Bruno Etain; et al
19 de março de 2014
Childhood Trauma Is Associated With Severe Clinical Characteristics of Bipolar Disorders
Bruno Etain, MD, PhD; Monica Aas, PhD; Ole A. Andreassen, MD, PhD; Steinar Lorentzen, MD, PhD; Ingrid Dieset, MD; Sebastien Gard, MD; Jean-Pierre Kahn, MD, PhD; Frank Bellivier, MD, PhD; Marion Leboyer, MD, PhD; Ingrid Melle, MD, PhD; and Chantal Henry, MD, PhD
ABSTRACT
Objective: Beyond genetic risk variants, the pathophysiology of bipolar disorders is likely to be partly determined by environmental susceptibility factors. Our study is one of the first to investigate, in a large sample of well-characterized bipolar patients, associations between clinical presentations and childhood trauma subtypes, including neglect and abuse items.
Method: 587 patients with DSM-IV–defined bipolar disorder were recruited from France and Norway between 1996–2008 and 2007–2012, respectively. History of childhood trauma was obtained using the Childhood Trauma Questionnaire. Clinical variables were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (Norwegian sample) or the Diagnostic Interview for Genetic Studies (French sample).
Results: Earlier age at onset of bipolar illness, suicide attempts, rapid cycling, and an increased number of depressive episodes each had significant associations (P≤ .001) with at least 1 subtype of childhood trauma (emotional abuse, sexual abuse, and emotional neglect). Multivariate analyses investigating trauma variables together showed that both emotional and sexual abuse were independent predictors of lower age at onset (P = .002 for each) and history of suicide attempts (OR = 1.60 [95% CI, 1.07 to 2.39], P = .023; OR = 1.80 [95% CI, 1.14 to 2.86], P = .012, respectively), while sexual abuse was the strongest predictor of rapid cycling (OR = 2.04 [95% CI, 1.21 to 3.42], P = .007). Females reported overall higher childhood trauma frequency and greater associations to clinical expressions than males (P values < .05).
Conclusions: Our results demonstrate consistent associations between childhood trauma and more severe clinical characteristics in bipolar disorder. Further, they show the importance of including emotional abuse as well as the more frequently investigated sexual abuse when targeting clinical characteristics of bipolar disorder.
J Clin Psychiatry 2013;74(10):991–998
© Copyright 2013 Physicians Postgraduate Press, Inc.
Submitted: January 4, 2013; accepted March 2, 2013 (doi:10.4088/JCP.13m08353).
Corresponding author: Monica Aas, PhD, TOP Study Group, KG Jebsen Centre of Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, Bygg 49, Ullevål sykehus, PO Box 4956, Nydalen, 0424 Oslo, Norway (monica.aas@medisin.uio.no).
Patients with psychiatric illnesses more frequently report a history of childhood trauma compared to the general population.1–5 In bipolar disorders, there are indications that childhood trauma is associated with various clinical characteristics of severity, including an earlier onset of the illness,6 a rapid-cycling course,6 psychotic features,7–10 a higher number of lifetime mood episodes,11–13 and suicide ideation and attempts.14 However, the quality of these studies has been reported to be relatively low,15thus reducing the level of evidence. A recent review of 18 association studies performed by Daruy-Filho and coworkers15 highlighted several limitations: lack of use of a structured clinical interview for diagnosis, lack of use of a standardized trauma assessment, low sample size (fewer than 100 patients), and insufficient current mood state measures as a potential bias in trauma assessment. On the basis of the limitations above, only 1 study14 fulfilled Fisher and Hosang’s edited quality criteria.16 Therefore, high-quality studies are required in order to further explore the relationship between childhood trauma and clinical severity of bipolar disorders.
Knowledge of how specific types of trauma are associated with clinical characteristics is still sparse. Childhood physical abuse and sexual abuse seem to be the strongest predictors of unfavorable clinical characteristics in bipolar disorders.15,16 However, very few studies have focused attention on emotional abuse and neglect.15Interestingly, there is evidence of the specific implications of certain subtypes of trauma, particularly emotional abuse,1,5in patients with bipolar disorder. Indeed, higher prevalence of emotional abuse in patients with bipolar disorder compared to healthy controls has been reported, even after controlling for other types of abuse.1,5 We have also suggested that, among trauma subtypes, emotional abuse could be the type most closely associated with an earlier age at bipolar illness onset.5
Finally, it has been postulated that females report childhood trauma more frequently than males.17 Females also tend to be overrepresented in the diagnosis of bipolar disorder compared to males, although the exact gender distribution varies across studies.18 Thus, investigating the relationship between gender, childhood trauma, and clinical characteristics of bipolar disorder would be of interest. Until now, this relationship has not been thoroughly investigated.
