title: Affective instability, childhood trauma and major affective disorders.
abstract: BACKGROUND
  Affective instability (AI), childhood trauma, and mental illness are linked, but evidence in affective disorders is limited, despite both AI and childhood trauma being associated with poorer outcomes. Aims were to compare AI levels in bipolar disorder I (BPI) and II (BPII), and major depressive disorder recurrent (MDDR), and to examine the association of AI and childhood trauma within each diagnostic group.
  
  
  METHODS
  AI, measured using the Affective Lability Scale (ALS), was compared between people with DSM-IV BPI (n=923), BPII (n=363) and MDDR (n=207) accounting for confounders and current mood. Regression modelling was used to examine the association between AI and childhood traumas in each diagnostic group.
  
  
  RESULTS
  ALS scores in descending order were BPII, BPI, MDDR, and differences between groups were significant (p<0.05). Within the BPI group any childhood abuse (p=0.021), childhood physical abuse (p=0.003) and the death of a close friend in childhood (p=0.002) were significantly associated with higher ALS score but no association was found between childhood trauma and AI in BPII and MDDR.
  
  
  CONCLUSIONS
  The ALS is a self-report scale and is subject to retrospective recall bias.
  
  
  CONCLUSIONS
  AI is an important dimension in bipolar disorder independent of current mood state. There is a strong link between childhood traumatic events and AI levels in BPI and this may be one way in which exposure and disorder are linked. Clinical interventions targeting AI in people who have suffered significant childhood trauma could potentially change the clinical course of bipolar disorder.
authors.affiliation: Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick Coventry, CV4 7AL UK; Affective Disorders Service (IPU 3-8), Caludon Centre, Coventry CV2 2TE, UK.
authors.forename: S
authors.initials: S
authors.lastname: Marwaha
authors.affiliation: Department of Psychological Medicine, University of Worcester, WR2 6AJ UK.
authors.forename: K
authors.initials: K
authors.lastname: Gordon-Smith
authors.affiliation: Department of Psychiatry, University of Oxford, OX3 4JX UK.
authors.forename: M
authors.initials: M
authors.lastname: Broome
authors.affiliation: School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Briley
authors.affiliation: Department of Psychological Medicine, University of Worcester, WR2 6AJ UK.
authors.forename: A
authors.initials: A
authors.lastname: Perry
authors.affiliation: Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, CF24 4HQ UK.
authors.forename: L
authors.initials: L
authors.lastname: Forty
authors.affiliation: Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, CF24 4HQ UK.
authors.forename: N
authors.initials: N
authors.lastname: Craddock
authors.affiliation: Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, CF24 4HQ UK.
authors.forename: I
authors.initials: I
authors.lastname: Jones
authors.affiliation: Department of Psychological Medicine, University of Worcester, WR2 6AJ UK. Electronic address: lisa.jones@worc.ac.uk.
authors.forename: L
authors.initials: L
authors.lastname: Jones
mesh_terms: D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology* / Q000706:statistics & numerical data; D000339:Affect; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D057566:Self Report
keywords: Affective instability; Affective symptoms; Bipolar disorder; Depressive disorder; Mood disorders; Stressful events