Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-03T22:05:37.517Z Has data issue: false hasContentIssue false
  • English
  • Français

Chronic stressors and trauma: prospective influences on the course of bipolar disorder

Published online by Cambridge University Press:  18 February 2013

A. Gershon ,
S. L. Johnson  and
I. Miller
A. Gershon*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
S. L. Johnson
Affiliation:
Department of Psychology, University of California, Berkeley, CA, USA
I. Miller
Affiliation:
Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
*
*Address for correspondence: A. Gershon, Ph.D., Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305-5717, USA. (Email: gershon@stanford.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Exposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients.

Method

One hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments).

Results

Trauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance.

Conclusions

Overall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.

Keywords

Bipolar disorderdisease progressionprospective studiessocial environmentstress
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 12 , December 2013 , pp. 2583 - 2592
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychiatric Association: Washington, DC.Google Scholar
Bauer, MS, McBride, L, Shea, N, Gavin, C (1997). Impact of an easy-access VA clinic-based program for patients with bipolar disorder? Psychiatric Services 48, 491–496.Google ScholarPubMed
Bech, P, Baastrup, PC, de Bleeker, E, Ropert, R (2001). Dimensionality, responsiveness and standardization of the Bech-Rafaelsen Mania Scale in the ultra-short therapy with anti-psychotics in patients with severe manic episodes? Acta Psychiatrica Scandinavica 104, 25–30.CrossRefGoogle Scholar
Bech, P, Bolwig, TG, Kramp, P, Rafaelsen, OJ (1979). The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale: evaluation of homogeneity and inter-observer reliability? Acta Psychiatrica Scandinavica 59, 420–430.CrossRefGoogle Scholar
Brewin, CR, Andrews, B, Gotlib, IH (1993). Psychopathology and early experience: a reappraisal of retrospective reports? Psychological Bulletin 113, 82–98.CrossRefGoogle ScholarPubMed
Brown, GW, Harris, TO (1978). The Bedford College Life Events and Difficulty Schedule: Directory of Contextual Threat Ratings of Events. Bedford College, University of London: London.Google Scholar
Cassidy, F, Ahearn, EP, Carroll, BJ (2001). Substance abuse in bipolar disorder? Bipolar Disorders 3, 181–188.CrossRefGoogle ScholarPubMed
Cirino, PT, Chin, CE, Sevcik, RA, Wolf, M, Lovett, M, Morris, RD (2002). Measuring socioeconomic status: reliability and preliminary validity for different approaches? Assessment 9, 145–155.CrossRefGoogle ScholarPubMed
Cohen, AN, Hammen, C, Henry, RM, Daley, SE (2004). Effects of stress and social support on recurrence in bipolar disorder? Journal of Affective Disorders 82, 143–147.CrossRefGoogle ScholarPubMed
Coryell, W, Scheftner, W, Keller, M, Endicott, J, Maser, J, Klerman, GL (1993). The enduring psychological consequences of mania and depression? American Journal of Psychiatry 150, 720–727.Google ScholarPubMed
Cuellar, AK, Johnson, SL, Winters, R (2005). Distinctions between bipolar and unipolar depression? Clinical Psychology Review 25, 307–339.CrossRefGoogle ScholarPubMed
Dienes, KA, Hammen, C, Henry, RM, Cohen, AN, Daley, SE (2006). The stress sensitization hypothesis: understanding the course of bipolar disorder? Journal of Affective Disorders 95, 43–49.CrossRefGoogle ScholarPubMed
