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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
- Source :
- Psychological Medicine
- Publication Year :
- 2020
- Publisher :
- Cambridge University Press, 2020.
-
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.
- Subjects :
- Adult
Male
Bipolar I disorder
Substance-Related Disorders
impulsivity
Suicide, Attempted
Impulsivity
Bipolar disorder research
03 medical and health sciences
0302 clinical medicine
Risk Factors
medicine
path analysis
Humans
Affective Symptoms
Bipolar disorder
Path analysis (statistics)
Childhood abuse
Applied Psychology
bipolar disorder
business.industry
Adult Survivors of Child Abuse
childhood abuse
Original Articles
Middle Aged
medicine.disease
030227 psychiatry
Psychiatry and Mental health
Logistic Models
Impulsive Behavior
Anxiety
Female
Affective instability
medicine.symptom
Age of onset
business
030217 neurology & neurosurgery
Clinical psychology
Subjects
Details
- Language :
- English
- ISSN :
- 00332917
- Database :
- OpenAIRE
- Journal :
- Psychological Medicine
- Accession number :
- edsair.doi.dedup.....e4717425acc1228b2a89036d6ead85db