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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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Janiri D, Di Luzio M, Montanari S, Hirsch D, Simonetti A, Moccia L, Conte E, Contaldo I, Veredice C, Mercuri E, Sani G. Childhood Trauma and Self-harm in Youths with Bipolar Disorders. Curr Neuropharmacol 2024; 22:152-158. [PMID: 36788693 DOI: 10.2174/1570159x21666230213155249] [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: 05/30/2022] [Revised: 07/03/2022] [Accepted: 08/04/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Bipolar disorders (BD) in youth are associated with a high risk of self-harm behaviors. Childhood trauma (CT) is a relevant environmental stressor that is related to both BD diagnosis and self-harm in adulthood. It is not yet established whether CT may impact self-harm risk in youth. Therefore, the aim of this study was to investigate the distribution patterns of CT in youth BD with and without self-harm. METHODS We assessed 273 participants (aged 13-25 years), 96 youths with BD according to DSM-5 criteria and 177 healthy controls (HC). History of CT was obtained using the Childhood Trauma Questionnaire (CTQ). The association between CT and self-harm was tested using multivariate statistical models. RESULTS Over 45% of participants with BD reported lifetime self-harm. The BD Self-harm group reported more emotional abuse, emotional neglect, sexual abuse, and physical abuse than HC. The BD No-Self-harm group reported more emotional abuse than HC. The BD Self-harm group reported more emotional abuse and neglect than the BD No-Self-harm group. The BD Self-harm group also reported separated parents, hospitalizations, smoking, use of antiepileptics, antipsychotics and lithium. Emotional abuse was an independent predictor of self-harm in youths with BD. CONCLUSION Findings support the importance of assessing CT, in particular emotional abuse, in youth with BD at risk for self-harm.
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Affiliation(s)
- Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Psychiatry and Neurology, Sapienza University of Rome, Rome, Italy
| | - Michelangelo Di Luzio
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Silvia Montanari
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Hirsch
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eliana Conte
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Early Intervention Unit, ASL Roma 3, Rome, 00152, Italy
| | - Ilaria Contaldo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chiara Veredice
- Pediatric Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Child Health Area, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
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Janiri D, Moccia L, Montanari S, Simonetti A, Conte E, Chieffo D, Monti L, Kotzalidis GD, Janiri L, Sani G. Primary emotional systems, childhood trauma, and suicidal ideation in youths with bipolar disorders. CHILD ABUSE & NEGLECT 2023; 146:106521. [PMID: 37931544 DOI: 10.1016/j.chiabu.2023.106521] [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: 04/11/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Bipolar disorders (BD) in youths are strongly associated with suicidal ideation. Childhood trauma is a prominent environmental stressor associated with both BD diagnosis and suicide. Primary emotional systems are altered in adult BD and may contribute to suicide risk in youths. OBJECTIVE The aim of this study was to investigate primary emotional systems distribution patterns and childhood trauma in youths' BD with and without suicidal ideation (BD-IS, BD-NIS). PARTICIPANTS AND SETTING We assessed 289 participants, 103 youths with DSM-5 BD and 186 healthy controls (HCs). METHODS Primary emotional systems were obtained with Panksepp's Affective Neuroscience Personality Scale (ANPS), and history of childhood trauma using the Childhood Trauma Questionnaire (CTQ). Suicidal ideation was assessed through the Columbia Suicide Scale for the Rating of Suicide Severity (C-SSRS). The associations with suicidal ideation were tested using two different multivariate models. RESULTS Over 48 % of participants reported lifetime suicidal ideation and differed on clinical variables from BD-NIS. According to the first model (Wilk's Lambda = 0.72, p < 0.0001), BD-IS scored higher on Panksepp's ANGER and lower on PLAY and CARE than BD-NIS. Both BD-SI and BD-NSI scored higher on ANGER and SEEK and lower on PLAY and CARE than HCs. BD-IS reported more emotional abuse than BD-NIS. They also reported more emotional, sexual, and physical abuse, and emotional neglect than HCs. Only ANGER (OR = 1.13, 95 % CI = 1.01-1.26, Wald = 5.72) and CTQ-Emotional abuse (OR = 1.26, 95 % C.I. = 1.04-1.52, Wald = 5.72) independently predicted suicidal ideation. CONCLUSIONS Findings support the importance of assessing primary emotional systems and childhood trauma, in particular emotional abuse, in youths with BD at risk for suicide.