Our study is one of the first to investigate, in a large sample of bipolar disorder patients (N = 587), whether childhood trauma, including neglect (both emotional and physical) as well as abuse (emotional, physical, and sexual), is associated with a more severe clinical presentation (ie, lower age at onset, more suicide attempts, rapid cycling, mood episodes, and substance misuse). We also investigated whether there are dose effects of abuse on clinical characteristics. Second, we performed multilevel analyses to investigate whether specific subtypes of childhood trauma are driving associations between childhood trauma and clinical characteristics. Last, the large sample provided us with sufficient statistical power to perform additional analyses to thoroughly investigate the effect of gender on these associations.
METHOD
Participants
Patients from France were included from 3 French university-affiliated psychiatry departments (in Paris/Créteil, Bordeaux, and Nancy). Patients from Norway were included as part of an ongoing study of severe psychiatric disorders (Thematically Organized Psychosis [TOP] Study) and recruited from psychiatric inpatient and outpatient units at 3 major hospitals in Oslo, Norway. For inclusion in the study, all patients had to have a diagnosis of bipolar disorder (type I, type II, or not otherwise specified [NOS]) according to DSM-IV criteria. The Norwegian project was approved by the Regional Committee for Medical Research Ethics and the Data Inspectorate. The local institutional review boards approved the French study. Written informed consent for participating in the study was obtained from all participants.
Clinical Assessment
In both countries, clinical assessment was carried out by trained psychiatrists, MDs or psychiatrists in training, and clinical psychologists. The French patients were interviewed with the French version of the Diagnostic Interview for Genetic Studies (DIGS),19 which provides lifetime DSM-IV Axis I diagnoses. French patients were euthymic at inclusion (ie, Mania Rating Scale20 and Montgomery-Asberg Depression Rating Scale21 scores ≤ 5). Clinical variables collected with the DIGS included age at onset and lifetime history of rapid cycling and history of mixed episodes (both defined as in the DSM-IVcriteria) during the course of the disorder. Several variables related to suicide attempts were also collected: lifetime history of suicide attempt and of violent suicide attempt (including hanging attempts, jumping from heights, and the use of knives or firearms), number of suicide attempts, and age at first suicide attempt. A similar approach was taken in the Norwegian sample using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).22 For both samples, age at onset was defined as the age at which the subject first met DSM-IV criteria for a major depressive, manic, hypomanic, or mixed episode. Duration of illness was calculated by current age at time of assessment minus age at onset.
Childhood Trauma Questionnaire
To measure childhood adverse events, we used the Childhood Trauma Questionnaire (CTQ), a retrospective questionnaire inquiring about traumatic experiences in childhood with 5 answers ranging from “never true” to “very often true,” yielding a total score as well as 5 subscores: physical, emotional, and sexual abuse and physical and emotional neglect.23Reliability and validity of the CTQ have been demonstrated previously.23 In this study, the short versions (28-item version) of the CTQ translated into Norwegian24 or previously validated in French25 were used. We used a score in the “moderate to severe” range as a cutoff to dichotomize each subscore and to classify subjects as having or not having a history of childhood trauma in that category, as recommended by Bernstein and Fink.26 The French sample was euthymic at the time of CTQ assessment, while no standardized assessments were conducted in the Norwegian sample, apart from clinical judgment.
Statistical Analyses
All statistical analyses were performed with the packages PASW Statistics 18 (Release 18.0.1; SPSS Inc, Chicago, Illinois) and R (Version 2.12.0; Statistics Department, University of Auckland, Auckland, New Zealand). Continuous variables are presented as mean ± SD. As the continuous clinical variables (such as age at onset and number of episodes) were not normally distributed, nonparametric tests (Mann-Whitney or Kruskal-Wallis) were used to investigate clinical variables and childhood trauma, dichotomized into abuse and no abuse. For the simple linear regression analyses, the continuous clinical variables were log transformed. As the hypomanic/manic variable was still skewed after log transformation, it was excluded from the regression analysis. Reassuringly, although the childhood trauma subtypes significantly correlated with each other, the collinearity analyses for the regression analyses were found sufficient (variance inflation factor ≤ 1.4). As gender differences are suggested in both childhood trauma prevalence17 and the effect of childhood trauma on pathology,27 follow-up linear and logistic regression analyses were conducted stratified by gender. For the multiregression analyses, post hoc analyses were conducted controlling for gender and diagnosis (bipolar I, bipolar II, bipolar NOS). Because inclusion of diagnosis (bipolar I, bipolar II, bipolar NOS) did not improve the model, it was taken out of the final analyses. Duration of illness was also used as a covariate when investigating mood episodes, rapid cycling, and suicide attempts. For clinical characteristics for which prevalence differed between France and Norway (ie, duration of illness and rapid cycling), the recruitment site was added as a covariate in the model.
