity. There was no relationship between total insight and total resilience scores. Resilience scores were negatively correlated with number of depressive episodes and number of suicide attempts. Degree of aggression, degree of impulsivity, scores of depressive and hyperthymic temperament significantly predicted resilience.

LIMITATIONS

Recruitment of patients from a tertiary centre limits the generalizability of the findings.

CONCLUSIONS

Better insight was related to negative perception of the future and did not have significant associations with total resilience. Number of depressive episodes, number of past suicide attempts correlated with resilience, emphasizing the importance of interventions to increase resilience in BD.

The relationship between insight and affective temperament in bipolar disorder: an exploratory study

INTRODUCTION

In recent years, the association between temperament and clinical characteristics of mood disorders has been studied. Most bipolar patients show deficits in their awareness of signs and symptoms. The relationship between affective temperament and insight in bipolar patients has not been carried out in the literature so far.

OBJECTIVE

To evaluate the relationship between affective temperament and insight in bipolar disorder.

METHOD

A group of 65 bipolar patients were followed during a year. Patients underwent a clinical assessment and were diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Insight was evaluated through the Insight Scale for Affective Disorders (ISAD), and affective temperament, through the TEMPS-Rio de Janeiro. The relationship between affective temperament and insight was explored with Spearman rho correlations between scores on each item of the ISAD and on the TEMPS-Rio de Janeiro subscales.

RESULTS

In euthymic phases, bipolars with depressive temperament were associated with a higher level of insight about the consequences of the disorder; when in mania, patients showed better insight about having an affective disorder, presenting psychomotor alterations, and suffering from guilt or grandiosity. Similarly, bipolar patients with higher scores of anxious temperament, when in mania, had better insight on alterations in attention. Bipolar patients with higher scores of hyperthymic temperament, when in mania, showed the worst insight about thought disorder.

CONCLUSION

In addition to being determined by the phase of the disease and several varying symptoms, the level of insight in bipolar patients is also influenced by affective temperament.

Resilience Predicts Social Functioning in Clinically Stable Patients With Bipolar Disorder

The current study focused on the association between resilience and social functioning in patients with bipolar disorder (BD). Forty clinically stable patients with BD type I and BD type II, as well as 40 healthy controls, matched for age, sex, and educational background were enrolled. Clinical status was assessed by the Montgomery-Åsberg Depression Rating Scale and the Young Mania Rating Scale. Functioning was evaluated by the Mini International Classification of Functioning, Disability and Health rating of activities and participation in mental illnesses, and the Social and Occupational Functioning Scale. Resilience was measured by the Connor-Davidson Resilience scale. Patients demonstrated significantly lower resilience levels compared with healthy individuals. A stepwise regression analysis indicated that only resilience contributed significantly to social functioning's outcome. Because resilience may constitute a social functioning moderator in clinically stable patients with BD, a paradigm shift toward protective factors could lead to implementation of resilience-oriented interventions designed specifically for patients with BD.

Epigenetics of Metabolic Syndrome as a Mood Disorder

Mood disorders comprise major depressive disorder (MDD), bipolar disorder (BD) and the milder forms of these two disorders. Reccurring MDD is also known as unipolar disorder. The distinction between unipolar and bipolar disorders was first suggested in 1957 by Leonard and was made official after support by several studies in 1980. Indeed, in 150 AD, Aretaeus of Cappadocia wrote “It seems to me that melancholia is the beginning and a part of mania”. Additionally, Kraepelin, who proposed the first medical disease model in psychiatry a century ago, considered recurrent unipolar depression cases under the category of bipolar disorder and conceptualized spectrum disorders. Because today’s classification systems conduct cross-sectional diagnosis, they do not consider family history, long-term characteristics and multidimensional approaches on symptoms. This method prioritizes reliability over validity and it rules out psychiatric disorders in etiology. Actually, a spectrum model which covers physical diseases is conceivable. The concept of epigenetics considers mood disorders, Alzheimer’s disease, attention deficit and hyperactivity disorder, Carney syndrome, multiple endocrine neoplasia type I and II, breast and prostate cancers, carsinoid tumors, cerebrovascular and cardiovascular diseases and metabolic syndrome together. This review addressed the relationship between metabolic syndrome and mood disorders in this context along with genetic, clinical and environmental factors such as climate, geographic factors, migration and changeable lifestyles. Genetic and clinical variables are affective temperament, childhood trauma and use of antidepressants and antipsychotics.

Mediating Effect of Resilience on the Association between Emotional Neglect and Depressive Symptoms

OBJECTIVE

Previous studies have reported that childhood maltreatment experiences could induce biological and psychological vulnerability in depressive disorders. However, it is still unclear that type-specific effects of childhood maltreatment on psychological resilience, depressive symptoms and interactions among childhood maltreatment experiences, resilience, and depressive symptoms.

METHODS

A total of 438 medical students were included in the study. The Childhood Trauma Questionnaire-Short Form, the Conner-Davidson Resilience Scale, and the Beck Depression Inventory were used for measuring childhood maltreatment experiences, psychological resilience, and depressive symptoms, respectively. We investigated the effects of childhood maltreatment experiences on resilience and depressive symptoms using correlation analysis. In addition, we analyzed the mediating effect of resilience on the association between childhood maltreatment and symptoms of depression.

RESULTS

Among childhood maltreatment, emotional neglect was a significant predictor of the scores of low resilience and high depressive symptoms in both gender groups (all ps<0.05). Furthermore, resilience was found to be a mediator connecting emotional neglect experiences with depressive symptoms.

CONCLUSION

Our results suggest that emotional neglect has detrimental effects on mood and resilience, and clinicians need to focus on the recovery of resilience when they deal with depressive symptoms in victims of childhood maltreatment.

