Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder—A systematic review

Abstract

Background: Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence. Methodology:A systematic review of PubMed (1946PubMed ( -2017 and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria. Results:Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences. Limitations: Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability. Conclusion: Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved. K E Y W O R D S bipolar disorder, recurrence, review, risk factors studies only), and race; (i) sample clinical characteristics (number of participants diagnosed with BD, BD I %, illness duration, type of course (eg, predominant polarity, rapid cycling), polarity of the first episode, number of manic, hypomanic, mixed, depressive and total episodes, subsyndromal mood symptoms, comorbid disorders, suicide attempts, and psychotic symptoms); (j) environmental characteristics (living with both natural parents and stressors); (k) family history of BD; (l) assessment tools (eg, how were diagnosis, mood recurrence, and factors measured); (m) outcome or recurrence (definition of recurrence, S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Estrada-Prat X, Van Meter AR, Camprodon-Rosanas E, Batlle-Vila S, Goldstein BI, Birmaher B.Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review.

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“…In line with previous reviews, our study confirms the association of individual, relationship, community and societal factors with the mental health of CYP [13][14][15][16][17][18][19][20][21]29]. Unlike previous reviews there were mixed finding for some of the key factors like parent-to-parent relationship and social status.…”

“…More specifically these factors include age, gender, ethnicity, family composition, urbanisation, family and friend support, social isolation, peer victimization, physical/sexual abuse or emotional neglect and parent psychopathology [16,17]. In more severe cases additional factors include substance use, comorbid disorders and intellectual disabilities [18,19]. As for marginalised groups, based on ethnicity or sexuality, experiences of discrimination were also identified as having a negative association with mental health [9,20].…”

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“…The existing empirical literature disproportionately focuses on the treatment of manic and mixed episodes, at the expense of bipolar depression and prophylactic treatment. Children and adolescents with BD typically have pre-existing conditions such as attention deficit hyperactivity disorder, conduct disorder or anxiety problems (Estrada-Prat et al, 2019). Those presenting for acute treatment of mania may not have new or recent onset problems, but rather a worsening of difficulties that have been present for some time.…”

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