To avoid type I error, we corrected for number of childhood trauma variables tested (emotional neglect, physical neglect, physical abuse, sexual abuse, emotional abuse, and dose [number of types] of abuse) using a P value of .008 as a marker of significance. As the study was hypothesis-driven, with a priori ideas on directions, we decided that this P value was sufficient without the potential of losing important data.
Sociodemographics and Clinical Variables
Four hundred eighteen patients from France recruited between 1996–2008 and 169 patients from Norway recruited between 2007–2012 were included in this study. The total sample is presented in Table 1. Before the 2 samples were merged, comparison analyses were conducted between the 2 sites. Differences between samples were found concerning rapid cycling (France: 23% vs Norway: 16%) and alcohol dependence (Norway: 14% vs France: 7%); also, the French sample was older and thus had a longer illness duration than the Norwegian sample (see Supplementary eTable 1 at PSYCHIATRIST.COM). The difference between sites regarding rapid cycling did not persist after duration was considered as a confounding factor. The difference between sites regarding lifetime alcohol dependence remained significant (P =.017) even when age at interview was used as a covariate. The 2 samples were similar in terms of CTQ total score (France: 41.74 ± 12.88 vs Norway: 44.03 ± 16.43; z = 0.88, P = .37), and the frequencies of trauma subtypes were also similar, with the exception of physical neglect (more frequent in Norway; P = .001).
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Because the effects of trauma on the clinical expression of bipolar disorder are not likely to be related to differences across sites, the samples were pooled and analyzed together. Analysis by gender showed that females overall reported a higher prevalence of childhood trauma than males (CTQ total score: females, 43.48 ±14.83; males, 40.78 ± 12.54; f = 3.60, t =−2.24, P = .025).
Childhood Trauma and Clinical Characteristics
Associations between childhood trauma subtypes (dichotomized into presence and absence) and clinical characteristics of bipolar disorder are presented in Table 2. We found that age at onset of bipolar illness was lower in patients who had experienced various trauma subtypes, specifically, sexual abuse, emotional abuse, emotional neglect, and physical neglect. A significant dose relationship between childhood abuse and lower age at onset was also observed: patients exposed to more types of abuse had a significantly lower age at onset (Figure 1). Females with childhood sexual abuse reported earlier age at onset than females without childhood sexual abuse (20.09 ± 7.16 vs 24.27 ± 9.83 years, r2 = 0.04, P <.001). Also, males with childhood sexual abuse reported earlier age at onset than males without childhood sexual abuse (21.68 ± 9.36 vs 26.21 ± 11.03 years, r2 = 0.02, P = .042). Similar findings were observed for emotional abuse and emotional neglect (data not shown).
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Suicide attempts (present/absent) were significantly associated with sexual and emotional abuse. A significant dose-dependent relationship between childhood abuse and suicide attempts was observed: patients exposed to more types of abuse (physical, sexual, and/or emotional abuse) significantly more frequently had a history of suicide attempts. Females with childhood sexual abuse were significantly more likely to report having made at least 1 suicide attempt than females without childhood sexual abuse (53.1% vs 38.2%, r2 = 0.02, P = .018). Also, males with childhood sexual abuse were significantly more likely to report at least 1 suicide attempt than males without childhood sexual abuse (45.5% vs 26.7%); however, this remained at a trend level for statistical significance (P = .07). Similar findings were observed for emotional abuse (data not shown).
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Rapid cycling was significantly associated with childhood trauma, specifically, sexual abuse and emotional abuse. Moreover, a significant dose relationship between childhood abuse and rapid cycling was observed: patients exposed to more abuse types (from 0 to 3 types of abuse; physical, sexual, and/or emotional) showed significantly increased prevalence of rapid cycling. Analysis according to gender demonstrated that females with sexual or emotional abuse presented a higher prevalence of rapid cycling than females without sexual or emotional abuse (sexual abuse: 34.2% vs 18.6%, r2 = 0.04, P = .005; emotional abuse: 31.3% vs 18.4%, r2 = 0.03, P =.011). Also, in males, patients with sexual or emotional abuse presented a higher prevalence of rapid cycling than patients without sexual or emotional abuse; however, for males, this difference reached only trend levels, not statistical significance (sexual abuse: 33.3% vs 16.8%, r2 = 0.02, P = .07; emotional abuse: 27.7% vs 16.2%, r2 = 0.02, P = .078). Having said this, the subsample of males with trauma was smaller than the subsample of females with trauma; therefore, the findings should be viewed in light of possible loss of power to detect significant findings in the male group compared to the female group.
