The psychosocial correlates of the recurrence of bipolar I disorder from the National Comorbidity Survey.
Holmes, Carolyn Alice
1996
Abstract
Bipolar I (BPI) disorder is a recurrent affective psychiatric disorder with a disruptive and debilitating course. Clinical evidence indicates that the frequency of recurrence is positively associated with a more severe course and progressive functional deterioration. Thus, research is needed to identify the factors that increase the likelihood of recurrence and to assess the mechanisms by which these factors exert their effect. This study examined the psychosocial risk factors associated with increased recurrence in persons with meeting DSM-III-R criteria for a diagnosis of BPI disorder. Using data from the National Comorbidity Survey (NCS), psychosocial correlates of BPI episode recurrence were investigated in a representative population sample of noninstitutionalized Americans between the ages of 15 and 54. The NCS was the first psychiatric epidemiologic survey administered to a nationally representative sample (N = 8098) and was completed with a response rate of 82.4%. In addition to documenting prevalence and incidence of 14 psychiatric disorders, the NCS data included extensive measures on childhood and family risk factors as well as on intrapsychic characteristics and current events and stressors. A diathesis-stress model was tested to ascertain whether adverse experiences during childhood (e.g., parental psychopathology, relationship difficulties, and violence during childhood) create a vulnerability that predisposes the bipolar respondent to increased risk of recurrence, especially in the presence of certain adult characteristics and circumstances (e.g., comorbidity, traumatic events, chronic stressors, and personality characteristic). Two childhood adversities showed robust direct effects on recurrence, parental psychopathology and childhood abuse. Significant adult risk factors were marital difficulties, interpersonal conflicts, and current traumatic events of an aggressive or financial nature. When all significant childhood and adult predictors were placed in one multivariate model, three factors remained strongly predictive of recurrence: childhood abuse, parental psychopathology, and ongoing marital difficulties. No associations between social support and recurrence were found. Remarkably, with each additional risk factor the risk of recurrence more than doubled. None of the childhood effects were mediated through adult adversities, but traumatic events reduced the effect size of other adult predictors, suggesting the need to further examine the possibility of a triggering effect for traumatic events.Subjects
Bipolar Childhood Abuse Comorbidity Correlates Difficulties Disorder Marital Family System National Parental Psychopathology Psychosocial Recurrence Sur Survey
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