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Affiliation(s)
- Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Montanari
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eliana Conte
- Early Intervention Unit, ASL Roma 3, 00152 Rome, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Chieffo
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Monti
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
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Andreu-Pascual M, Merranko J, Gill MK, Levenson JC, Hafeman D, Hower H, Yen S, Strober M, Goldstein BI, Diler R, Ryan ND, Weinstock LM, Keller MB, Axelson D, Birmaher B, Goldstein TR. Risk factors preceding new onset abuse among youth with bipolar disorder: A longitudinal prospective analysis. J Affect Disord 2022; 300:296-304. [PMID: 34990625 PMCID: PMC10601969 DOI: 10.1016/j.jad.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/01/2021] [Accepted: 01/01/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Childhood abuse negatively impacts the course of Bipolar Disorder (BD). Yet, no study has examined risk factors associated with prospectively evaluated physical/sexual abuse, specifically, those preceding first abuse among BD youth. We investigate past/intake/follow-up factors preceding first physical/sexual abuse among BD youth. METHODS Childhood-onset BD participants (n = 279 youth, mean age at intake = 12, mean length of follow-up = 12 years) enrolled in the Course and Outcome of Bipolar Youth (COBY) study. Demographic, clinical and family history variables were assessed every 7 months on average using Longitudinal Interval Follow-up Evaluation and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). Abuse was evaluated at intake using the K-SADS-PL, over follow-up with a Traumatic Events Screen. Family psychopathology was assessed using Family History Screen/Structured Clinical Interview for Diagnostic Statistical Manual-IV. RESULTS Fifteen-percent of youth reported new-onset abuse during follow-up (62% physical, 26% sexual; 12% both). Intake predictors included more severe depressive symptoms (HR = 1.29), low socioeconomic-status (SES) in families with substance abuse (HR = 0.84) (physical abuse), and female sex (HR = 2.41) (sexual abuse). Follow-up predictors preceding physical abuse included: older age (HR = 1.42), disruptive disorders (HR = 1.39), and the interaction between low SES and family substance abuse (HR = 0.86). For sexual abuse, female sex (HR = 4.33) and a non-biologically related father presence in the household (HR = 2.76). Good relationships with friends (prospectively evaluated) protected against physical/sexual abuse (HR = 0.72/0.70, respectively). LIMITATIONS Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; perpetrator information and abuse severity were not available. CONCLUSIONS Identifying factors temporally preceding new onset physical/sexual abuse may hold promise for identifying high-risk youth with BD.
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Affiliation(s)
- Maria Andreu-Pascual
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA; Child and Adolescent Psychiatry and Psychology Department. Hospital Sant Joan de Déu Barcelona, Spain. Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain.
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Jessica C Levenson
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; Department of Psychiatry, School of Medicine, University of California at San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, 760 Westwood Plaza, Mail Code 175919, Los Angeles, CA 90095, USA
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON M4N-3M5, Canada
| | - Rasim Diler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Neal D Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Lauren M Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Butler Hospital, 700 Butler Drive, Providence, RI 02906, USA
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Butler Hospital, 700 Butler Drive, Providence, RI 02906, USA
| | - David Axelson
- Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, 1670 Upham Dr., Columbus, OH 43210, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
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Impact of Childhood Trauma and Attachment on Resilience in Remitted Patients with Bipolar Disorder. J Affect Disord 2021; 280:219-227. [PMID: 33220557 DOI: 10.1016/j.jad.2020.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/22/2020] [Accepted: 11/07/2020] [Indexed: 11/23/2022]
Abstract
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.