Number of depressive episodes was significantly associated with emotional abuse. Stratification by gender showed that females with emotional abuse demonstrated an increased number of depressive episodes compared to females without emotional abuse (mean ± SD number of depressive episodes: 7.07 ± 6.96 vs 4.72 ± 5.44, r2 = 0.03, P = .002). When we investigated males only, no significant difference in the number of depressive episodes was observed in patients with or without emotional abuse (4.67 ± 5.27 vs 3.77 ± 4.40, r2 = 0.01, P= .25).
Number of hypomanic or manic episodes was associated (Mann-Whitney test) with increased frequency of emotional abuse, as well as a dose effect of abuse, although the adjusted P values were above the cutoff for statistical significance. Also, after we corrected for multiple testing, no significant associations were observed for psychotic episodes.
Significant associations were observed between cannabis abuse and sexual abuse, as well as cannabis abuse and emotional abuse. No significant associations were observed between alcohol dependence and childhood trauma.
Is a Specific Subtype of Childhood Trauma Driving the Association Between Childhood Trauma and Clinical Characteristics?
Multilevel regression analyses were performed to investigate whether specific underlying childhood trauma subtypes were driving the associations with clinical characteristics (Table 3). Only sexual abuse and emotional abuse were independently associated with earlier age at onset. Moreover, as shown in step 2, this association was still significant after gender was added into the model. Emotional and sexual abuse were independently associated with increased frequency of a history of suicide attempt and remained so after gender and duration of illness were introduced into the model. Sexual abuse was the only statistically significant predictor of rapid cycling. Sexual abuse was still associated with rapid cycling after gender and duration of illness were added into the model.
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We performed an additional post hoc analysis correcting for recruitment site, as the French sample had a slightly higher number of rapid-cycling subjects than the Norwegian sample, and the Norwegian sample had a slightly lower age at onset than the French sample. Reassuringly, after we corrected for recruitment site, sexual abuse was still significantly associated with rapid cycling (P = .006), and sexual abuse (P = .002) and emotional abuse (P = .002) were significantly associated with earlier age at onset (data not shown). Last, we performed a multivariate analysis controlling for alcohol and cannabis use, and our results remained the same.
Our study demonstrated robust associations between a more severe clinical presentation and childhood adverse events in a large, thoroughly described sample of bipolar disorder patients with the use of a broad range of childhood trauma variables, including neglect (both emotional and physical) and emotional, physical, and sexual abuse. Our results show that childhood traumatic events are associated with a more severe form of bipolar disorder characterized by earlier onset of the illness, greater prevalence of a history of suicide attempt, rapid cycling, greater proneness toward depression, and more cannabis use. We found a clear dose-response effect of abuse on all of these clinical variables, in the direction of an association of increased trauma with more severe clinical expression. The current findings also include gender differences, which have not been observed before.
Across clinical characteristics, our results demonstrate that the association of childhood trauma is stronger for abuse (emotional, physical, and sexual) than neglect (emotional and physical). The effect observed for neglect seems to be driven by an underlying effect of abuse, specifically emotional abuse. This suggests that the trauma probably must reach a certain level of intensity (abuse vs neglect and at least a moderate to severe intensity) to have an effect on the phenotype. Indeed, a unidirectional relation can be observed between abuse and neglect, with the abuse increasing the relative risk for being exposed to neglect (the inverse being false). For example, we observed a relationship between neglect and higher prevalence of at least 1 suicide attempt (P = .02); however, this effect disappeared when other types of trauma were entered into a multivariate model, and only emotional and sexual abuse remained significantly associated with suicide attempt.
Regarding the effect of individual specific subtypes of abuse, we found that sexual abuse was the strongest predictor of rapid cycling, while both emotional and sexual abuse were related to lower age at onset and to suicide attempts. There are some indications that physical abuse is associated more with psychosis, and emotional abuse, with bipolar disorder, while sexual abuse might be associated more with impulsivity dyscontrol.1,5 Sexual abuse does not seem to be strongly associated with psychosis,28 but rather with suicide attempt.29 Indeed, emotional abuse is increased in patients with bipolar disorder, also after correcting for other types of abuse, compared to healthy controls.1,5 It might be that emotional abuse is specifically linked to bipolar disorder based on possible links to emotional dysregulation, which is a core symptom of bipolar disorder. We could hypothesize that emotional abuse and sexual abuse are associated with development of emotional dysregulation, which may be an underlying core link between childhood trauma and increased symptomatology in bipolar disorder patients; the link could be mediated by intermediate dimensions such as increased affective dysregulation5 or impulsivity.30 We suggest further investigation of this in future studies.
