Stressful life events (SLEs), particularly independent severe, loss, and danger events, are significantly associated with depressive symptoms in patients with bipolar disorder (BD), study results show.
However, Georgina Hosang (King's College London) and colleagues found no significant association between the occurrence of such events and manic symptoms in patients with the mood disorder.
"Our results add to the growing body of evidence which supports the role of SLEs in the course of BD, and emphasizes the need for the experience of SLEs to be monitored among individuals with BD, which could have strong clinical utility," the researchers write in the Journal of Psychiatric Research.
"For instance, people with BD, their families and clinicians could be coached to identify events that could trigger depression, and develop effective coping strategies (eg, through cognitive behavioural therapy) to deal with such events helping to avoid symptom exacerbation or relapse," they add.
The findings come from a 4-month study of 96 BD patients who were assessed for SLEs at baseline and follow-up using the Life Events and Difficulties Schedule.
The researchers focused on independent SLEs, defined as those deemed to be outside the control of the individual. These were further characterized as severe events with a marked or moderate long-term effect, loss events (eg, death of a loved one), or danger events (eg, serious illness diagnosis in a family member).
The participants were also assessed for depressive symptoms over the study period using the Beck Depression Inventory-Second Edition and the Montgomery Asberg Depression Rating Scale, and for mania symptoms using the Self-Report Mania Inventory and the Clinician-Administered Rating Scale for Mania.
Overall, 33% of patients reported a severe event at baseline and 31% at follow-up, 24% reported a loss event at baseline and 20% at follow-up, and 22% reported a danger event at both time points.
Over the course of the study period, 22% of patients experienced a worsening of depressive symptoms, and 22% experienced a worsening of mania symptoms.
After accounting for factors such as age, gender, employment status, and change in medications, the team found that exposure to at least one severe, loss, or danger event over the study period was significantly associated with exacerbation of depressive symptoms.
No such association was observed regarding manic symptoms, after adjustment for confounding variables.
"The results from this study suggest that loss and danger events are important for BD depression," conclude Hosang et al.
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