Family history of suicidal behavior and early traumatic experiences: Additive effect on suicidality and course of bipolar illness?

Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY 10032, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 08/2008; 109(1-2):57-63. DOI: 10.1016/j.jad.2007.12.225
Source: PubMed


Bipolar disorder (BD) is associated with a high prevalence of suicide attempt and completion. Family history of suicidal behavior and personal history of childhood abuse are reported risk factors for suicide among BD subjects.
BD individuals with family history of suicidal behavior and personal history of childhood abuse (BD-BOTH), BD individuals with family history of suicidal behavior or personal history of childhood abuse (BD-ONE), and BD individuals with neither of these two risk factors (BD-NONE) were compared with regard to demographic variables and clinical measures.
Almost 70% of the sample had a history of a previous suicide attempt. There were significantly higher rates of previous suicide attempts in the BD-BOTH and BD-ONE relative to the BD-NONE group. BD-BOTH were significantly younger at the time of their first suicide attempt and had higher number of suicide attempts compared with BD-NONE. BD-BOTH were significantly younger at the time of their first episode of mood disorder and first psychiatric hospitalization and had significantly higher rates of substance use and borderline personality disorders compared to BD-NONE.
Retrospective study. Use of semi-structured interview for the assessment of risk factors.
BD individuals with a familial liability for suicidal behavior and exposed to physical and/or sexual abuse during childhood are at a greater risk to have a more impaired course of bipolar illness and greater suicidality compared to those subjects with either only one or none of these risk factors. Prospective studies are needed to confirm these findings.

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    • "However, the role of social factors in the development of suicidality within the context of bipolar disorder remains largely under researched. The few studies which have focused upon social factors and suicidality in bipolar disorder have highlighted the significance of adversities during early life, such as childhood physical and sexual abuse (Alvarez et al., 2011; Carballo et al., 2008; Garno et al., 2005; Leverich et al., 2002), a family history of suicidal behaviour (Galfalvy et al., 2006; Leverich et al., 2002; MacKinnon et al., 2005; Pawlak et al., 2013), a family history of mental health problems (Lopez et al., 2001; Pawlak et al., 2013), problems with social relationships (Leverich et al., 2002; Tsai et al., 1999), and stressful life events (Antypa et al., 2013; Azorin et al., 2009). However, none of the aforementioned studies involved directly asking individuals with past experiences of suicidality and bipolar disorder to identify the socially relevant processes or factors they feel are involved in pathways leading to suicidal thoughts and behaviours . "
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    ABSTRACT: The prevalence rate of completed suicide in bipolar disorder is estimated to be as high as 19%. Social factors or influences, such as stigmatisation and family conflict, contribute to the development of suicidal ideation in clinical and non-clinical populations. Yet, there is a lack of studies examining suicidality from a psychosocial perspective in people who experience bipolar disorder. Semi-structured interviews were used to collect qualitative data from 20 participants with bipolar disorder. The interview focused on the effects of social factors upon participants׳ experiences of suicidality (suicidal thoughts, feelings or behaviours). A thematic analysis was used to understand the data. Social or interpersonal factors which participants identified as protective against suicidality included, 'the impact of suicide on others' and, 'reflecting on positive social experiences'. Social factors which triggered suicidal thoughts included, 'negative social experiences' and, 'not being understood or acknowledged'. Social factors which worsened suicidal thoughts or facilitated suicidal behaviour were, 'feeling burdensome,' and 'reinforcing negative self-appraisals'. Some participants had not experienced suicidal thoughts for many years and were recalling experiences which had taken place over ten years ago. The accuracy and reliability of these memories must therefore be taken into consideration when interpreting the results. The themes help to enhance current understanding of the ways in which social factors affect suicidality in people who experience bipolar disorder. These results highlight the importance of considering the social context in which suicidality is experienced and incorporating strategies to buffer against the effects of negative social experiences in psychological interventions which target suicide risk in bipolar disorder. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Feb 2015 · Journal of Affective Disorders
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    • "Childhood trauma can influence clinical outcome by inducing earlier disease onset, a greater number of episodes, a rapid cycling course and suicide attempts and increasing the need for hospitalization . Finally, specific types of childhood trauma are associated with different clinical features, (Daruy‐Filho et al., 2011) like suicide attempts (Carballo et al., 2008; Leverich et al., 2002). Specifically, previous studies found that suicide attempts are associated with both sexual and emotional abuse (Garno et al., 2005; Etain et al., 2013). "
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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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    • "Adverse experiences in childhood have been recognized as common events in individuals with bipolar disorder (BD), with approximately half (49%) of these individuals reporting at least some form of abuse or neglect during childhood (Garno, Goldberg, Ramirez, & Ritzler, 2005; Leverich et al., 2002). Furthermore, a history of childhood maltreatment (CMT) has been associated with unfavorable characteristics of BD (Alvarez, Roura, Oses, Foguet, Sola, & Arrufat, 2011; Angst, Gamma, Rossler, Ajdacic, & Klein, 2011; Daruy-Filho, Brietzke, Lafer, & Grassi-Oliveira, 2011; Etain, Henry, Bellivier, Mathieu, & Leboyer, 2008; McIntyre et al., 2008), including early age of onset (Carballo et al., 2008; Dienes, Hammen, Henry, Cohen, & Daley, 2006), recurrence (Brown, McBride, Bauer, & Williford, 2005), and decreased response to treatment (Marchand, Wirth, & Simon, 2005). Childhood maltreatment has also been significantly associated with impairment in cognitive performance among various samples. "
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    ABSTRACT: A personal history of childhood maltreatment has been associated with unfavorable outcomes in bipolar disorder (BD). The impact of early life stressors on the course of BD may be influenced by individual differences in coping skills. The coping construct relies on neurocognitive mechanisms that are usually influenced by childhood maltreatment. The objective of the present study was to verify the association between childhood maltreatment and coping skills in individuals with BD Type 1. Thirty female euthymic outpatients with BD Type 1 were evaluated using the Childhood Trauma Questionnaire and two additional instruments to measure their coping preferences: Ways of Coping Questionnaire (coping strategies) and Brief COPE (coping styles). Reports of physical abuse (B =.64, p ≤.01) and emotional abuse (B =.44, p =.01) were associated with the use of maladaptive strategies that focused on emotional control. Adaptive strategies and styles of coping, such as focusing on the problem, were chosen less frequently by women who had experienced emotional neglect (B =.53, p ≤.01) and physical abuse (B = -.48, p ≤.01) in childhood. The small sample size in the present study prevented subgroup analyses. The sample did not include male BD participants. Our results indicate that early traumatic events may have a long-lasting deleterious influence on coping abilities in female BD patients. Future prospective studies may investigate whether the negative impact of childhood maltreatment over the course of BD is mediated by individual differences in coping abilities.
    Full-text · Article · Dec 2013 · Psychology and Neuroscience
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