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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    • "Age of onset appears to be less clearly heritable, though some evidence for familiality has emerged (Lin et al., 2006b; Schulze et al., 2006). A number of studies have shown that earlylife trauma, such as sexual or physical abuse, is associated with an earlier age of onset of bipolar illness as well as a more complicated and treatment-resistant course (Brown et al., 2005; Garno et al., 2005; Gilman et al., 2015; Leverich et al., 2002; Leverich and Post, 2006; Romero et al., 2009). Importantly, presence or absence of childhood trauma and family history of BPD have been reported to demonstrate interaction in their influence on the age of onset and course of bipolar disorder; the effect of trauma upon age of onset was observed to be substantially larger when family history is present (Post and Leverich, 2006). "
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    ABSTRACT: This study investigated whether early life trauma mediates genetic effects on the age at onset (AAO) of bipolar disorder. Data from the BiGS Consortium case samples (N=1119) were used. Childhood traumatic events were documented using the Childhood Life Events Scale (CLES). Interaction between occurrence of childhood trauma and common genetic variants throughout the genome was tested to identify single nucleotide polymorphic gene variants (SNPs) whose effects on bipolar AAO differ between individuals clearly exposed (CLES≥2) and not exposed (CLES=0) to childhood trauma. The modal response to the CLES was 0 (N=480), but an additional 276 subjects had CLES=1, and 363 subjects reported 2 or more traumatic lifetime events. The distribution of age at onset showed a broad peak between ages 12 and 18, with the majority of subjects having onset during that period, and a significant decrease in age of onset with the number of traumatic events. No single SNP showed a statistically significant interaction with the presence of traumatic events to impact bipolar age at onset. However, SNPs in or near genes coding for calcium channel activity-related proteins (Gene Ontology: 0005262) were found to be more likely than other SNPs to show evidence of interaction using the INRICH method (p<0.001). Retrospective ascertainment of trauma and AAO. Interaction effects of early life trauma with genotype may have a significant effect on the development and manifestation of bipolar disorder. These effects may be mediated in part by genes involved in calcium signaling. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Mar 2015 · Journal of Affective Disorders
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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.
    Full-text · Article · Dec 2014 · Journal of Affective Disorders
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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.
    Full-text · Article · Oct 2014 · Journal of Affective Disorders
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