Ellicott, A, Hammen, C, Gitlin, M, Brown, G, Jamison, K (1990). Life events and the course of bipolar disorder? American Journal of Psychiatry 147, 1194–1198.Google ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1995). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition. New York State Psychiatric Institute: New York.Google Scholar
Foster, CJ, Garber, J, Durlak, JA (2008). Current and past maternal depression, maternal interaction behaviors, and children's externalizing and internalizing symptoms? Journal of Abnormal Child Psychology 36, 527–537.CrossRefGoogle ScholarPubMed
Garno, JL, Goldberg, JF, Ramirez, PM, Ritzler, BA (2005). Impact of childhood abuse on the clinical course of bipolar disorder? British Journal of Psychiatry 186, 121–125.CrossRefGoogle ScholarPubMed
Gitlin, MJ, Swendsen, J, Heller, TL, Hammen, C (1995). Relapse and impairment in bipolar disorder? American Journal of Psychiatry 152, 1635–1640.Google ScholarPubMed
Hammen, C (1991). Generation of stress in the course of unipolar depression? Journal of Abnormal Psychology 100, 555–561.CrossRefGoogle ScholarPubMed
Hammen, C (2005). Stress and depression? Annual Review of Clinical Psychology 1, 293–319.CrossRefGoogle ScholarPubMed
Hammen, C, Gitlin, M (1997). Stress reactivity in bipolar patients and its relation to prior history of disorder? American Journal of Psychiatry 154, 856–857.Google ScholarPubMed
Hammen, C, Henry, R, Daley, SE (2000). Depression and sensitization to stressors among young women as a function of childhood adversity? Journal of Consulting and Clinical Psychology 68, 782–787.CrossRefGoogle ScholarPubMed
Hollingshead, AB (1957). Two Factor Index of Social Position. Yale University: New Haven, CT.Google Scholar
Joffe, RT, MacQueen, GM, Marriott, M, Trevor Young, L (2004). A prospective, longitudinal study of percentage of time spent ill in patients with bipolar I or bipolar II disorders? Bipolar Disorders 6, 62–66.CrossRefGoogle ScholarPubMed
Johnson, SL, Cuellar, AK, Ruggero, C, Winett-Perlman, C, Goodnick, P, White, R, Miller, I (2008). Life events as predictors of mania and depression in bipolar I disorder? Journal of Abnormal Psychology 117, 268–277.CrossRefGoogle ScholarPubMed
Johnson, SL, Fingerhut, R (2006). Life events as predictors of relapse, depression and mania in bipolar disorder. In The Psychology of Bipolar Disorder (ed. Jones, S. and Bentall, R.), pp. 47–72. Oxford University Press: Oxford.CrossRefGoogle ScholarPubMed
Johnson, SL, Miller, I (1997). Negative life events and time to recovery from episodes of bipolar disorder? Journal of Abnormal Psychology 106, 449–457.CrossRefGoogle ScholarPubMed
Johnson, SL, Roberts, JE (1995). Life events and bipolar disorder: implications from biological theories? Psychological Bulletin 117, 434–449.CrossRefGoogle ScholarPubMed
Johnson, SL, Winett, CA, Meyer, B, Greenhouse, WJ, Miller, I (1999). Social support and the course of bipolar disorder? Journal of Abnormal Psychology 108, 558–566.CrossRefGoogle ScholarPubMed
Kendler, KS, Kuhn, JW, Prescott, CA (2004). Childhood sexual abuse, stressful life events and risk for major depression in women? Psychological Medicine 34, 1475–1482.CrossRefGoogle ScholarPubMed
Kim, EY, Miklowitz, DJ, Biuckians, A, Mullen, K (2007). Life stress and the course of early-onset bipolar disorder? Journal of Affective Disorders 99, 37–44.CrossRefGoogle ScholarPubMed
Lam, DH, Hayward, P, Watkins, ER, Wright, K, Sham, P (2005). Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years? American Journal of Psychiatry 162, 324–329.CrossRefGoogle ScholarPubMed
