Examining the association of familial and social stress, trauma, and support on mood, anxiety, and behavioral symptoms and diagnoses in youth at risk for bipolar disorder and controls

• Published in: Journal of affective disorders Vol. 363; pp. 79 - 89
• Main Authors: Kamali, Masoud, Stapp, Emma K., Fullerton, Janice M., Ghaziuddin, Neera, Hulvershorn, Leslie, McInnis, Melvin G., Mitchell, Philip B., Roberts, Gloria, Wilcox, Holly C., Nurnberger, John I.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15-10-2024
• Subjects: Adolescent; Adult; Affect; Anxiety - epidemiology; Anxiety - psychology; Anxiety Disorders - diagnosis; Anxiety Disorders - epidemiology; Anxiety Disorders - psychology; At-risk; Behavioral Symptoms - epidemiology; Bipolar disorder; Bipolar Disorder - epidemiology; Bipolar Disorder - psychology; Child; Female; Humans; Life Change Events; Life events; Male; Risk Factors; Severity of Illness Index; Social Support; Stress; Stress, Psychological - psychology; Trauma; Young Adult; Bipolar disorder; Life events; Trauma; Stress; At-risk
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2024.07.125

Youth with a family history of bipolar disorder (At-Risk) have a higher risk of developing psychiatric disorders and experiencing environmental stressors than youth without such family history (Control). We studied the differential associations of familial and environmental factors on developing psychiatric diagnoses and symptoms, in At-Risk and Control youth.
At-Risk and Control youth (N = 466, ages 9–22) were systematically assessed for severity of symptoms, psychiatric diagnoses, and self-reported measures of stress and social support. We tested the association of family history and measures of stress or support with symptom severity and diagnoses.
At-Risk youth had higher symptom severity scores and were more frequently diagnosed with psychiatric disorders (all p values < 0.001). When predicting mood symptom severity, family history had an interaction effect with stressful life events (p < 0.001) and number of distinct traumatic events (p = 0.001). In multivariate models, At-Risk status predicted anxiety disorders (OR = 2.7, CI 1.3–5.4, p = 0.005) and anxiety severity (Coefficient = 0.4, CI 0.2–0.7, p < 0.001) but not mood or behavioral disorder diagnoses or severity.
Measures of stress and social support were based on self-report. Not all participants had passed through the period of risk for developing the outcomes under study and the follow up period was variable. We could not fully study the differential impact of physical or sexual abuse due to low frequency of occurrence in controls.
At-Risk youth exhibit more severe mood symptoms compared to Controls when exposed to similar levels of stress or trauma. At-Risk youth are also more prone to develop anxiety which may be a precursor for bipolar disorder.
•Youth at risk for bipolar disorder had more mood, anxiety, behavior and substance use diagnoses or symptoms than controls.•At risk youth had higher levels of mood symptoms compared to controls when exposed to similar levels of stress and trauma.•Controlling for several environmental factors, at risk status was more predictive of anxiety disorders and symptoms.