Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder

University of Pittsburgh Medical Center. Western Psychiatric Institute Clinic, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 07/2008; 112(1-3):144-50. DOI: 10.1016/j.jad.2008.04.005
Source: PubMed


Adult bipolar disorder (BP) has been associated with lifetime history of physical and sexual abuse. However, there are no reports of the prevalence of abuse in BP youth. The objective of this study was to examine the prevalence and correlates of physical and/or sexual abuse among youth with BP spectrum disorders.
Four hundred forty-six youths, ages 7 to 17 years (12.7+/-3.2), meeting DSM-IV criteria for BP-I (n=260), BP-II (n=32) or operationalized definition of BP-NOS (n=154) were assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime version (K-SADS-PL). Abuse was ascertained using the K-SADS.
Twenty percent of the sample experienced physical and/or sexual abuse. The most robust correlates of any abuse history were living with a non-intact family (OR=2.6), lifetime history of posttraumatic stress disorder (PTSD) (OR=8.8), psychosis (OR=2.1), conduct disorder (CD) (OR=2.3), and first-degree family history of mood disorder (OR=2.2). After adjusting for confounding demographic factors, physical abuse was associated with longer duration of BP illness, non-intact family, PTSD, psychosis, and first-degree family history of mood disorder. Sexual abuse was associated with PTSD. Subjects with both types of abuse were older, with longer illness duration, non-intact family, and greater prevalence of PTSD and CD as compared with the non-abused group.
Retrospective data. Also, since this is a cross-sectional study, no inferences regarding causality can be made.
Sexual and/or physical abuse is common in youth with BP particularly in subjects with comorbid PTSD, psychosis, or CD. Prompt identification and treatment of these youth is warranted.

