Effects of stress and social support on recurrence in bipolar disorder.
BACKGROUND
Limited research has examined the impact of social support on the course of bipolar disorder, although results suggest a probable link. This study examines prospectively the effects of stressful events and social support on episode recurrence in bipolar I disorder.


METHODS
Fifty-two outpatients with bipolar I disorder recruited from an urban community were followed every 3 months for up to 1 year. At the initial interview, individuals reported separately on perceived social support from a best friend, parent, and romantic partner, combined to form a total network support score. Ongoing prospective assessments of stressful life events, symptomatology, and medication compliance were completed over 1 year. Logistic regressions were utilized to predict episode recurrence.


RESULTS
As predicted, both higher levels of stress and lower levels of social support from the total network independently predicted depressive recurrence over a 1-year follow-up, after controlling for clinical history and compliance. Social support did not moderate the impact of stress.


CONCLUSIONS
Only a 1-year follow-up was obtained, and sample sizes may have been insufficient to detect prediction of manic episodes. Direction of causality between support and recurrence is hypothesized but cannot be definitively determined.


CONCLUSIONS
Higher levels of stress and perceptions of less available and poorer quality close relationships are associated with recurrence. Interventions that target these psychosocial vulnerabilities may help alter the course of bipolar I disorder. Research with larger samples should further examine the possible polarity-specific effects of social risk factors.
West Los Angeles VA Healthcare Center and Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA.
Amy N
AN
Cohen
Constance
C
Hammen
Risha M
RM
Henry
Shannon E
SE
Daley
D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012944:Social Support; D013315:Stress, Psychological; D014505:Urban Population