Females reported greater frequency of trauma, as well as greater associations with clinical characteristics of bipolar disorder, than males. Females with childhood trauma showed stronger associations with earlier onset of illness, rapid cycling, suicide attempts, and more depressive episodes than males with trauma. We therefore performed additional analyses controlling for gender to rule out that female patients drove the association between childhood trauma and the development of more severe clinical characteristics in bipolar disorder. The results remained the same, indicating an additive effect of gender, as well as a significant gender-nonspecific effect of childhood trauma, on clinical characteristics in bipolar disorder.
Lastly, future research should investigate the mechanisms behind associations between childhood trauma and clinical symptomatology in bipolar disorder, such as the link between childhood trauma and substance abuse. As already mentioned, childhood trauma has been related to an increased risk of substance abuse,31 and patients with bipolar disorder show a higher frequency of substance abuse compared to the general population.32 In bipolar disorder, substance abuse is associated with increased sensitization and vulnerability to recurrent episodes, thus possibly driving illness progression.33 It would therefore be of interest to investigate if substance abuse is moderating the effect of childhood trauma on clinical characteristics in bipolar disorder. Moreover, we know that bipolar disorder is highly heritable; to further investigate how genetic variants may moderate the effect of childhood trauma on clinical expressions of bipolar disorder would be of great interest. Bipolar disorder is determined by both genetic and environmental risk factors, with interactions between factors remaining to be clarified.34 Some attempts have been made to explore such an issue in bipolar disorder with, for example, interactions between BDNF gene variants and early life stress on bipolar course.35 Future studies will focus on identifying how some genetic susceptibility factors are likely to moderate the effects of childhood trauma on the clinical expression of the disorder.
With regard to study limitations, first, data on childhood trauma were, as in most clinical studies of this phenomenon, obtained retrospectively, with the inherent weakness of retrospective reporting designs. However, the retrospective collection of childhood trauma data in patients with severe mental disorders has been found a valid and reliable source of information in previous studies.2 Our study fulfills the quality criteria of Fisher and Hosang,16with the limitation that in the Norwegian sample no standardized assessment, but rather clinical judgment, was used to decide whether patients were in a suitable mood to reliably fill in the CTQ form; all patients from the French sample were systematically evaluated and defined as euthymic at time of assessment. Another limitation of using the CTQ is that it does not identify all types of traumas, such as childhood traumas due to early parental loss, divorce, natural disasters, house fires, and so on. As a result, these kinds of childhood traumas are left out of the multivariate analysis, yet may explain some of the dependent variables. Also, not assessing for these traumas may lead to misclassification of cases and noncases, with some who may have had 1 or more of these other traumas still being classified as not having an early trauma using the CTQ form. However, although the CTQ has its limitations, it is a well-used questionnaire in the literature, which improves the possibility of comparing findings across studies. We cannot rule out, though, that some patients may have experienced other types of traumas not assessed here.
Moreover, we have previously reported that in bipolar disorder, substance abuse is associated with increased sensitization and vulnerability to recurrent episodes, thus possibly driving illness progression.33 Substance abuse has also been linked to a possibly worse course of illness (increased risk of suicide, lower age at onset, rapid cycling).36–38 We also know that there is a high correlation between childhood trauma and substance use,39,40 and although we performed additional multivariate analyses controlling for lifetime cannabis and alcohol abuse, the association between substance abuse, childhood trauma, and bipolar symptomatology should be further investigated. It may also be that disorders comorbid with bipolar disorder, such as anxiety disorders, are driving some of the effects we see; for example, anxiety disorders have been associated with suicidality.41 Unfortunately, we do not have complete data on comorbid diagnoses and have therefore not included them as possible confounders in our analyses. Finally, clinical variables were assessed using the SCID-I or the DIGS. Reliability analysis comparing DIGS and DSM criteria has shown excellent reliability scores for bipolar disorders,19 indicating that use of the DIGS did not bias our results.
