title: The relationship of family characteristics and bipolar disorder using causal-pie models.
abstract: Many family characteristics were reported to increase the risk of bipolar disorder (BPD). The development of BPD may be mediated through different pathways, involving diverse risk factor profiles. We evaluated the associations of family characteristics to build influential causal-pie models to estimate their contributions on the risk of developing BPD at the population level. We recruited 329 clinically diagnosed BPD patients and 202 healthy controls to collect information in parental psychopathology, parent-child relationship, and conflict within family. Other than logistic regression models, we applied causal-pie models to identify pathways involved with different family factors for BPD. The risk of BPD was significantly increased with parental depression, neurosis, anxiety, paternal substance use problems, and poor relationship with parents. Having a depressed mother further predicted early onset of BPD. Additionally, a greater risk for BPD was observed with higher numbers of paternal/maternal psychopathologies. Three significant risk profiles were identified for BPD, including paternal substance use problems (73.0%), maternal depression (17.6%), and through poor relationship with parents and conflict within the family (6.3%). Our findings demonstrate that different aspects of family characteristics elicit negative impacts on bipolar illness, which can be utilized to target specific factors to design and employ efficient intervention programs.
authors.affiliation: Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: C-F
authors.initials: CF
authors.lastname: Kao
authors.affiliation: Department of Health, Jia Nan Mental Hospital, Tainan, Taiwan.
authors.forename: M-K
authors.initials: MK
authors.lastname: Lu
authors.affiliation: Department of Psychiatry, National Cheng Kung University and Hospital, Tainan, Taiwan.
authors.forename: Y-K
authors.initials: YK
authors.lastname: Yang
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: S-C
authors.initials: SC
authors.lastname: Liao
authors.affiliation: Department of Psychiatry, Chi Mei Medicine Center, Tainan, Taiwan.
authors.forename: F-L
authors.initials: FL
authors.lastname: Jang
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: W J
authors.initials: WJ
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, National Cheng Kung University and Hospital, Tainan, Taiwan.
authors.forename: R-B
authors.initials: RB
authors.lastname: Lu
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: phkuo@ntu.edu.tw.
authors.forename: P-H
authors.initials: PH
authors.lastname: Kuo
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001714:Bipolar Disorder / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D015984:Causality; D005191:Family Characteristics / Q000208:ethnology; D054541:Family Conflict / Q000208:ethnology; D005195:Family Relations / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010287:Parent-Child Relations / Q000208:ethnology; D010290:Parents / Q000523:psychology*; D013624:Taiwan / Q000453:epidemiology / Q000208:ethnology; D055815:Young Adult
keywords: Age of onset; Bipolar disorder; Causal-pie; Family relationship; Psychopathology