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Diaz AP, Cuellar VA, Vinson EL, Suchting R, Durkin K, Fernandes BS, Scaini G, Kazimi I, Zunta-Soares GB, Quevedo J, Sanches M, Soares JC. The Greater Houston Area Bipolar Registry-Clinical and Neurobiological Trajectories of Children and Adolescents With Bipolar Disorders and High-Risk Unaffected Offspring. Front Psychiatry 2021; 12:671840. [PMID: 34149481 PMCID: PMC8211873 DOI: 10.3389/fpsyt.2021.671840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/05/2021] [Indexed: 12/02/2022] Open
Abstract
The aims of this article are to discuss the rationale, design, and procedures of the Greater Houston Area Bipolar Registry (HBR), which aims at contributing to the effort involved in the investigation of neurobiological mechanisms underlying bipolar disorder (BD) as well as to identify clinical and neurobiological markers able to predict BD clinical course. The article will also briefly discuss examples of other initiatives that have made fundamental contributions to the field. This will be a longitudinal study with participants aged 6-17 at the time of enrollment. Participants will be required to meet diagnostic criteria for BD, or to be offspring of a parent with BD. We will also enroll healthy controls. Besides clinical information, which includes neurocognitive performance, participants will be asked to provide blood and saliva samples as well as to perform neuroimaging exams at baseline and follow-ups. Several studies point to the existence of genetic, inflammatory, and brain imaging alterations between individuals at higher genetic risk for BD compared with healthy controls. Longitudinal designs have shown high conversion rates to BD among high-risk offspring, with attempts to identify clinical predictors of disease onset, as well as clarifying the burden associated with environmental stressors. The HBR will help in the worldwide effort investigating the clinical course and neurobiological mechanisms of affected and high-risk children and adolescents with BD.
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Affiliation(s)
- Alexandre Paim Diaz
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Valeria A Cuellar
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Elizabeth L Vinson
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Robert Suchting
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kathryn Durkin
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Brisa S Fernandes
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Giselli Scaini
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Iram Kazimi
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Methodist Hospital, Houston, TX, United States
| | - Giovana B Zunta-Soares
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - João Quevedo
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States.,Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina, Criciúma, SC, Brazil
| | - Marsal Sanches
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jair C Soares
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Quidé Y, Tozzi L, Corcoran M, Cannon DM, Dauvermann MR. The Impact of Childhood Trauma on Developing Bipolar Disorder: Current Understanding and Ensuring Continued Progress. Neuropsychiatr Dis Treat 2020; 16:3095-3115. [PMID: 33364762 PMCID: PMC7751794 DOI: 10.2147/ndt.s285540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
Childhood trauma (CT) has been repeatedly linked to earlier onset and greater severity of bipolar disorder (BD) in adulthood. However, such knowledge is mostly based on retrospective and cross-sectional studies in adults with BD. The first objective of this selective review is to characterize the short-term effects of CT in the development of BD by focusing on studies in young people. The second objective is to describe the longer-term consequences of CT by considering studies with adult participants. This review first outlines the most prominent hypotheses linking CT exposure and the onset of BD. Then, it summarizes the psychological and biological risk factors implicated in the development of BD, followed by a discussion of original studies that investigated the role of CT in young people with early-onset BD, youths at increased risk of developing BD, or young people with BD with a focus on subclinical and clinical outcome measures. The review considers additional biological and psychological factors associated with a negative impact of CT on the long-term course of BD in later adulthood. Finally, we discuss how the integration of information of CT can improve ongoing early identification of BD and mitigate severe clinical expression in later adulthood.
