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06-09-2011 | Psychology | Article

Childhood maltreatment linked to poorer BD outcomes


Free abstract

MedWire News: Childhood abuse and neglect are significantly associated with poorer outcomes in patients with bipolar disorder (BD), a systematic review and meta-analysis of published studies suggest.

Writing in the journal Acta Psychiatrica Scandinavica, Rodrigo Grassi-Oliveira (Pontifical Catholic University, Porto Alegre, Brazil) and team explain that a number of studies have identified an association between adverse events in childhood and BD, but few have investigated the direct influence of childhood maltreatment on clinical outcomes in BD patients.

To investigate further, the researchers searched the literature for all relevant studies published between 2000 and 2011 that contained data on childhood maltreatment and outcomes in patients with BD.

In total, 19 studies, involving 3875 patients with BD, met criteria for inclusion in the final analysis. All of the studies were retrospective, the researchers note.

Of the types of maltreatment studied, they found that physical abuse was the strongest predictor of unfavorable BD outcomes and was associated with early onset of the disorder, and delay in diagnosis and first treatment.

Patients reporting physical abuse were more likely than others have rapid-cycling BD (odds ratio [OR]=1.96), mood episodes with psychotic symptoms (OR=2.3), and were more likely to have made suicide attempts. Childhood physical abuse was also associated with comorbid post-traumatic stress disorder (PTSD; OR=2.6-10.4) and substance abuse.

Childhood sexual abuse had a similar impact on BD outcomes as physical abuse, being associated with early onset, treatment delay, and rapid-cycling. It was also associated with suicidality (OR=2.27-3.32), a higher frequency of psychosis, and an increased severity of manic symptoms.

In addition, childhood sexual abuse was associated with high psychiatric comorbidity rates, such as PTSD (OR=4.9-7.8) and substance abuse.

Although few studies analyzed emotional abuse and/or neglect separately, one study found they were associated with trait aggression, while a number found that childhood neglect was associated with early onset BD.

Grassi-Oliveira and team conclude: "Results of this review corroborate the importance of systematically investigating the history of childhood abuse and neglect in BD."

They add: "It is very important to know which predictors play a role in accelerating BD course to determine which interventions could help to prevent illness progression, including suicide prevention and child abuse prevention programs."

By Mark Cowen

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