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. 2020 Sep 1:274:126-135.
doi: 10.1016/j.jad.2020.05.131. Epub 2020 May 22.

The Effect of Traumatic Events on the Longitudinal Course and Outcomes of Youth with Bipolar Disorder

Maria Andreu Pascual  1 , Jessica C Levenson  2 , John Merranko  2 , Mary Kay Gill  2 , Heather Hower  3 , Shirley Yen  4 , Michael Strober  5 , Tina R Goldstein  2 , Benjamin I Goldstein  6 , Neal D Ryan  2 , Lauren M Weinstock  7 , Martin B Keller  7 , David Axelson  8 , Boris Birmaher  2
Affiliations

The Effect of Traumatic Events on the Longitudinal Course and Outcomes of Youth with Bipolar Disorder

Maria Andreu Pascual et al. J Affect Disord. .

Abstract

Background: Exposure to severe Traumatic Events (TEs) has been associated with poor course and outcomes among individuals with Bipolar Disorder (BD). However, there is limited research on TEs among youth with BD, and few studies are longitudinal. This study prospectively followed a large sample of BD youth, examining the associations of lifetime TEs with their mood and functioning.

Methods: BD participants (n=375; mean age=17; range 8-25y) were assessed, on average, every 7 months for a median 8.7 years. Psychopathology and lifetime trauma history were prospectively evaluated using the Longitudinal Interval Follow-Up Evaluation, and a traumatic events screening.

Results: Accounting for covariates, participants with one or more lifetime TEs (84%) showed earlier BD onset, poorer psychosocial functioning, worse mood symptoms, and more suicidal ideation, comorbidities, and family psychopathology than those without TEs. TEs during recovery periods increased recurrence risk (p<0.02). More TEs were associated with poorer mood course, particularly among victims of violence/abuse (p<0.02). Abused participants (34% physical; 17% sexual) showed earlier onset of substance use disorders, more suicidality and comorbidities compared to those without abuse. Comparisons of mood course before and after abuse occurred, and with participants without abuse, showed worsening mood symptoms after, specifically hypo/mania (p<0.03).

Limitations: Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; given approximate dates causality cannot be inferred; TEs severity was not assessed.

Conclusions: Severe TEs, particularly abuse, were associated with poorer course and outcomes among BD youth. Prompt screening of trauma and early intervention may be warranted to minimize TEs impact.

Keywords: Bipolar disorder; longitudinal study; physical abuse; sexual abuse; traumatic events; youth.

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Conflict of interest statement

Declaration of Competing Interest Dr. Andreu Pascual has received a grant from the Alicia Koplowitz Foundation. Dr. Levenson receives salary support and grant funding from NICHD, grant funding American Academy of Sleep Medicine Foundation and the University of Pittsburgh, and royalties from American Psychological Association Book. Dr. Birmaher reports grants from NIMH, during the conduct of the study; royalties from Random House, Woltas Kluwer (UpToDate) and Lippincott, Williams & Wilkins, outside of the submitted work. Ms. Hower has received research support from NIMH, and honoraria from the Department of Defense (DOD). Dr. Yen has received research support from NIMH, NCCIH, and the American Foundation for Suicide Prevention. Dr. Strober has received research support from NIMH, and support from the Resnick Endowed Chair in Eating Disorders. Dr. T. Goldstein reports grants from NIMH, The American Foundation for Suicide Prevention, University of Pittsburgh Clinical and Translational Science Institute (CTSI) and The Brain and Behavior Foundation and royalties from Guilford Press, outside the submitted work. Dr. B Goldstein reports grants from Brain & Behavior Research Foundation, Brain Canada, Canadian Institutes of Health Research, Heart & Stroke Foundation, and the departments of psychiatry of Sunnybrook Health Sciences Centre and the University of Toronto Department of Psychiatry. Dr. Ryan reports grants from NIH and Axsome Therapeutics. Dr. Weinstock has received research support from NIMH, NCCIH, the NIH OBSSR, and NIJ. Dr. Keller has received research support from NIMH and the John J. McDonnell and Margaret T. O'Brien Foundation. Dr. Axelson reports grants from NIMH, during the conduct of the study; personal fees from Janssen Research and Development, LLC, and UpToDate, outside the submitted work. Mr. Merranko, Ms. Gill report no financial relationships with commercial interests.

Figures

Figure 1.
Figure 1.
Kaplan-Meier survival estimation: substance use disorder risk stratified by history of abuse * *Model controls for demographics, comorbid diagnoses, and family history retained by Least Absolute Shrinkage and Selection Operator (LASSO).
See this image and copyright information in PMC

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