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Child abuse increases negative outcomes in bipolar disorder

Childhood maltreatment increased risk for negative outcomes in bipolar disorder, according to recent findings.

“These findings lend support to the notion that maltreatment can affect neurobiological processes associated with progression of the disorder,” Jessica Agnew-Blais, ScD, of King’s College London, said in a press release. “Our findings have important implications for clinical practice, as they suggest that a history of childhood maltreatment could be used as an early indicator of high risk for poor outcomes among individuals with bipolar disorder. This information could be valuable for identifying patients with bipolar disorder who may benefit from greater support and treatment.”

To evaluate the association between childhood maltreatment and negative outcomes in bipolar disorder, researchers conducted a systematic review and meta-analysis of 30 studies on maltreatment before age 18 years and bipolar disorder.

Analysis indicated individuals with bipolar disorder and a history of childhood maltreatment had more severe mania (OR = 2.02; 95% CI, 1.21-3.39; P = .008), depression (OR = 1.57; 95% CI, 1.25-1.99; P =.0001) and psychosis (OR = 1.49; 95% CI, 1.1-2.04; P = .011) than those with bipolar disorder and no childhood maltreatment history.

Individuals with bipolar disorder and a history of maltreatment had higher risk for comorbidity with PTSD (OR = 3.6; 95% CI, 2.45-5.3; P < .0001), anxiety disorders (OR = 1.9; 95% CI, 1.39-2.61; P < .0001), substance abuse disorders (OR = 1.84; 95% CI, 1.41-2.39; P < .0001) and alcohol abuse disorder (OR = 1.44; 95% CI, 1.13-1.83; P < .0001).

Compared with individuals with bipolar disorder and without maltreatment history, risk for rapid cycling (OR = 1.89; 95% CI, 1.45-2.48; P < .0001) and suicide attempts (OR = 2.25; 95% CI, 1.88-2.7; P < .0001) was higher among individuals with bipolar disorder and a history of maltreatment.

Individuals with bipolar disorder and a history of maltreatment had a greater number of manic episodes (OR = 1.26; 95% CI, 1.09-1.47; P = .003) and depressive episodes (OR = 1.38; 95% CI, 1.07-1.79; P = .013).

“Future research should identify mechanisms that link childhood maltreatment to unfavorable clinical outcomes in [bipolar disorder], which is associated with disability and life-threatening risks,” study researcher Andrea Danese, MD, of King’s College London, said in the release. “We hope this study will point to vulnerabilities that could inform innovative treatment strategies for people with [bipolar disorder], including anti-inflammatory medications or treatments aimed at trauma and anxiety-related symptoms.” – by Amanda Oldt

Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.