title: Chronic stressors and trauma: prospective influences on the course of bipolar disorder.
abstract: BACKGROUND
  Exposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients.
  
  
  METHODS
  One hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments).
  
  
  RESULTS
  Trauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance.
  
  
  CONCLUSIONS
  Overall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.
authors: Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
authors: A
authors: A
authors: Gershon
authors: S L
authors: SL
authors: Johnson
authors: I
authors: I
authors: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000209:etiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D012931:Social Environment; D040921:Stress Disorders, Traumatic / Q000150:complications / Q000453:epidemiology; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology*; D055815:Young Adult