title: Individual and familial risk factors for bipolar affective disorders in Denmark.
abstract: BACKGROUND
  Few population-based studies have addressed risk factors for bipolar affective disorder.
  
  
  OBJECTIVE
  To study the possible association between bipolar affective disorder and history of mental illness in a parent or sibling; urbanicity of birth place; season of birth; sibship characteristics, including birth order; influenza epidemics during pregnancy; and early parental loss.
  
  
  METHODS
  We used a population-based cohort of 2.1 million individuals based on data from the Danish Civil Registration System linked with the Danish Psychiatric Central Register.
  
  
  METHODS
  Nationwide population-based sample of all individuals hospitalized or in outpatient clinic contact for the first time with bipolar affective disorder. Patients Overall, 2299 individuals were first diagnosed with bipolar affective disorder during the 31.8 million person-years of follow-up.
  
  
  RESULTS
  Risk of bipolar affective disorder was associated with a history of bipolar affective disorder as well as other psychiatric disorders, including schizophrenia and schizoaffective disorder, in parents or siblings. People with a first-degree relative with bipolar affective disorder had a 13.63-fold (95% confidence interval, 11.81-15.71) increased risk of bipolar affective disorder. No other consistent associations were found with the exception of an association between early parental loss, in particular maternal, and bipolar affective disorder. Children who experienced maternal loss before their fifth birthday had a 4.05 (95% confidence interval, 1.68-9.77) increased risk of bipolar affective disorder.
  
  
  CONCLUSIONS
  Early parental loss may represent both environmental and genetic risk factors for bipolar affective disorder. Most of the risk factors included in our study that previously have been associated with schizophrenia were not associated with bipolar affective disorder, supporting that the 2 disorders may be at least partially separate etiological entities.
authors.affiliation: National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark. pbm@ncrr.dk
authors.forename: Preben Bo
authors.initials: PB
authors.lastname: Mortensen
authors.forename: C B
authors.initials: CB
authors.lastname: Pedersen
authors.forename: M
authors.initials: M
authors.lastname: Melbye
authors.forename: O
authors.initials: O
authors.lastname: Mors
authors.forename: H
authors.initials: H
authors.lastname: Ewald
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000235:genetics*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D005828:Genetics, Population; D006801:Humans; D008297:Male; D008426:Maternal Deprivation; D008875:Middle Aged; D011618:Psychotic Disorders / Q000453:epidemiology / Q000235:genetics; D012306:Risk; D012559:Schizophrenia / Q000453:epidemiology / Q000235:genetics