More Resilience in Males with Probable Bipolar Depression than Probable Unipolar Depression among Korean Conscripts

OBJECTIVE

This study investigated whether the resilience of males with probable bipolar depression (PBD) can be strengthened and compared it to that of males with probable unipolar depression (PUD).

METHODS

Prospective data for 198 participants (PBD: 66, PUD: 66, normal control: 66) were analyzed. The participants' resilience, bipolarity and severity of depressive symptoms were evaluated at baseline and after 5 weeks. Analysis of variance (ANOVA) and repeated measure ANOVA was performed for comparing resilience between three groups through a basic military training.

RESULTS

The PBD group demonstrated more resilience than the PUD group at baseline. Participants with PBD became significantly more resilient than participants with PUD after 5 weeks (p<0.01, F=6.967, η²_p=0.052).

CONCLUSION

The study indicates that interventions that strengthen resilience need to be developed for males with PBD and that such interventions are more effective for males with PBD than PUD.

Factor analysis of temperament and personality traits in bipolar patients: Correlates with comorbidity and disorder severity

BACKGROUND

Temperament and personality traits have been suggested as endophenotypes for bipolar disorder based on several lines of evidence, including heritability. Previous work suggested an anxious-reactive factor identified across temperament and personality inventories that produced significant group discrimination and could potentially be useful in genetic analyses. We have attempted to further characterize this factor structure in a sample of bipolar patients.

METHODS

A sample of 1195 subjects with bipolar I disorder was evaluated, all with complete data available. Dimension reduction across two inventories identified 18 factors explaining 39% of the variance.

RESULTS

The two largest factors reflected affective instability and general anxiety/worry, respectively. Subsequent analyses of the clinical features associated with bipolar disorder revealed specificity for the factors in a predictable pattern. Cluster analysis of the factors identified a subgroup defined by a strong lack of general anxiety and low affective instability represented by the first two factors. The remaining subjects could be distinguished into two clusters by the presence of either more positive characteristics, including persistence/drive, spirituality, expressivity, and humor, or more negative characteristics of depression and anxiety.

LIMITATIONS

These analyses involved bipolar I subjects only and must be extended to other bipolar spectrum diagnoses, unaffected relatives, and individuals at risk.

CONCLUSIONS

These results suggest that temperament and personality measures access latent traits associated with important clinical features of bipolar disorder. By translating clinical variables into quantitative traits, we may identify subgroups of bipolar patients with distinct clinical profiles, thereby facilitating both individual treatment strategies and genetic analyses.

Bipolar Disorder and Early Emotional Trauma: A Critical Literature Review on Indicators of Prevalence Rates and Clinical Outcomes

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Evaluate the prevalence of early emotional trauma in patients with bipolar disorder (BD)• Assess the impact of these traumas on patients and on their development of BD OBJECTIVES: We performed a systematic literature review to (1) evaluate the prevalence of early emotional trauma (EET) in patients with bipolar disorder (BD) and the impact of these traumas on the development of the disorder, and (2) integrate the findings of our review with those previously reported by Fisher and Hosang, Daruy-Filho and colleagues, and Maniglio.

METHODS

The literature search was performed on PubMed, SciELO, and PsycINFO databases using the keywords bipolar disorder, early trauma, physical abuse, emotional abuse, sexual abuse, maltreatment, adversity, and neglect.

RESULTS

Twenty-eight articles were selected and analyzed. Taken together, the articles described a high prevalence of EET in BD, consisting mainly of emotional neglect/abuse (approximately 40%), particularly when compared to healthy subjects. The review also identified substantial evidence regarding an association between the presence of EET, early disease onset, rapid cycling, comorbidity with anxiety/stress disorders, and cannabis use.

CONCLUSION

The integration of the current findings with the identified studies reveals that (1) the methodological limitations noted by Daruy-Filho and colleagues have been largely resolved in more recent studies and (2) the presence of EET in patients with BD is associated with worse clinical outcomes, particularly early disease onset, presence of clinical or psychiatric comorbidities, suicide, and presence of psychotic episodes/symptoms. The review shows that patients with BD experience more traumatic situations than controls and that emotional trauma is the most frequent type of trauma in this group.

Affective instability, childhood trauma and major affective disorders

BACKGROUND

Affective instability (AI), childhood trauma, and mental illness are linked, but evidence in affective disorders is limited, despite both AI and childhood trauma being associated with poorer outcomes. Aims were to compare AI levels in bipolar disorder I (BPI) and II (BPII), and major depressive disorder recurrent (MDDR), and to examine the association of AI and childhood trauma within each diagnostic group.

METHODS

AI, measured using the Affective Lability Scale (ALS), was compared between people with DSM-IV BPI (n=923), BPII (n=363) and MDDR (n=207) accounting for confounders and current mood. Regression modelling was used to examine the association between AI and childhood traumas in each diagnostic group.

RESULTS

ALS scores in descending order were BPII, BPI, MDDR, and differences between groups were significant (p<0.05). Within the BPI group any childhood abuse (p=0.021), childhood physical abuse (p=0.003) and the death of a close friend in childhood (p=0.002) were significantly associated with higher ALS score but no association was found between childhood trauma and AI in BPII and MDDR.

LIMITATIONS

The ALS is a self-report scale and is subject to retrospective recall bias.

CONCLUSIONS

AI is an important dimension in bipolar disorder independent of current mood state. There is a strong link between childhood traumatic events and AI levels in BPI and this may be one way in which exposure and disorder are linked. Clinical interventions targeting AI in people who have suffered significant childhood trauma could potentially change the clinical course of bipolar disorder.