More stressors prior to and during the course of bipolar illness in patients from the United States compared with the Netherlands and Germany |
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| Authors: | Robert M. Post Lori Altshuler Gabriele Leverich Willem Nolen Ralph Kupka Heinz Grunze Mark Frye Trisha Suppes Sue McElroy Paul Keck Mike Rowe |
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| Affiliation: | 1. Bipolar Collaborative Network, Bethesda MD; Clinical Professor Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C.;2. Bipolar Collaborative Network, Bethesda, MD, USA;3. UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA, USA;4. University Medical Center, University of Groningen, Groningen, Netherlands;5. Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands;6. Institute of Neuroscience, University of Newcastle upon Tyne, Newcastle, United Kingdom;g Professor of Psychiatry, Mayo Clinic, Rochester, MI, USA;h Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine and VA Palo Alto Health Care System, Palo Alto, CA, USA;i Linder Center of Hope, Mason, OH, and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA;j Professor of Psychiatry & Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; President-CEO of Lindner Center of Hope, Mason, OH, USA;k Biostatistician, Bipolar Collaborative Network, Bethesda, MD, USA |
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| Abstract: | ![]()
Considerable data suggest that compared to some European countries, in the U.S. there are more childhood onset bipolar disorders, more adverse courses of illness, and greater treatment resistance. Psychosocial variables related to these findings have not been adequately explored. Therefore we analyzed psychosocial stressors in three time domains: childhood; the year prior to illness Onset; and the Last Episode from questionnaires in 968 outpatients (mean age 41) with bipolar I or II disorder; 676 from four sites in the U.S. and 292 from three in the Netherlands and Germany (abbreviated here as Europe). Compared to the Europeans, those from the U.S. had significantly more stressors in childhood and prior to the last episode. Stressors prior to the last episode were related to: childhood stressors; an earlier age at illness onset; anxiety and substance abuse comorbidity; lower income; both parents having an affective illness; and feeling more stigma. These data suggest a greater prevalence of adverse life events in childhood and over the course of bipolar illness in the U.S. compared to the Netherlands and Germany. Clinical, therapeutic, and public health approaches to these illness-relevant stressors require further exploration. |
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| Keywords: | Psychosocial stress Childhood adversity Anxiety disorder Substance abuse disorder Social support |
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