title: More stressors prior to and during the course of bipolar illness in patients from the United States compared with the Netherlands and Germany.
abstract: Considerable data suggest that compared to some European countries, in the U.S. there are more childhood onset bipolar disorders, more adverse courses of illness, and greater treatment resistance. Psychosocial variables related to these findings have not been adequately explored. Therefore we analyzed psychosocial stressors in three time domains: childhood; the year prior to illness Onset; and the Last Episode from questionnaires in 968 outpatients (mean age 41) with bipolar I or II disorder; 676 from four sites in the U.S. and 292 from three in the Netherlands and Germany (abbreviated here as Europe). Compared to the Europeans, those from the U.S. had significantly more stressors in childhood and prior to the last episode. Stressors prior to the last episode were related to: childhood stressors; an earlier age at illness onset; anxiety and substance abuse comorbidity; lower income; both parents having an affective illness; and feeling more stigma. These data suggest a greater prevalence of adverse life events in childhood and over the course of bipolar illness in the U.S. compared to the Netherlands and Germany. Clinical, therapeutic, and public health approaches to these illness-relevant stressors require further exploration.
authors.affiliation: Bipolar Collaborative Network, Bethesda MD; Clinical Professor Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C.; Bipolar Collaborative Network, Bethesda, MD, USA. Electronic address: robert.post@speakeasy.net.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Post
authors.forename: Lori
authors.initials: L
authors.lastname: Altshuler
authors.forename: Gabriele
authors.initials: G
authors.lastname: Leverich
authors.forename: Willem
authors.initials: W
authors.lastname: Nolen
authors.forename: Ralph
authors.initials: R
authors.lastname: Kupka
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
authors.forename: Mark
authors.initials: M
authors.lastname: Frye
authors.forename: Trisha
authors.initials: T
authors.lastname: Suppes
authors.forename: Sue
authors.initials: S
authors.lastname: McElroy
authors.forename: Paul
authors.initials: P
authors.lastname: Keck
authors.forename: Mike
authors.initials: M
authors.lastname: Rowe
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D014481:United States / Q000453:epidemiology
keywords: Anxiety disorder; Childhood adversity; Psychosocial stress; Social support; Substance abuse disorder