Assortative mating in the affective disorders: a systematic review and meta-analysis.

Assortative mating, or the tendency for individuals with similar phenotypes to mate more frequently than expected by chance, has been reported for a variety of complex traits, including many neuropsychiatric disorders. Although assortative mating has been reported in affective disorders, the studies done to date have been inconclusive. This study attempts to assess the degree of assortative mating in individuals with affective disorders using systematic review and meta-analytic techniques. Studies on assortative mating in affective disorders were identified by a computerized literature search and by bibliographic assessment of published studies and reviews. Studies were selected if they had a case-control design and if they reported rates of affective disorders in the spouses of probands and controls. Of the 17 studies reviewed, six were selected for meta-analysis. All studies were blinded. Details of study design, patient characteristics, and rates of affective disorders were assessed by two independent reviewers. Twelve of the 17 studies assessed reported an increase in assortative mating. Results of the meta-analysis supported these findings, and indicated that assortative mating occurs in both bipolar disorder and major depression. Although most studies examined reported an increase in assortative mating among individuals with affective disorders, the degree of assortative mating reported varied widely. Meta-analysis with six controlled studies showed evidence for assortative mating, and suggested that the degree of assortative mating is higher for individuals with bipolar disorder than for those with major depression. These results support the previously reported findings, and may have important implications for genetic studies.     

Assortative mating in primary affective disorder.

Psychiatric illness in spouses of patients with primary affective disorder was determined and compared to psychiatric illness in spouses of a nonpsychiatrically ill control group. An increase in affective illness in wives of bipolar male patients with affective disorder was found. There was no increase in affective illness among husbands of female patients. Marital status of these patients was evaluated and the percentages of patients who had never married or who had married but had ever been divorced or separated were similar to control data. Several of the marriages were quite stable over long time periods in spite of the severe recurrent affective illness experienced by these patients.     

Assortative mating

Psychosocial programs that introduce young people with psychosis to each other encourage bonding and, perhaps, marriage. By providing such programs, are we unwittingly promoting assortative mating, with ill effects for offspring? Or, on the other hand, are we ensuring better health for young people with psychosis and perhaps laying the groundwork for stronger marital unions than they would otherwise have formed? Instead of steering young people with psychosis into specialized services, should we be "mainstreaming" them, equipping them in situ with the skills necessary to navigate the larger social world? Should we even be considering the welfare of future generations, or is this beyond psychiatry's ken?     

Maternal affective disorders, illness, and stress: risk for children's psychopathology

Stressful circumstances that covary with maternal affective disorder may account for some of the risk to children for psychological dysfunction. Children (ages 8-16) of mothers with unipolar or bipolar disorders were compared with children of mothers who had chronic medical illness and children of normal mothers. Comparisons included Kiddie-SADS (Schedule for Affective Disorders and Schizophrenia) diagnoses and evaluations of behavior problems, school functioning, and social competence. Compared to the other groups, children of mothers with affective disorder (especially unipolar) had high rates of diagnosis. With the effects of chronic stress statistically controlled, psychosocial outcome variables showed fewer differences between groups but indicated particular impairment for children of unipolar mothers.     

Predictors of psychopathology in children of patients with major affective disorders

The present study reports on variables associated with psychopathology in children of patients hospitalized with major affective disorders. The primary instrument used in this investigation was a structured diagnostic interview that was completed by a child psychiatrist. Univariate and multivariate statistical analyses of these data suggest that severity of parental psychopathology (as measured by a higher score on the SCL-90 and a longer stay in the hospital) and the report of child abuse were associated with general childhood psychopathology. The significance of these and other findings are discussed.     

Psychiatric disorders among offspring of depressed mothers: associations with paternal psychopathology

OBJECTIVE: The association between maternal depression and offspring dysfunction is well documented; however, little attention has been paid to psychopathology in the partners of these depressed mothers or to how paternal psychopathology might influence the relationship between maternal depression and offspring dysfunction. The purpose of this study was to explore whether major depression and/or antisocial behavior tended to occur more frequently among partners of depressed mothers (compared to partners of nondepressed mothers) and to examine how these paternal disorders related to offspring psychopathology. METHOD: Participants were drawn from the Minnesota Twin Family Study, a community-based study of twins and their parents. Depressed and nondepressed mothers, their partners (the biological fathers of the twins), and their 17-year-old offspring were included. Structured interviews were used to assess participants for the presence of major depression, conduct disorder, and adult antisocial behavior. RESULTS: Depressed mothers tended to partner with antisocial fathers. Depression in mothers and antisocial behavior in fathers were both significantly and independently associated with offspring depression and conduct disorder. No interactions of the parental diagnoses with each other or with the gender of the offspring were found. CONCLUSIONS: Many offspring of depressed mothers experience the additional risk of having an antisocial father. The implications of these findings for risk among the offspring of depressed mothers are discussed.     

