Risk factors preceding new onset abuse among youth with bipolar disorder: A longitudinal prospective analysis

Maria Andreu-Pascual; John Merranko; Mary Kay Gill; Jessica C Levenson; Danella Hafeman; Heather Hower; Shirley Yen; Michael Strober; Benjamin I Goldstein; Rasim Diler; Neal D Ryan; Lauren M Weinstock; Martin B Keller; David Axelson; Boris Birmaher; Tina R Goldstein

doi:10.1016/j.jad.2022.01.003

Risk factors preceding new onset abuse among youth with bipolar disorder: A longitudinal prospective analysis

J Affect Disord. 2022 Mar 1:300:296-304. doi: 10.1016/j.jad.2022.01.003. Epub 2022 Jan 3.

Authors

Maria Andreu-Pascual¹, John Merranko², Mary Kay Gill², Jessica C Levenson², Danella Hafeman², Heather Hower³, Shirley Yen⁴, Michael Strober⁵, Benjamin I Goldstein⁶, Rasim Diler², Neal D Ryan², Lauren M Weinstock⁷, Martin B Keller⁷, David Axelson⁸, Boris Birmaher², Tina R Goldstein²

Affiliations

¹ Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA; Child and Adolescent Psychiatry and Psychology Department. Hospital Sant Joan de Déu Barcelona, Spain. Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain. Electronic address: andreupascual1988@gmail.com.
² Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
³ Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; Department of Psychiatry, School of Medicine, University of California at San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA.
⁴ Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
⁵ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, 760 Westwood Plaza, Mail Code 175919, Los Angeles, CA 90095, USA.
⁶ Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON M4N-3M5, Canada.
⁷ Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Butler Hospital, 700 Butler Drive, Providence, RI 02906, USA.
⁸ Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, 1670 Upham Dr., Columbus, OH 43210, USA.

Abstract

Background: Childhood abuse negatively impacts the course of Bipolar Disorder (BD). Yet, no study has examined risk factors associated with prospectively evaluated physical/sexual abuse, specifically, those preceding first abuse among BD youth. We investigate past/intake/follow-up factors preceding first physical/sexual abuse among BD youth.

Methods: Childhood-onset BD participants (n = 279 youth, mean age at intake = 12, mean length of follow-up = 12 years) enrolled in the Course and Outcome of Bipolar Youth (COBY) study. Demographic, clinical and family history variables were assessed every 7 months on average using Longitudinal Interval Follow-up Evaluation and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). Abuse was evaluated at intake using the K-SADS-PL, over follow-up with a Traumatic Events Screen. Family psychopathology was assessed using Family History Screen/Structured Clinical Interview for Diagnostic Statistical Manual-IV.

Results: Fifteen-percent of youth reported new-onset abuse during follow-up (62% physical, 26% sexual; 12% both). Intake predictors included more severe depressive symptoms (HR = 1.29), low socioeconomic-status (SES) in families with substance abuse (HR = 0.84) (physical abuse), and female sex (HR = 2.41) (sexual abuse). Follow-up predictors preceding physical abuse included: older age (HR = 1.42), disruptive disorders (HR = 1.39), and the interaction between low SES and family substance abuse (HR = 0.86). For sexual abuse, female sex (HR = 4.33) and a non-biologically related father presence in the household (HR = 2.76). Good relationships with friends (prospectively evaluated) protected against physical/sexual abuse (HR = 0.72/0.70, respectively).

Limitations: Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; perpetrator information and abuse severity were not available.

Conclusions: Identifying factors temporally preceding new onset physical/sexual abuse may hold promise for identifying high-risk youth with BD.

Keywords: Bipolar disorder; Physical abuse; Prospective study; Risk factor; Sexual abuse; Youth.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Bipolar Disorder* / epidemiology
Bipolar Disorder* / psychology
Child
Child Abuse* / psychology
Comorbidity
Female
Humans
Retrospective Studies
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding