Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder: a path analysis of 923 people with bipolar I disorder

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Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder : a path analysis of 923 people with bipolar I disorder. / Marwaha, Steven; Briley, Paul M.; Perry, Amy ; Rankin, Phillip; DiFlorio, Arianna; Craddock, Nick; Jones, Ian; Broome, Matthew; Gordon-Smith, Katherine; Jones, Lisa.

In: Psychological Medicine, 18.09.2019, p. 1-9.

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Marwaha, Steven ; Briley, Paul M. ; Perry, Amy ; Rankin, Phillip ; DiFlorio, Arianna ; Craddock, Nick ; Jones, Ian ; Broome, Matthew ; Gordon-Smith, Katherine ; Jones, Lisa. / Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder : a path analysis of 923 people with bipolar I disorder. In: Psychological Medicine. 2019 ; pp. 1-9.

Bibtex

@article{7756b04935894f9093623541a8506e82,
title = "Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder: a path analysis of 923 people with bipolar I disorder",
abstract = "BackgroundChildhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.MethodsWe analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.ResultsAffective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.ConclusionsAffective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.",
keywords = "Affective instability, bipolar disorder, childhood abuse, impulsivity, path analysis",
author = "Steven Marwaha and Briley, {Paul M.} and Amy Perry and Phillip Rankin and Arianna DiFlorio and Nick Craddock and Ian Jones and Matthew Broome and Katherine Gordon-Smith and Lisa Jones",
year = "2019",
month = sep,
day = "18",
doi = "10.1017/S0033291719002411",
language = "English",
pages = "1--9",
journal = "Psychological Medicine",
issn = "0033-2917",
publisher = "Cambridge University Press",

}

RIS

TY - JOUR

T1 - Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder

T2 - a path analysis of 923 people with bipolar I disorder

AU - Marwaha, Steven

AU - Briley, Paul M.

AU - Perry, Amy

AU - Rankin, Phillip

AU - DiFlorio, Arianna

AU - Craddock, Nick

AU - Jones, Ian

AU - Broome, Matthew

AU - Gordon-Smith, Katherine

AU - Jones, Lisa

PY - 2019/9/18

Y1 - 2019/9/18

N2 - BackgroundChildhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.MethodsWe analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.ResultsAffective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.ConclusionsAffective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.

AB - BackgroundChildhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.MethodsWe analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.ResultsAffective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.ConclusionsAffective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.

KW - Affective instability

KW - bipolar disorder

KW - childhood abuse

KW - impulsivity

KW - path analysis

UR - http://www.scopus.com/inward/record.url?scp=85072389572&partnerID=8YFLogxK

U2 - 10.1017/S0033291719002411

DO - 10.1017/S0033291719002411

M3 - Article

C2 - 31530330

SP - 1

EP - 9

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

ER -