Psychopathology in the offspring of parents with bipolar affective disorders

Thirty-nine children from intact families with a manic-depressive parent were evaluated by a semi-structured clinical interview and a number of rating scales for the presence or absence of psychopathology. This sample represents a larger one than in an earlier study, which showed minimal offspring psychopathology compared with reports of other investigators. The current study also examines the inter-relationships between the presence or absence of offspring psychopathology with both genetic loading and a number of psychosocial variables including measures of parental marital adjustment, severity and chronicity of proband parent illness and early exposure of children to parental illness. Nine of the thirty-nine children, (23%) received a positive DSM-III diagnosis, with depression of the dysthymic type being the most common. There was no significant correlation between genetic loading and offspring psychopathology. However, there were significant associations between children with psychopathology and paternal marital dissatisfaction and the age and chronicity of illness of the proband parent as compared with the children with no psychopathology.     

Influence of parental concordance for psychiatric disorders on psychopathology in offspring

OBJECTIVE: To examine the influence of parental mating types for substance abuse and anxiety/affective disorders on the risk of psychopathology among child and adolescent offspring. METHOD: Emotional and behavioral disorders were assessed in offspring, aged 7 to 17 years, of male and female parents who served as probands from a family study of comorbidity of substance abuse and anxiety disorders. RESULTS: The findings indicated that (1) patterns of psychopathology among offspring were similar for mothers and fathers; (2) spouse concordance for psychopathology was greater among parents with substance abuse than among those with anxiety, particularly among female substance abusers; (3) there was a direct relationship between the number of affected parents and the magnitude of psychopathology in children, particularly with respect to the anxiety disorders; and (4) by contrast, rates of conduct disorder were elevated only among offspring of dually affected parents, irrespective of the specific parental disorders. CONCLUSIONS: These findings underscore the importance of the contribution of both mothers and fathers, particularly those with concordance for psychiatric disorders, to the development of psychopathology in offspring.     

Correlation between serum and urinary calcium levels and psychopathology in patients with affective disorders

Summary To examine whether serum and urinary calcium levels were related to the psychopathology index (i.e. average score in clinically relevant scales of Minnesota Multiphasic Personality Inventory), 24 women aged 35.6 ± 2.5 years and 20 men aged 34.3 ± 2.1 years, suffering from affective disorders, were studied. A non-parametric bivariate correlation analysis revealed a negative correlation between PI and serum calcium (r=–0.256, p < 0.01), while urinary calcium levels correlated positively with PI (r=0.236, p < 0.02). A positive correlation occurred between serum and urinary calcium (r=0.968, p < 0.0001). When the data were analyzed by categorical classification of patients with normal or abnormal PI scores, serum calcium levels were smaller, and urinary calcium levels higher, in patients with abnormal PI (p < 0.01). The results support to the concept that alterations of calcium homeostasis occur in psychopathology.     

Assortative mating in schizophrenia: results from the Copenhagen High-Risk Study

Assortative mating denotes a tendency for mated pairs to be more similar for some phenotypic trait (similar constitution) than would be the case if the choice of a partner occurred at random. Assortative mating occurs for a variety of physical (e.g., anthropometric variables) and psychological traits (e.g., IQ), including mental illness (Vandenberg 1972). Several studies have shown an excess of married couples suffering from a variety of psychiatric syndromes as compared to the frequency expected on the basis of noncontingent admissions into treatment facilities (Kreitman 1962, 1964, 1968; Nielsen 1964), a finding confirmed in a community study by Hagnell and Kreitman (1974). A recent review of the research literature (Merikangas 1982) concluded that there exists a true primary assortative mating for mental illness. This conclusion is strongly supported by the demonstration of an increased prevalence of mental disorders in the spouses' first-degree relatives (Slater and Woodside 1951; Guze et al. 1970; Cloninger et al. 1975; Gershon et al. 1973; Merikangas et al., in this issue.     

Maternal psychopathology and offspring mental health service utilization in adolescents without mental disorders: a national representative survey

European Child & Adolescent Psychiatry - We investigated whether maternal psychopathology predicts offspring mental health service utilization in adolescents without mental disorders. We used...     

Influence of premorbid psychopathology and lesion location on affective and behavioral disorders after ischemic stroke

Early recognition of psychopathological symptoms (PSs) after stroke is important because they greatly influence the recovery of patients. The aim of this study was to investigate the predictive factors of PSs occurring in patients with ischemic stroke. Eighty-nine patients were prospectively evaluated upon admission and 4, 12, and 26 weeks later with the Neuropsychiatric Inventory, Hamilton's Rating Scales for Depression and Anxiety, and a battery of neuropsychological and functional scales. Depression and apathy were the most frequent PSs detected after stroke. Premorbid psychopathologies and right-hemisphere location were the main predictive indicators of early and long-term PSs.     

