title: The role of life events and psychological factors in the onset of first and recurrent mood episodes in bipolar offspring: results from the Dutch Bipolar Offspring Study.
abstract: BACKGROUND
  Life events are an established risk factor for the onset and recurrence of unipolar and bipolar mood episodes, especially in the presence of genetic vulnerability. The dynamic interplay between life events and psychological context, however, is less studied. In this study, we investigated the impact of life events on the onset and recurrence of mood episodes in bipolar offspring, as well as the effects of temperament, coping and parenting style on this association.
  
  
  METHODS
  Bipolar offspring (n = 108) were followed longitudinally from adolescence to adulthood. Mood disorders were assessed with: the Kiddie Schedule of Affective Disorders and Schizophrenia - Present and Lifetime Version or the Structured Clinical Interview for DSM-IV Axis I disorders; life events with the Life Events and Difficulties Schedule; and psychological measures using the Utrecht Coping List, Temperament and Character Inventory and short-EMBU (memories of upbringing instrument). Anderson-Gill models (an extension of the Cox proportional hazard model) were utilized.
  
  
  RESULTS
  Life events were associated with an increased risk for first and, although less pronounced, subsequent mood episodes. There was a large confounding effect for the number of previous mood episodes; findings suggest a possible kindling effect. Passive coping style increased the risk of mood episode onset and recurrent episodes, but also altered the effect of life events on mood disorders. Harm avoidance temperament was associated with mood episode recurrence.
  
  
  CONCLUSIONS
  Life events are especially a risk factor in the onset of mood disorders, though less so in recurrent episodes. Psychological features (passive coping and harm-avoidant temperament) contribute to the risk of an episode occurring, and also have a moderating effect on the association between life events and mood episodes. These findings create potential early intervention strategies for bipolar offspring.
authors: Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht,The Netherlands.
authors: S M
authors: SM
authors: Kemner
authors: Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht,The Netherlands.
authors: E
authors: E
authors: Mesman
authors: Department of Psychiatry,University of Groningen,University Medical Center Groningen,Groningen,The Netherlands.
authors: W A
authors: WA
authors: Nolen
authors: Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,Utrecht,The Netherlands.
authors: M J C
authors: MJ
authors: Eijckemans
authors: Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht,The Netherlands.
authors: M H J
authors: MH
authors: Hillegers
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology*; D016241:Child of Impaired Parents / Q000523:psychology; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology*; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D055815:Young Adult
keywords: Bipolar disorder; bipolar offspring; coping; life events; mood disorders