title: Contributions of the social environment to first-onset and recurrent mania.
abstract: In treated cohorts, individuals with bipolar disorder are more likely to report childhood adversities and recent stressors than individuals without bipolar disorder; similarly, in registry-based studies, childhood adversities are more common among individuals who later become hospitalized for bipolar disorder. Because these types of studies rely on treatment-seeking samples or hospital diagnoses, they leave unresolved the question of whether or not social experiences are involved in the etiology of bipolar disorder. We investigated the role of childhood adversities and adulthood stressors in liability for bipolar disorder using data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=33 375). We analyzed risk for initial-onset and recurrent DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) manic episodes during the study's 3-year follow-up period. Childhood physical abuse and sexual maltreatment were associated with significantly higher risks of both first-onset mania (odds ratio (OR) for abuse: 2.23; 95% confidence interval (CI)=1.71, 2.91; OR for maltreatment: 2.10; CI=1.55, 2.83) and recurrent mania (OR for abuse: 1.55; CI=1.00, 2.40; OR for maltreatment: 1.60; CI=1.00, 2.55). In addition, past-year stressors in the domains of interpersonal instability and financial hardship were associated with a significantly higher risk of incident and recurrent mania. Exposure to childhood adversity potentiated the effects of recent stressors on adult mania. Our findings demonstrate a role of social experiences in the initial onset of bipolar disorder, as well as in its prospective course, and are consistent with etiologic models of bipolar disorder that implicate deficits in developmentally established stress-response pathways.
authors.affiliation: 1] Department of Social and Behavioral Sciences,  Harvard School of Public Health, Boston, MA, USA [2] Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA [3] Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Gilman
authors.affiliation: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: M Y
authors.initials: MY
authors.lastname: Ni
authors.affiliation: 1] Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA [2] Department of Psychiatry, Harvard Medical School, Boston, MA, USA [3] Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge,  MA, USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Dunn
authors.affiliation: RAND Corporation, Pittsburgh, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Breslau
authors.affiliation: Department of Psychology, University of Washington, Seattle, WA, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: McLaughlin
authors.affiliation: 1] Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA [2] Department of Psychiatry, Harvard Medical School, Boston, MA, USA [3] Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge,  MA, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Smoller
authors.affiliation: 1] Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge,  MA, USA [2] Center for Experimental Drugs and Diagnostics, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Perlis
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data; D015331:Cohort Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012931:Social Environment; D055815:Young Adult
references.citation: Arch Gen Psychiatry. 2007 May;64(5):543-52
references.pmid: 17485606
references.citation: Dev Psychopathol. 2006 Fall;18(4):1169-79
references.pmid: 17064433
references.citation: J Child Adolesc Psychopharmacol. 2003 Fall;13(3):243-51
references.pmid: 14661614
references.citation: Psychol Med. 2013 Feb;43(2):303-16
references.pmid: 22640506
references.citation: Arch Gen Psychiatry. 2009 Mar;66(3):287-96
references.pmid: 19255378
references.citation: Psychol Bull. 2006 May;132(3):477-95
references.pmid: 16719570
references.citation: Curr Psychiatry Rep. 2003 Dec;5(6):477-83
references.pmid: 14609503
references.citation: Dev Psychopathol. 2006 Fall;18(4):1055-103
references.pmid: 17064429
references.citation: Bipolar Disord. 2004 Apr;6(2):122-9
references.pmid: 15005750
references.citation: Br J Psychiatry. 1986 Aug;149:191-201
references.pmid: 3535979
references.citation: Neuroscience. 2009 Nov 24;164(1):331-43
references.pmid: 19358880
references.citation: Clin Psychol Rev. 2005 Dec;25(8):1043-75
references.pmid: 16140445
references.citation: Soc Sci Med. 2010 Nov;71(10):1847-54
references.pmid: 20870332
references.citation: J Affect Disord. 2011 Nov;134(1-3):434-7
references.pmid: 21658777
references.citation: Drug Alcohol Depend. 2008 Jan 1;92(1-3):27-36
