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Mol Psychiatry DOI:10.1038/mp.2014.36

Contributions of the social environment to first-onset and recurrent mania.

Publication TypeJournal Article
Year of Publication2015
AuthorsGilman, SE, Ni, MY, Dunn, EC, Breslau, J, McLaughlin, KA, Smoller, JW, Perlis, RH
JournalMol Psychiatry
Date Published2015 Mar
KeywordsAdolescent, Adult, Bipolar Disorder, Child, Child Abuse, Cohort Studies, Diagnostic and Statistical Manual of Mental Disorders, Female, Humans, Logistic Models, Male, Middle Aged, Recurrence, Social Environment, Young Adult

In treated cohorts, individuals with bipolar disorder are more likely to report childhood adversities and recent stressors than individuals without bipolar disorder; similarly, in registry-based studies, childhood adversities are more common among individuals who later become hospitalized for bipolar disorder. Because these types of studies rely on treatment-seeking samples or hospital diagnoses, they leave unresolved the question of whether or not social experiences are involved in the etiology of bipolar disorder. We investigated the role of childhood adversities and adulthood stressors in liability for bipolar disorder using data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=33 375). We analyzed risk for initial-onset and recurrent DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) manic episodes during the study's 3-year follow-up period. Childhood physical abuse and sexual maltreatment were associated with significantly higher risks of both first-onset mania (odds ratio (OR) for abuse: 2.23; 95% confidence interval (CI)=1.71, 2.91; OR for maltreatment: 2.10; CI=1.55, 2.83) and recurrent mania (OR for abuse: 1.55; CI=1.00, 2.40; OR for maltreatment: 1.60; CI=1.00, 2.55). In addition, past-year stressors in the domains of interpersonal instability and financial hardship were associated with a significantly higher risk of incident and recurrent mania. Exposure to childhood adversity potentiated the effects of recent stressors on adult mania. Our findings demonstrate a role of social experiences in the initial onset of bipolar disorder, as well as in its prospective course, and are consistent with etiologic models of bipolar disorder that implicate deficits in developmentally established stress-response pathways.


Alternate JournalMol. Psychiatry
PubMed ID24751965
PubMed Central IDPMC4206672
Grant ListK24 MH094614 / MH / NIMH NIH HHS / United States
K24MH094614 / MH / NIMH NIH HHS / United States
R01MH087544 / MH / NIMH NIH HHS / United States
K01 MH102403 / MH / NIMH NIH HHS / United States
R01 MH087544 / MH / NIMH NIH HHS / United States
K01 MH092526 / MH / NIMH NIH HHS / United States