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. 2020 Oct;50(14):2346-2354.
doi: 10.1017/S0033291719002411. Epub 2019 Sep 18.

Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder: a path analysis of 923 people with bipolar I disorder

Steven Marwaha  1 , Paul M Briley  2 , Amy Perry  3 , Phillip Rankin  4 , Arianna DiFlorio  5 , Nick Craddock  5 , Ian Jones  5 , Matthew Broome  1 , Katherine Gordon-Smith  3 , Lisa Jones  3
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Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder: a path analysis of 923 people with bipolar I disorder

Steven Marwaha et al. Psychol Med. 2020 Oct.

Abstract

Background: Childhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.

Methods: We analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.

Results: Affective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.

Conclusions: Affective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.

Keywords: Affective instability; bipolar disorder; childhood abuse; impulsivity; path analysis.

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Figures

Fig. 1.
Fig. 1.
Pathways between childhood abuse and clinical outcomes in bipolar disorder
See this image and copyright information in PMC

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