Stress coping strategies may protect against bipolar disorder recurrence

By Lucy Piper, Senior medwireNews Reporter

Researchers have found a link between low levels of resilience to stress in euthymic patients with bipolar disorder and impulsive behaviour, which may make them vulnerable to depressive episodes.

“Patients with [bipolar disorder] who exhibited low levels of resilience seem to behave in an impulsive manner under stressful conditions”, say researcher Boseok Cha (Gyeongsang National University Hospital, Jinju, Republic of Korea) and colleagues.

Either low levels of resilience are associated with vulnerability to making rapid decisions during times of stress or, conversely, functional impairments such as cognitive deficits, which are associated with impulsivity, reduce the ability of patients to cope with stress or adversity, they note.

Among 62 outpatients with bipolar disorder, average levels of resilience, measured on the Connor–Davidson Resilience Scale (CD-RISC), were 60.58, which was significantly lower than the 72.77 among 62 age- and gender-matched mentally healthy individuals.

By contrast, levels of impulsivity were significantly higher, with average total scores on the Barratt Impulsiveness Scale (BIS) of 62.00 for bipolar disorder patients versus 55.68 for controls. This was also the case for the BIS attention, BIS motor and BIS non-planning subscale scores.

Resilience correlated significantly with the degree of impulsivity, number of depressive episodes according to the Center for Epidemiological Studies for Depression Scale, Clinical Global Impression (CGI) scores and length of education.

And resilience remained a significant independent predictor of depressive episodes, explaining 12.3% of variance in episodes, after age, gender, length of education and impulsivity were controlled. This makes resilience “an important prognostic factor related to the course of [bipolar disorder]”, say Cha and colleagues.

Attention impulsivity and non-planning impulsivity also remained significantly associated with low levels of resilience after controlling for age, gender, length of education and CGI scores, explaining 42% of variance in CD-RISC scores.

The findings, published in the Journal of Affective Disorders, suggest “the need to develop and monitor the effectiveness of systematic resilience-enhancing programs that are tailored to prevent the recurrence of depressive episodes in patients with BD”, write Cha and team.

These may involve protective factors such as active coping, optimism, positive emotions, cognitive reappraisal, social support, having purpose in life, relying on a moral compass, and spirituality, they add.

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