Study findings support a role for childhood and adulthood stressors in the risk of both new-onset and recurrent mania.
Childhood stressors also acted as a sensitizer to mania, with stresses during adulthood acting as a trigger.
“This study advances our understanding of the social determinants of bipolar disorder because of several methodological improvements over previous studies”, say lead researcher Stephen Gilman (Harvard School of Public Health, Boston, Massachusetts, USA) and co-workers.
The data were derived from 33,375 participants of the National Epidemiologic Survey on Alcohol and Related Conditions, rather than from patient populations, and included a 3-year period of prospective follow-up.
In all, 3.5% of the participants met the DSM-IV criteria for a previous manic episode, and 14.4% of these had recurrent episodes during follow-up. A further 1.9% of participants had a first-onset episode during the study period.
Childhood abuse, reported by 9.8% of the cohort, and sexual maltreatment, reported by 7.2%, were both associated with a more than doubled risk of having a first manic episode during the study period. Economic disadvantage during childhood did not predict mania after accounting for confounders including age, gender, educational attainment, adulthood stressors and history of alcohol or substance dependence.
Childhood adversity, most notably sexual maltreatment, also predicted recurrent mania, the team reports in Molecular Psychiatry.
In addition, some adulthood stressors, such as social support group problems (including death of close family member or friend), economic problems and occupational problems, predicted first-onset and recurrent mania.
“This evidence is consistent with emerging theoretical models of bipolar disorder that implicate stress-related pathways in the etiology of mania, and propose that these pathways have developmental origins”, say the researchers.
They note that childhood and adulthood predictors of first-onset and current mania were very similar. “We interpret this finding to suggest that social context over the life course is associated with heightened vulnerability to mania, and that this vulnerability is not attenuated after remission of an individual’s first manic episode.”
There was also evidence that childhood adversity could act as a sensitizer, particularly in the case of participants reporting childhood abuse, which significantly increased the likelihood of them having a first-ever manic episode in the year following a personal loss (differential effect =2.2%).
“Sexual maltreatment, in contrast, was such a powerful predictor of bipolar disorder that stressful life events in adulthood did not further increase the risk of mania among adults who experienced this type of adversity”, say Gilman et al.
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