references.pmid: 17706375
references.citation: Arch Gen Psychiatry. 2004 Aug;61(8):807-16
references.pmid: 15289279
references.citation: Bipolar Disord. 2008 Dec;10(8):867-76
references.pmid: 19594502
references.citation: Psychol Med. 1997 Sep;27(5):1079-89
references.pmid: 9300513
references.citation: Drug Alcohol Depend. 2003 Jul 20;71(1):7-16
references.pmid: 12821201
references.citation: Curr Opin Psychiatry. 2010 Nov;23(6):498-503
references.pmid: 20733493
references.citation: Clin Psychol Rev. 2011 Apr;31(3):383-98
references.pmid: 21334286
references.citation: Biol Psychiatry. 2002 Feb 15;51(4):288-97
references.pmid: 11958779
references.citation: J Clin Psychol. 2010 Sep;66(9):907-26
references.pmid: 20694958
references.citation: Am J Psychiatry. 1986 Jul;143(7):904-7
references.pmid: 3717432
references.citation: Psychiatr Serv. 2002 Dec;53(12):1547-55
references.pmid: 12461214
references.citation: Psychol Bull. 1993 Jan;113(1):82-98
references.pmid: 8426875
references.citation: Psychol Med. 2010 Oct;40(10):1647-58
references.pmid: 20018126
references.citation: J Affect Disord. 2009 Jan;112(1-3):144-50
references.pmid: 18538857
references.citation: Arch Gen Psychiatry. 2010 Feb;67(2):124-32
references.pmid: 20124112
references.citation: Am J Psychiatry. 1989 Jan;146(1):61-6
references.pmid: 2912251
references.citation: Acta Psychiatr Scand. 2011 Dec;124(6):427-34
references.pmid: 21848703
references.citation: Ann Epidemiol. 2010 May;20(5):385-94
references.pmid: 20382340
references.citation: J Clin Psychiatry. 2012 Jun;73(6):829-36
references.pmid: 22394428
references.citation: J Affect Disord. 1992 May;25(1):13-20
references.pmid: 1624643
references.citation: J Affect Disord. 2005 Jun;86(2-3):151-9
references.pmid: 15935234
references.citation: Am J Psychiatry. 1995 May;152(5):795-7
references.pmid: 7726323
references.citation: J Abnorm Psychol. 1997 Aug;106(3):449-57
references.pmid: 9241946
references.citation: Nat Neurosci. 2013 Jan;16(1):33-41
references.pmid: 23201972
references.citation: Psychiatry Res. 2011 Apr 30;186(2-3):267-71
references.pmid: 20888051
references.citation: J Affect Disord. 2011 Oct;133(3):381-7
references.pmid: 21106249
references.citation: J Abnorm Psychol. 2008 May;117(2):268-277
references.pmid: 18489203
references.citation: J Psychiatr Res. 2010 Aug;44(11):732-40
references.pmid: 20144464
references.citation: J Abnorm Psychol. 1984 May;93(2):222-30
references.pmid: 6725756
references.citation: J Affect Disord. 2007 Apr;99(1-3):37-44
references.pmid: 17084905
references.citation: Am J Psychiatry. 1990 Sep;147(9):1194-8
references.pmid: 1974746
references.citation: Am J Psychiatry. 1997 Jun;154(6):856-7
references.pmid: 9167516
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2012 Oct 1;39(1):1-8
references.pmid: 22613185
references.citation: J Clin Psychiatry. 2005 Oct;66(10):1205-15
references.pmid: 16259532
references.citation: Lancet. 2013 May 11;381(9878):1654-62
references.pmid: 23663951
references.citation: Alcohol Clin Exp Res. 2007 Dec;31(12):2036-45
references.pmid: 18034696
references.citation: Clin Child Fam Psychol Rev. 2006 Mar;9(1):23-64
references.pmid: 16718583
references.citation: Arch Gen Psychiatry. 2003 Dec;60(12):1209-15
references.pmid: 14662553
references.citation: Clin Psychol Rev. 2005 Dec;25(8):1008-27
references.pmid: 16129530
references.citation: Bipolar Disord. 2003 Oct;5(5):356-61
references.pmid: 14525556
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2012 Oct;47(10):1591-605
references.pmid: 22241530
references.citation: Br J Psychiatry. 2005 Feb;186:121-5
references.pmid: 15684234
references.citation: Br J Psychiatry. 1983 Apr;142:398-403
references.pmid: 6850179
references.citation: Br J Psychiatry. 1993 Sep;163:381-5
references.pmid: 8401970
references.citation: J Child Psychol Psychiatry. 2004 Feb;45(2):260-73
references.pmid: 14982240
references.citation: Clin Psychol (New York). 2009 Jun 1;16(2):281-296
references.pmid: 19684882
references.citation: Acta Psychiatr Scand. 1987 Jun;75(6):571-6
references.pmid: 3618278
references.citation: J Affect Disord. 2005 Dec;89(1-3):57-67
references.pmid: 16213029
references.citation: J Affect Disord. 2006 Oct;95(1-3):43-9
references.pmid: 16837055
references.citation: Bipolar Disord. 2000 Jun;2(2):131-5
references.pmid: 11252652
references.citation: J Abnorm Psychol. 2000 Nov;109(4):777-86
references.pmid: 11196004
references.citation: Br J Psychiatry. 1987 Feb;150:235-40
references.pmid: 3651678
references.citation: Community Ment Health J. 2005 Feb;41(1):67-75
references.pmid: 15932053
references.citation: Nat Genet. 2008 Sep;40(9):1056-8
references.pmid: 18711365