The main strength of this study is the large sample size, which provided the power to investigate gender differences, as well as made it possible to perform multilevel analyses, in studying individual associations of trauma with clinical characteristics. Lastly, our large study also included measures of neglect and emotional abuse as well as the more frequently investigated sexual and physical abuse, which was an advantage of our study compared to studies in the literature.15 Our findings have multiple important implications: first, improving the understanding of the clinical heterogeneity of bipolar disorder presentation, and second, identifying those at risk of a more severe clinical picture.
To conclude, the strong associations between reports of childhood trauma and increased symptom levels in bipolar disorder patients observed in this large study support a role of childhood trauma in the development of more severe clinical characteristics in bipolar disorder. The findings further highlight the importance of assessing childhood trauma in bipolar disorder research, which should be systematically included in the clinical assessment of the patients.42
Author affiliations: Pôle de Psychiatrie, Hôpital Henri Mondor–Albert Chenevier, Assistance Publique Hôpitaux de Paris (APHP); and Institut National de la Santé et de la Recherche Médicale (INSERM) U955 (Drs Etain, Leboyer, and Henry); Faculté de Médecine, Université Paris Est (Drs Leboyer and Henry); and Fondation Fondamental (Drs Etain, Gard, Kahn, Bellivier, Leboyer, and Henry), Créteil; Pôle Addictologie-Toxicologie-Psychiatrie, Hôpital Fernand Widal, APHP, and Université Paris-7, Paris (Dr Bellivier); Pôle 3-4-7, Service de Psychiatrie Adulte, Centre Expert Trouble Bipolaire, Hôpital Charles Perrens, Bordeaux (Dr Gard); Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy, Nancy (Dr Kahn); European Network of Bipolar Research Expert Centres (ENBREC), Paris (Drs Etain, Andreassen, Bellivier, Leboyer, and Henry), France; and KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo (Drs Aas, Andreassen, Lorentzen, Dieset, and Melle), and Division of Mental Health and Addiction, Oslo University Hospital (Drs Andreassen, Lorentzen, Dieset, and Melle), Oslo, Norway.
Author contributions: Drs Etain and Aas contributed equally to this article.
Potential conflicts of interest: The authors declare that they have no conflict of interest concerning this manuscript. Dr Etain has received honoraria as a speaker from Bristol-Myers Squibb, AstraZeneca, Servier, and Lundbeck. Dr Gard has received honoraria as a speaker from AstraZeneca, Lundbeck, Bristol-Myers Squibb, and Otsuka. Dr Henry has received honoraria as a speaker from Bristol-Myers Squibb.
Funding/support: This research was funded by INSERM, APHP, Agence Nationale de la Recherche (ANR), and Fédération pour la Recherche sur le Cerveau (FRC) (France) and the South Eastern Norway Health Authority (#2004123, #2006258) and Research Council of Norway (#167153/V50).
Role of sponsors: The funding organizations had no role in the design of the study; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the paper for publication.
Acknowledgments: The authors thank E. Abadie, Research Nurse (Hôpital Henri Mondor–Albert Chenevier, APHP), for the monitoring and quality control of the French data and J. R. Richard, MSc (INSERM), who was in charge of ethical procedures. They also thank the clinical psychologists who participated in the clinical assessment of patients at Hôpital Henri Mondor–Albert Chenevier, APHP (A. Raust, Psych, and B. Cochet, Psych); Hôpital Charles Perrens (L. Zanouy, Psych); and CHU de Nancy, Vandoeuvre Les Nancy (R. F. Cohen, Psych, and O. Wajsbrot-Elgrabli, Psych). These individuals have no conflict of interest to report. Finally, the authors thank the patients who took part in the study and the Thematically Organized Psychosis [TOP] Study researchers who contributed to the data collection.
Supplementary material: Supplementary material available at PSYCHIATRIST.COM.