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Affiliation(s)
- Yann Quidé
- School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Leonardo Tozzi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Mark Corcoran
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Maria R Dauvermann
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
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8
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Pascual MA, Levenson JC, Merranko J, Gill MK, Hower H, Yen S, Strober M, Goldstein TR, Goldstein BI, Ryan ND, Weinstock LM, Keller MB, Axelson D, Birmaher B. The Effect of Traumatic Events on the Longitudinal Course and Outcomes of Youth with Bipolar Disorder. J Affect Disord 2020; 274:126-135. [PMID: 32469795 PMCID: PMC7365761 DOI: 10.1016/j.jad.2020.05.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/02/2020] [Accepted: 05/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Exposure to severe Traumatic Events (TEs) has been associated with poor course and outcomes among individuals with Bipolar Disorder (BD). However, there is limited research on TEs among youth with BD, and few studies are longitudinal. This study prospectively followed a large sample of BD youth, examining the associations of lifetime TEs with their mood and functioning. METHODS BD participants (n=375; mean age=17; range 8-25y) were assessed, on average, every 7 months for a median 8.7 years. Psychopathology and lifetime trauma history were prospectively evaluated using the Longitudinal Interval Follow-Up Evaluation, and a traumatic events screening. RESULTS Accounting for covariates, participants with one or more lifetime TEs (84%) showed earlier BD onset, poorer psychosocial functioning, worse mood symptoms, and more suicidal ideation, comorbidities, and family psychopathology than those without TEs. TEs during recovery periods increased recurrence risk (p<0.02). More TEs were associated with poorer mood course, particularly among victims of violence/abuse (p<0.02). Abused participants (34% physical; 17% sexual) showed earlier onset of substance use disorders, more suicidality and comorbidities compared to those without abuse. Comparisons of mood course before and after abuse occurred, and with participants without abuse, showed worsening mood symptoms after, specifically hypo/mania (p<0.03). LIMITATIONS Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; given approximate dates causality cannot be inferred; TEs severity was not assessed. CONCLUSIONS Severe TEs, particularly abuse, were associated with poorer course and outcomes among BD youth. Prompt screening of trauma and early intervention may be warranted to minimize TEs impact.
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Affiliation(s)
- Maria Andreu Pascual
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA, 15213, USA
| | - Jessica C. Levenson
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA, 15213, USA
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA, 15213, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA, 15213, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA.,Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.,Department of Psychiatry, School of Medicine, University of California at San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA.,Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, 760 Westwood Plaza, Mail Code 175919, Los Angeles, CA, 90095, USA
| | - Tina R. Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA, 15213, USA
| | - Benjamin I. Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON, M4N-3M5, Canada
| | - Neal D. Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA, 15213, USA
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA.,Butler Hospital, 700 Butler Drive, Providence, RI, 02906, USA
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA.,Butler Hospital, 700 Butler Drive, Providence, RI, 02906, USA
| | - David Axelson
- Department of Psychiatry, Nationwide Children’s Hospital and The Ohio State College of Medicine, 1670 Upham Dr., Columbus, OH, 43210, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA, 15213, USA
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9
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Carmassi C, Bertelloni CA, Dell'Oste V, Foghi C, Diadema E, Cordone A, Pedrinelli V, Dell'Osso L. Post-traumatic stress burden in a sample of hospitalized patients with Bipolar Disorder: Which impact on clinical correlates and suicidal risk? J Affect Disord 2020; 262:267-272. [PMID: 31732278 DOI: 10.1016/j.jad.2019.10.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/05/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing evidence suggests Bipolar Disorder (BD) to be frequently associated to a history of traumatic experiences and Post-traumatic Stress Disorder (PTSD), with consequent greater symptoms severity, number of hospitalizations and worsening in quality of life. The aim of the present study was to investigate the lifetime exposure to traumatic events and PTSD rates in-patients with BD and to analyze the relationships between PTSD symptoms, clinical characteristics and severity of the mood disorder. METHODS A consecutive sample of 212 in-patients with a DSM-5 diagnosis of BD was enrolled at the psychiatric unit of a major University hospital in Italy and assessed by the SCID-5 and MOOD Spectrum-Self Report lifetime version (MOODS-SR). Socio-demographic characteristics, clinical features, substance or alcohol abuse, history of suicide related behaviors were also collected. RESULTS Lifetime trauma exposure emerged in 72.3% subjects, with a DSM-5 PTSD diagnosis reported by 35.6%. Patients with PTSD showed more frequently a (hypo)manic episode at onset, alcohol or substance abuse, psychotic features, suicide behaviors, higher scores in almost all the MOODS-SR domains, compared to those without PTSD. LIMITATIONS Cross sectional study. Lack of data about the time since trauma exposure or PTSD onset. CONCLUSIONS Our findings show a history of multiple traumatic experiences in hospitalized patients with BD besides high rates of PTSD, with the co-occurrence of these conditions appearing to be related to a more severe BD. Detailed investigation of post-traumatic stress symptoms is recommended for the relevant implications on the choice of a tailored treatment and the prognosis assessment.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Claudia Foghi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Elisa Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Annalisa Cordone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
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