Perspectives in affective disorders: Clocks and sleep

Mood disorders are often characterised by alterations in circadian rhythms, sleep disturbances and seasonal exacerbation. Conversely, chronobiological treatments utilise zeitgebers for circadian rhythms such as light to improve mood and stabilise sleep, and manipulations of sleep timing and duration as rapid antidepressant modalities. Although sleep deprivation (“wake therapy”) can act within hours, and its mood‐elevating effects be maintained by regular morning light administration/medication/earlier sleep, it has not entered the regular guidelines for treating affective disorders as a first‐line treatment. The hindrances to using chronotherapeutics may lie in their lack of patentability, few sponsors to carry out large multi‐centre trials, non‐reimbursement by medical insurance and their perceived difficulty or exotic “alternative” nature. Future use can be promoted by new technology (single‐sample phase measurements, phone apps, movement and sleep trackers) that provides ambulatory documentation over long periods and feedback to therapist and patient. Light combinations with cognitive behavioural therapy and sleep hygiene practice may speed up and also maintain response. The urgent need for new antidepressants should hopefully lead to reconsideration and implementation of these non‐pharmacological methods, as well as further clinical trials. We review the putative neurochemical mechanisms underlying the antidepressant effect of sleep deprivation and light therapy, and current knowledge linking clocks and sleep with affective disorders: neurotransmitter switching, stress and cortico‐limbic reactivity, clock genes, cortical neuroplasticity, connectomics and neuroinflammation. Despite the complexity of multi‐system mechanisms, more insight will lead to fine tuning and better application of circadian and sleep‐related treatments of depression.     

Prevalence of psychopathology in bipolar high-risk offspring and siblings: a meta-analysis

This meta-analysis aimed to update existing data on the comparison of prevalence rates of psychopathology primarily among offspring with at least one parent with bipolar disorder (BD) and offspring of parents without psychiatric illness. Seventeen studies were derived from a systematic search of PsychInfo, Medline, Scopus and Embase. Inclusion criteria were use of a control offspring group, standardized diagnostic procedures and reporting of clear frequency data. Risk of psychopathology was estimated by aggregating frequency data from selected studies. Compared to control offspring, high-risk BD offspring are nine times more likely to have a bipolar-type disorder, almost two and a half times more likely to develop a non-BD affective disorder and over two times more likely to develop at least one anxiety disorder. High-risk offspring also showed a significant increased risk of other non-mood psychopathology such as attention deficit hyperactivity disorder (ADHD), any type of behavioral disorder and substance use disorder (SUDs). Risk of developing a broad range of affective and non-affective psychopathology is significantly higher in high-risk BD offspring. Identifying clinical presentations of this genetically high-risk cohort is important in establishing appropriate preventative treatment.     

Dependence disorders in psychopathology]

Research concerning the psychopathological aspects of dependence implicates a wide range of behaviors reassembled under the term of "dependence behaviors": sexual, medical, alcoholic and tobacco dependencies. Speech samples of dependent subjects show that encountering the object of dependence (product, element, ...) introduces a particular form of organized psychological processes. According to several authors, psychopathological dependence can be attributed to: early personality development; failures in the separation-individuation processes; disorders in mother-infant interactions; and a deficit in the psychological functioning of the subjects. For psychopathology, the dependence cannot be reduced to physiological dependence on the product but is understood rather in terms of a complex process indicative of either specific or non-specific suffering which is addressed by abused substance that represents a solution--the effects of which constitute the addictive process. Understanding this process requires an analysis of the psychopathological dependence from a triple meta-psychological viewpoint (topographical, dynamic, economic). Such analysis allows for a psychoanalytical theoretical interpretation of dependence based on three models: pleasure, narcissism and stress reduction. At the same time, the analysis extends the examination of psychopathological dependence towards issues concerning the body. Such body issues are critically placed between the biological and the psychological processes.     

Neurogenesis and affective disorders

The neurogenesis hypothesis of depression was originally formed upon the demonstration that stress impacts levels of adult neurogenesis in the hippocampus. Since then much work has established that newborn neurons in the dentate gyrus are required for mediating some of the beneficial effects of antidepressant treatment. Recent studies combining behavioral, molecular and electrophysiological approaches have attempted to make sense of the role young neurons play in modulating mood by demonstrating a potential role in regulating the circuitry in the brain that underlies depression. Here we discuss the work that led to the neurogenesis hypothesis of depression, and the subsequent studies that have sought to test this hypothesis. We also discuss different animal models of depression that have been used to test the role of neurogenesis in mediating the antidepressant response.