REFERENCES
1. Etain B, Mathieu F, Henry C, et al. Preferential association between childhood emotional abuse and bipolar disorder. J Trauma Stress. 2010;23(3):376–383. PubMed Show Abstract
2. Fisher HL, Craig TK, Fearon P, et al. Reliability and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophr Bull. 2011;37(3):546–553. PubMeddoi:10.1093/schbul/sbp103 Show Abstract
3. Mondelli V, Dazzan P, Hepgul N, et al. Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment. Schizophr Res. 2010;116(2–3):234–242. PubMeddoi:10.1016/j.schres.2009.08.013 Show Abstract
4. Read J, van Os J, Morrison AP, et al. Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatr Scand. 2005;112(5):330–350. PubMed doi:10.1111/j.1600-0447.2005.00634.x Show Abstract
5. Etain B, Henry C, Bellivier F, et al. Beyond genetics: childhood affective trauma in bipolar disorder. Bipolar Disord. 2008;10(8):867–876. PubMed doi:10.1111/j.1399-5618.2008.00635.x Show Abstract
6. Garno JL, Goldberg JF, Ramirez PM, et al. Impact of childhood abuse on the clinical course of bipolar disorder. Br J Psychiatry. 2005;186(2):121–125. PubMeddoi:10.1192/bjp.186.2.121 Show Abstract
7. Bebbington PE, Bhugra D, Brugha T, et al. Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. Br J Psychiatry. 2004;185(3):220–226. PubMed doi:10.1192/bjp.185.3.220 Show Abstract
8. Janssen I, Krabbendam L, Bak M, et al. Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand. 2004;109(1):38–45. PubMed doi:10.1046/j.0001-690X.2003.00217.x Show Abstract
9. Shevlin M, Dorahy MJ, Adamson G. Trauma and psychosis: an analysis of the National Comorbidity Survey. Am J Psychiatry. 2007;164(1):166–169. PubMeddoi:10.1176/appi.ajp.164.1.166 Show Abstract
10. Hammersley P, Dias A, Todd G, et al. Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. Br J Psychiatry. 2003;182:543–547. PubMeddoi:10.1192/bjp.182.6.543 Show Abstract
11. Brown GR, McBride L, Bauer MS, et al; Cooperative Studies Program 430 Study Team. Impact of childhood abuse on the course of bipolar disorder: a replication study in US veterans. J Affect Disord. 2005;89(1–3):57–67. PubMed doi:10.1016/j.jad.2005.06.012Show Abstract
12. Nemeroff CB. Neurobiological consequences of childhood trauma. J Clin Psychiatry. 2004;65(suppl 1):18–28. PubMed Show Abstract
13. Weber K, Rockstroh B, Borgelt J, et al. Stress load during childhood affects psychopathology in psychiatric patients. BMC Psychiatry. 2008;8(1):63. PubMeddoi:10.1186/1471-244X-8-63 Show Abstract
14. Alvarez MJ, Roura P, Osés A, et al. Prevalence and clinical impact of childhood trauma in patients with severe mental disorders. J Nerv Ment Dis. 2011;199(3):156–161. PubMeddoi:10.1097/NMD.0b013e31820c751c Show Abstract
15. Daruy-Filho L, Brietzke E, Lafer B, et al. Childhood maltreatment and clinical outcomes of bipolar disorder. Acta Psychiatr Scand. 2011;124(6):427–434. PubMed doi:10.1111/j.1600-0447.2011.01756.x Show Abstract
16. Fisher HL, Hosang GM. Childhood maltreatment and bipolar disorder: a critical review of the evidence. Mind Brain, 2010;1(1):75–85.
17. Fisher H, Morgan C, Dazzan P, et al. Gender differences in the association between childhood abuse and psychosis. Br J Psychiatry. 2009;194(4):319–325. PubMeddoi:10.1192/bjp.bp.107.047985 Show Abstract
18. Diflorio A, Jones I. Is sex important? gender differences in bipolar disorder. Int Rev Psychiatry. 2010;22(5):437–452. PubMed doi:10.3109/09540261.2010.514601Show Abstract
19. Nurnberger JI Jr, Blehar MC, Kaufmann CA, et al. Diagnostic Interview for Genetic Studies: rationale, unique features, and training. NIMH Genetics Initiative. Arch Gen Psychiatry. 1994;51(11):849–859, discussion 863–864. PubMeddoi:10.1001/archpsyc.1994.03950110009002 Show Abstract
20. Bech P, Rafaelsen OJ, Kramp P, et al. The Mania Rating Scale: scale construction and inter-observer agreement. Neuropharmacology. 1978;17(6):430–431. PubMeddoi:10.1016/0028-3908(78)90022-9 Show Abstract
21. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change.Br J Psychiatry. 1979;134(4):382–389. PubMed doi:10.1192/bjp.134.4.382 Show Abstract
22. Ringen PA, Lagerberg TV, Birkenaes AB, et al. Differences in prevalence and patterns of substance use in schizophrenia and bipolar disorder. Psychol Med. 2008;38(9):1241–1249.PubMed doi:10.1017/S003329170700236X Show Abstract
23. Bernstein DP, Fink L, Handelsman L, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1994;151(8):1132–1136. PubMed Show Abstract
24. Aas M, Djurovic S, Athanasiu LTSM, et al. Serotonin transpoter gene polymorphism, childhood trauma, and cognition in patients with psychotic features. Schizophr Bull. 2012;38(1):15–22.. PubMed Show Abstract
25. Paquette D, Laporte L, Bigras M, et al. Validation of the French version of the CTQ and prevalence of the history of maltreatment. Sante Ment Que. 2004;29(1):201–220. PubMeddoi:10.7202/008831ar Show Abstract
26. Bernstein DP, Fink L. Childhood Trauma Questionnaire: A Retrospective Self- Report. San Antonio, TX: The Psychological Corporation; 1998.