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    • "Life events can significantly influence the clinical presentation of mood disorders (Kraepelin, 1899; Post, 1992). In particular, several studies consistently show that childhood trauma is a relevant environmental stressor associated with bipolar disorders (BD) (Bücker et al., 2014; Garno et al., 2005; Romero et al., 2009). "
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    ABSTRACT: Childhood trauma is an important environmental stressor associated with bipolar disorders (BD). It is still not clear if it is differently distributed between BD I and BD II. Therefore, the aim of this research was to investigate the distribution patterns of childhood trauma in BD I and BD II. In this perspective, we also studied the relationship between childhood trauma and suicidality. We assessed 104 outpatients diagnosed with BD I (n=58) or BD II (n=46) according to DSM-IV-TR criteria and 103 healthy controls (HC) matched for age, sex and education level. History of childhood trauma was obtained using the Childhood Trauma Questionnaire (CTQ). All patients with BD had had more severe traumatic childhood experiences than HC. Both BD I and BD II patients differed significantly from HC for trauma summary score and emotional abuse. BD I patients differed significantly from HC for sexual abuse, and BD II differed from HC for emotional neglect. BD I and BD II did not significantly differ for any type of trauma. Suicide attempts were linked to both emotional and sexual abuse in BD I and only to emotional abuse in BD II. Emotional abuse was an independent predictor of lifetime suicide attempts in BD patients. The reliability of the retrospective assessment of childhood trauma experiences with the CTQ during adulthood may be influenced by uncontrolled recall bias. The assessment of childhood trauma, which has great clinical importance because of its strong link with suicidality, can unveil slight differences between BD subtypes and HC. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 12/2014; 175C:92-97. DOI:10.1016/j.jad.2014.12.055 · 3.38 Impact Factor
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    • "Early trauma has been demonstrated to have a powerful effect on adult mental health (Norman et al., 2012). Exposure to early trauma has been linked to many psychopathologies, including bipolar disorder (Brown et al., 2005; Romero et al., 2009). The existing studies in western countries indicated that childhood maltreatment can be strongly associated with an early onset of "
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    ABSTRACT: Objectives Childhood trauma is a major public health problem which has a long-term consequence, a few studies have examined the relationship between childhood trauma and clinical features of bipolar disorder, most in western culture, with no such studies done in Chinese culture. Methods The CTQ-SF was administered to 132 Chinese patients with DSM-IV bipolar disorder. Participants also completed the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), the Impact of Events Scale-Revised (IES-R), and the State-Trait Anxiety Inventory (STAI). The CTQ-SF cut-off scores for exposure were used to calculate the prevalence of trauma. The relationship between childhood trauma and clinical features of bipolar disorder were examined. Results The internal consistency of CTQ-SF was good (Cronbach׳s α=0.826) and four week test–retest reliability was high (r=0.755). 61.4% of this sample reported physical neglect (PN) in childhood, followed by emotional neglect (EN, 49.6%), sexual abuse (SA, 40.5%), emotional abuse (EA, 26.0%) and physical abuse (PA,13.1%). Significant negative correlations existed between age of onset and EA and EN score (r=−0.178~–0.183, p<0.05). Significant positive correlations were observed between EA, CTQ-SF total score and intrusion and hyper-arousal scores of IES-R (r=0.223~0.309, p<0.05). Similarly, significant positive correlations were found between EN, PN, CTQ-SF total and STAI score (r=0.222~0.425, p<0.05). Limitations Data on childhood trauma were derived from a retrospective self-report questionnaire without independent corroboration. A number of potential patients (more severe or chronic patients) was excluded because they were either refused to participate or inappropriate to participate in research. Conclusions Significant number of subjects in patients with BD reported experience of childhood abuse and neglect. Exposure to childhood trauma is associated with age of onset of illness, co morbid PTSD and anxiety symptoms. To study the pathogenesis of childhood trauma on bipolar disorder and explanation the interaction between childhood trauma and susceptibility genes are proposed.
    Journal of Affective Disorders 10/2014; 168:58–63. DOI:10.1016/j.jad.2014.06.017 · 3.38 Impact Factor
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    • "About half of youths (Marchand et al. 2005) or adults (Garno et al. 2005) receiving outpatient treatment for bipolar disorder report histories of abuse or neglect when asked. However, excluding neglect makes the estimates lower (Maniglio 2013b), more in the range of 20 % for youths (Romero et al. 2009; Goldstein et al. 2010). Specific subtypes of abuse sometimes differentiate individuals with BPSD from those with BPSD. "
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    ABSTRACT: The objective of this study was to determine if physical and sexual abuse showed relationships to early-onset bipolar spectrum disorders (BPSD) consistent with findings from adult retrospective data. Participants (N = 829, M = 10.9 years old ± 3.4 SD, 60 % male, 69 % African American, and 18 % with BPSD), primarily from a low socio-economic status, presented to an urban community mental health center and a university research center. Physical abuse was reported in 21 %, sexual abuse in 20 %, and both physical and sexual abuse in 11 % of youths with BPSD. For youths without BPSD, physical abuse was reported in 16 %, sexual abuse in 15 %, and both physical and sexual abuse in 5 % of youths. Among youth with BPSD, physical abuse was significantly associated with a worse global family environment, more severe depressive and manic symptoms, a greater number of sub-threshold manic/hypomanic symptoms, a greater likelihood of suicidality, a greater likelihood of being diagnosed with PTSD, and more self-reports of alcohol or drug use. Among youth with BPSD, sexual abuse was significantly associated with a worse global family environment, more severe manic symptoms, a greater number of sub-threshold manic/hypomanic symptoms, greater mood swings, more frequent episodes, more reports of past hospitalizations, and a greater number of current and past comorbid Axis I diagnoses. These findings suggest that if physical and/or sexual abuse is reported, clinicians should note that abuse appears to be related to increased severity of symptoms, substance use, greater co-morbidity, suicidality, and a worse family environment.
    Journal of Abnormal Child Psychology 08/2014; 43(3). DOI:10.1007/s10802-014-9924-3 · 3.09 Impact Factor
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