Childhood trauma is associated with severe clinical characteristics of bipolar disorders

Bruno Etain; Monica Aas; Ole A. Andreassen; Steinar Lorentzen; Ingrid Dieset; Sebastien Gard; Jean Pierre Kahn; Frank Bellivier; Marion Leboyer; Ingrid Melle; Chantal Henry

doi:10.4088/JCP.13m08353

Childhood trauma is associated with severe clinical characteristics of bipolar disorders

Bruno Etain, Monica Aas^*, Ole A. Andreassen, Steinar Lorentzen, Ingrid Dieset, Sebastien Gard, Jean Pierre Kahn, Frank Bellivier, Marion Leboyer, Ingrid Melle, Chantal Henry

^*Corresponding author for this work

Social Genetic & Developmental Psychiatry

Research output: Contribution to journal › Article › peer-review

179 Citations (Scopus)

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.

Original language	English
Pages (from-to)	991-998
Number of pages	8
Journal	Journal of Clinical Psychiatry
Volume	74
Issue number	10
DOIs	https://doi.org/10.4088/JCP.13m08353
Publication status	Published - Oct 2013

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@article{68a3d844ba904c32a7e1ec5446fff206,

title = "Childhood trauma is associated with severe clinical characteristics of bipolar disorders",

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.",

author = "Bruno Etain and Monica Aas and Andreassen, {Ole A.} and Steinar Lorentzen and Ingrid Dieset and Sebastien Gard and Kahn, {Jean Pierre} and Frank Bellivier and Marion Leboyer and Ingrid Melle and Chantal Henry",

year = "2013",

month = oct,

doi = "10.4088/JCP.13m08353",

language = "English",

volume = "74",

pages = "991--998",

journal = "Journal of Clinical Psychiatry",

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T1 - Childhood trauma is associated with severe clinical characteristics of bipolar disorders

AU - Etain, Bruno

AU - Aas, Monica

AU - Andreassen, Ole A.

AU - Lorentzen, Steinar

AU - Dieset, Ingrid

AU - Gard, Sebastien

AU - Kahn, Jean Pierre

AU - Bellivier, Frank

AU - Leboyer, Marion

AU - Melle, Ingrid

AU - Henry, Chantal

PY - 2013/10

Y1 - 2013/10

N2 - 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.

AB - 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.

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U2 - 10.4088/JCP.13m08353

DO - 10.4088/JCP.13m08353

M3 - Article

C2 - 24229750

AN - SCOPUS:84887117505

SN - 0160-6689

VL - 74

SP - 991

EP - 998

JO - Journal of Clinical Psychiatry

JF - Journal of Clinical Psychiatry

IS - 10

ER -

Childhood trauma is associated with severe clinical characteristics of bipolar disorders

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