27. Aas M, Dazzan P, Fisher HL, et al. Childhood trauma and cognitive function in first-episode affective and non-affective psychosis. Schizophr Res. 2011;129(1):12–19. PubMeddoi:10.1016/j.schres.2011.03.017 Show Abstract
28. Chen LP, Murad MH, Paras ML, et al. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc. 2010;85(7):618–629.PubMed doi:10.4065/mcp.2009.0583 Show Abstract
29. Chou KL. Childhood sexual abuse and psychiatric disorders in middle-aged and older adults: evidence from the 2007 Adult Psychiatric Morbidity Survey. J Clin Psychiatry. 2012;73(11):e1365–e1371. PubMed doi:10.4088/JCP.12m07946 Show Abstract
30. Coulston CM, Tanious M, Mulder RT, et al. Bordering on bipolar: the overlap between borderline personality and bipolarity. Aust N Z J Psychiatry. 2012;46(6):506–521. PubMeddoi:10.1177/0004867412445528 Show Abstract
31. Houston JE, Murphy J, Shevlin M, et al. Cannabis use and psychosis: re-visiting the role of childhood trauma. Psychol Med. 2011;41(11):2339–2348. PubMeddoi:10.1017/S0033291711000559 Show Abstract
32. Holmes MK, Bearden CE, Barguil M, et al. Conceptualizing impulsivity and risk taking in bipolar disorder: importance of history of alcohol abuse. Bipolar Disord. 2009;11(1):33–40.PubMed doi:10.1111/j.1399-5618.2008.00657.x Show Abstract
33. Post RM. Mechanisms of illness progression in the recurrent affective disorders. Neurotox Res. 2010;18(3–4):256–271. PubMed doi:10.1007/s12640-010-9182-2 Show Abstract
34. Lichtenstein P, Yip BH, Björk C, et al. Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet. 2009;373(9659):234–239. PubMed doi:10.1016/S0140-6736(09)60072-6 Show Abstract
35. Miller S, Hallmayer J, Wang PW, et al. Brain-derived neurotrophic factor val66met genotype and early life stress effects upon bipolar course. J Psychiatr Res. 2013;47(2):252–258. PubMed doi:10.1016/j.jpsychires.2012.10.015 Show Abstract
36. Agrawal A, Nurnberger JI Jr, Lynskey MT; Bipolar Genome Study. Cannabis involvement in individuals with bipolar disorder. Psychiatry Res. 2011;185(3):459–461. PubMeddoi:10.1016/j.psychres.2010.07.007 Show Abstract
37. Javaid N, Kennedy JL, De Luca, V. Ethnicity and age at onset in bipolar spectrum disorders [published online ahead of print June 1, 2011]. CNS Spectr .2011. PubMed
38. Lagerberg TV, Sundet K, Aminoff SR, et al. Excessive cannabis use is associated with earlier age at onset in bipolar disorder. Eur Arch Psychiatry Clin Neurosci. 2011;261(6):397–405. PubMed doi:10.1007/s00406-011-0188-4 Show Abstract
39. Fergusson DM, Boden JM, Horwood LJ. The developmental antecedents of illicit drug use: evidence from a 25-year longitudinal study. Drug Alcohol Depend. 2008;96(1–2):165–177.PubMed doi:10.1016/j.drugalcdep.2008.03.003 Show Abstract
40. Shin SH, Edwards EM, Heeren T. Child abuse and neglect: relations to adolescent binge drinking in the national longitudinal study of Adolescent Health (AddHealth) Study. Addict Behav. 2009;34(3):277–280. PubMed doi:10.1016/j.addbeh.2008.10.023 Show Abstract
41. Crump C, Sundquist K, Winkleby MA, et al. Mental disorders and vulnerability to homicidal death: Swedish nationwide cohort study. BMJ. 2013;346):f557. PubMeddoi:10.1136/bmj.f557 Show Abstract
42. Henry C, Etain B, Mathieu F, et al. A French network of bipolar expert centres: a model to close the gap between evidence-based medicine and routine practice. J Affect Disord. 2011;131(1–3):358–363. PubMed doi:10.1016/j.jad.2010.11.013 Show Abstract
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