Leverich, GS, McElroy, SL, Suppes, T, Keck, PE Jr., Denicoff, KD, Nolen, WA, Altshuler, LL, Rush, AJ, Kupka, R, Frye, MA, Autio, KA, Post, RM (2002). Early physical and sexual abuse associated with an adverse course of bipolar illness? Biological Psychiatry 51, 288–297.CrossRefGoogle ScholarPubMed
Maguire, C, McCusker, CG, Meenagh, C, Mulholland, C, Shannon, C (2008). Effects of trauma on bipolar disorder: the mediational role of interpersonal difficulties and alcohol dependence? Bipolar Disorders 10, 293–302.CrossRefGoogle ScholarPubMed
McElroy, S, Altshuler, L, Suppes, T, Keck, P, Frye, M, Denicoff, K, Nolen, W, Kupka, R, Leverich, G, Rochussen, J, Rush, J, Post, R (2001). Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder? American Journal of Psychiatry 158, 420–426.CrossRefGoogle ScholarPubMed
McQuaid, JR, Monroe, SM, Roberts, JE, Kupfer, DJ, Frank, E (2000). A comparison of two life stress assessment approaches: prospective prediction of treatment outcome in recurrent depression? Journal of Abnormal Psychology 109, 787–791.CrossRefGoogle ScholarPubMed
Meuser, KT, Salyers, SD, Rosenberg, LA, Essock, SM, Osher, FC, Swartz, MS, Butterfield, MI; 5 Site Health and Risk Study Research Committee (2004). Interpersonal trauma and posttraumatic stress disorder in patients with severe mental illness: demographic, clinical, and health correlates? Schizophrenia Bulletin 30, 45–57.CrossRefGoogle Scholar
Miklowitz, DJ, Otto, MW, Frank, E, Reilly-Harrington, NA, Kogan, JN, Sachs, GS, Thase, ME, Calabrese, JR, Marangell, LB, Ostacher, MJ, Patel, J, Thomas, MR, Araga, M, Gonzalez, JM, Wisniewski, SR (2007). Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial? American Journal of Psychiatry 164, 1340–1347.CrossRefGoogle ScholarPubMed
Miller, IW, Bishop, S, Norman, WH, Maddever, H (1985). The Modified Hamilton Rating Scale for Depression: reliability and validity? Psychiatry Research 14, 131–142.CrossRefGoogle ScholarPubMed
Mueller, TI, Leon, AC, Keller, MB, Solomon, DA, Endicott, J, Coryell, W, Warshaw, M, Maser, JD (1999). Recurrence after recovery from major depressive disorder during 15 years of observational follow-up? American Journal of Psychiatry 156, 1000–1006.CrossRefGoogle ScholarPubMed
Pavlova, B, Uher, R, Dennington, L, Wright, K, Donaldson, C (2011). Reactivity of affect and self-esteem during remission in bipolar affective disorder: an experimental investigation? Journal of Affective Disorders 134, 102–111.CrossRefGoogle ScholarPubMed
Potts, MK, Daniels, M, Burnam, MA, Wells, KB (1990). A structured interview version of the Hamilton Rating Scale: evidence of reliability and versatility of administration? Psychiatry Research 24, 335–350.CrossRefGoogle ScholarPubMed
Robb, JC, Cooke, RG, Devins, GM, Young, LT, Joffe, RT (1997). Quality of life and lifestyle disruption in euthymic bipolar disorder? Journal of Psychiatric Research 31, 509–517.CrossRefGoogle ScholarPubMed
Rudolph, KD, Flynn, M (2007). Childhood adversity and youth depression: influence of gender and pubertal status? Developmental Psychopathology 19, 497–521.CrossRefGoogle ScholarPubMed
Simon, GE, Revicki, D, VonKorff, M (1993). Telephone assessment of depression severity? Psychiatry Research 27, 247–252.CrossRefGoogle ScholarPubMed
WHO (2001). World Health Report 2001. Mental Health: New Understanding, New Hope. World Health Organization: Geneva, Switzerland.Google Scholar
Yan, LJ, Hammen, C, Cohen, AN, Daley, SE, Henry, RM (2004). Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients? Journal of Affective Disorders 83, 199–206.CrossRefGoogle ScholarPubMed