title: Childhood maltreatment and the course of bipolar disorders among adults: epidemiologic evidence of dose-response effects.
abstract: BACKGROUND
  Childhood maltreatment (CM) is highly prevalent among individuals with bipolar disorders (BP); however few studies have examined its potential role in the course and outcome of individuals with BP. We aim to examine the dose response relationship between the number of types of CM and the course of individuals with BP.
  
  
  METHODS
  As part of the National Epidemiologic Survey on Alcohol and Related Conditions, 1600 adults who met lifetime DSM-IV criteria for BP-I (n=1172) and BP-II (n=428) were included. Individuals were evaluated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DMS-IV Version and data was analyzed lifetime and from Waves 1 and 2, approximately 3 years apart.
  
  
  RESULTS
  Around half of individuals with BP had a history of at least one type of CM. Overall, there was a clear dose-response relationship between number of CM and severity of BP across several domains, including clinical characteristics, probability of treatment, lifetime prevalence of psychiatric comorbidity, incidence of anxiety disorders, substance use disorder, and nicotine dependence, and level of psychosocial functioning.
  
  
  CONCLUSIONS
  The interviews were conducted by lay professional interviewers rather than clinicians, use of retrospective report to determine CM in individuals with BP, and not all respondents from Wave 1 were able to be interviewed in Wave 2.
  
  
  CONCLUSIONS
  The number of types of CM confers developmental differences in the course of BP with a worse course and outcome of BP. Early identification and treatment of CM are warranted to improve the course and outcome of individuals with BP.
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King׳s College London, London, UK. Electronic address: regina.sala_cassola@kcl.ac.uk.
authors.forename: Regina
authors.initials: R
authors.lastname: Sala
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA.
authors.forename: Shuai
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies
keywords: Bipolar disorder; Childhood maltreatment; Course; Dose-response; Epidemiology