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. 2021 Nov;60(11):1419-1429.
doi: 10.1016/j.jaac.2021.02.023. Epub 2021 Mar 27.

A Longitudinal Study of Psychiatric Disorders in Offspring of Parents With Bipolar Disorder From Preschool to Adolescence

Boris Birmaher  1 , John Merranko  2 , Danella Hafeman  2 , Benjamin I Goldstein  3 , Rasim Diler  2 , Jessica C Levenson  2 , Kelly Monk  2 , Satish Iyengar  4 , Mary Beth Hickey  2 , Dara Sakolsky  2 , David Axelson  5 , Tina Goldstein  2
Affiliations

A Longitudinal Study of Psychiatric Disorders in Offspring of Parents With Bipolar Disorder From Preschool to Adolescence

Boris Birmaher et al. J Am Acad Child Adolesc Psychiatry. 2021 Nov.

Abstract

Objective: To compare the prevalence of psychopathology, particularly bipolar disorder (BD), between preschool offspring of parents with BD and community controls.

Method: A total of 116 offspring of BD-I/II parents and 98 controls (53 parents with non-BD psychopathology and 45 healthy parents) were recruited at ages 2 to 5 years and followed on average 9.6 years (on average: 2-5: 1.6 times; after age 5: 4 times) (average ages at intake/last follow-up: 3.8/13.4, retention: 98%). Participants were evaluated with standardized instruments blinded to parental diagnoses.

Results: After adjusting for confounders, offspring of BD parents only showed more attention-deficit/hyperactivity disorder (ADHD) during ages 2 to 5 years than the other 2 groups. After age 5, offspring of BD parents did not differ from offspring of parents with non-BD psychopathology, but they had more anxiety, ADHD, and behavior problems than offspring of healthy parents. Only offspring of BD parents developed BD-I/II: 3.4% (n = 4) and BD-not-otherwise-specified (BD-NOS): 11.2% (n = 13), with mean onset ages 11.4 and 7.4, respectively. About 70% of offspring with BD had non-BD disorders before BD. Only ADHD, diagnosed before age 6 years, and early-onset parental BD were significantly associated with BD risk.

Conclusion: Most offspring of BD parents did not develop BD, but they were at specific high risk for developing BD, particularly those with preschool ADHD and early-onset parental BD. BD symptoms were scarce during the preschool years and increased throughout the school age, mainly in the form of BD-NOS, a disorder that conveys poor prognosis and high risk to develop BD-I/II. Developing early interventions to delay or, ideally, to prevent its onset are warranted.

Keywords: bipolar disorder; high-risk; offspring; preschoolers; psychopathology.

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Conflict of interest statement

Disclosure: Dr. Birmaher has received grants from NIMH, during the conduct of the study, and royalties from Random House, UpToDate, and Lippincott, Williams, and Wilkins, outside of the submitted work. Dr. Hafeman has received grants from NIMH and the Brain and Behavior Research Foundation. Dr. B. Goldstein has received grant funding from Brain Canada, the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, NIMH, and the departments of psychiatry of Sunnybrook Health Sciences Centre and the University of Toronto. Dr. Diler has received research support from NIMH. Dr. Levenson has received grant support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the University of Pittsburgh and royalties from American Psychological Association Books. Dr. Sakolsky has received grant support from NIMH. Dr. Axelson has received grants from NIMH, during the conduct of the study, and royalties from Wolters-Kluwer / UpToDate, outside the submitted work. Dr. T. Goldstein has received grants from NIMH, the American Foundation for Suicide Prevention, the 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. Iyengar, Mr. Merranko, and Mss. Monk and Hickey have reported no biomedical financial interests or potential conflicts of interest.

Figures

Figure 1.
Figure 1.. Cumulative Lifetime Risk of Developing Bipolar Disorder (BD) (1a) and Major Depressive Disorder (MDD) (1b) in Offspring of Parents With BD and Community Controls
Note: Seventeen (14.3%) offspring of parents with BD developed BD with a mean onset age=8.3±3.2 years old (log-rank X2 =16.74, p value=0.0002). Ten (8.6%) offspring of parents with BD, nine (17.0%) offspring of parents with non-BD psychopathology, and three (6.7%) offspring of healthy parents developed MDD with mean onset ages of 12.8 ± 4.3, 12.6 ± 2.5, and 13.6 ± 3.4 years old, respectively (X2=2.75, p value=0.3).
See this image and copyright information in PMC

Comment in

References

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