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Contributions of the social environment to first-onset and recurrent mania

Molecular Psychiatry volume 20, pages 329–336 (2015)Cite this article

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Abstract

In treated cohorts, individuals with bipolar disorder are more likely to report childhood adversities and recent stressors than individuals without bipolar disorder; similarly, in registry-based studies, childhood adversities are more common among individuals who later become hospitalized for bipolar disorder. Because these types of studies rely on treatment-seeking samples or hospital diagnoses, they leave unresolved the question of whether or not social experiences are involved in the etiology of bipolar disorder. We investigated the role of childhood adversities and adulthood stressors in liability for bipolar disorder using data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=33 375). We analyzed risk for initial-onset and recurrent DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) manic episodes during the study’s 3-year follow-up period. Childhood physical abuse and sexual maltreatment were associated with significantly higher risks of both first-onset mania (odds ratio (OR) for abuse: 2.23; 95% confidence interval (CI)=1.71, 2.91; OR for maltreatment: 2.10; CI=1.55, 2.83) and recurrent mania (OR for abuse: 1.55; CI=1.00, 2.40; OR for maltreatment: 1.60; CI=1.00, 2.55). In addition, past-year stressors in the domains of interpersonal instability and financial hardship were associated with a significantly higher risk of incident and recurrent mania. Exposure to childhood adversity potentiated the effects of recent stressors on adult mania. Our findings demonstrate a role of social experiences in the initial onset of bipolar disorder, as well as in its prospective course, and are consistent with etiologic models of bipolar disorder that implicate deficits in developmentally established stress-response pathways.

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Acknowledgements

We sincerely appreciate the contributions of Ms Kathleen McGaffigan to data management and statistical programming. This work was supported in part by National Institutes of Health Grants RO1MH087544 (to SEG) and K24MH094614 (to JWS).

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Authors and Affiliations

  1. Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA,

    S E Gilman

  2. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA,

    S E Gilman

  3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,

    S E Gilman

  4. School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China

    M Y Ni

  5. Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA

    E C Dunn & J W Smoller

  6. Department of Psychiatry, Harvard Medical School, Boston, MA, USA,

    E C Dunn & J W Smoller

  7. Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA,

    E C Dunn, J W Smoller & R H Perlis

  8. RAND Corporation, Pittsburgh, PA, USA

    J Breslau

  9. Department of Psychology, University of Washington, Seattle, WA, USA,

    K A McLaughlin

  10. Center for Experimental Drugs and Diagnostics, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA

    R H Perlis

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Correspondence to S E Gilman.

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Gilman, S., Ni, M., Dunn, E. et al. Contributions of the social environment to first-onset and recurrent mania. Mol Psychiatry 20, 329–336 (2015). https://doi.org/10.1038/mp.2014.36

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