title: Age of onset of bipolar disorder: Combined effect of childhood adversity and familial loading of psychiatric disorders.
abstract: Family history and adversity in childhood are two replicated risk factors for early onset bipolar disorder. However, their combined impact has not been adequately studied.
  
  
  
  Based on questionnaire data from 968 outpatients with bipolar disorder who gave informed consent, the relationship and interaction of: 1) parental and grandparental total burden of psychiatric illness; and 2) the degree of adversity the patient experienced in childhood on their age of onset of bipolar disorder was examined with multiple regression and illustrated with a heat map.
  
  
  
  The familial loading and child adversity vulnerability factors were significantly related to age of onset of bipolar and their combined effect was even larger. A heat map showed that at the extremes (none of each factor vs high amounts of both) the average age of onset differed by almost 20 years (mean = 25.8 vs 5.9 years of age).
  
  
  
  The data were not based on interviews of family members and came from unverified answers on a patient questionnaire.
  
  
  
  Family loading for psychiatric illness and adversity in childhood combine to have a very large influence on age of onset of bipolar disorder. These variables should be considered in assessment of risk for illness onset in different populations, the need for early intervention, and in the design of studies of primary and secondary prevention.
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington D.C., USA. Electronic address: Robert.post@speakeasy.net.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Post
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA.
authors.forename: Lori L
authors.initials: LL
authors.lastname: Altshuler
authors.affiliation: Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Kupka
authors.affiliation: Lindner Center of HOPE, Mason, OH, USA; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.affiliation: Department of Psychiatry, Mayo Clinic, Rochester, MI, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rowe
authors.affiliation: Paracelsus Medical University, Salzburg, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; V.A. Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Trisha
authors.initials: T
authors.lastname: Suppes
authors.affiliation: Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Lindner Center of HOPE, Mason, OH, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Keck
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, USA.
authors.forename: Gabriele S
authors.initials: GS
authors.lastname: Leverich
authors.affiliation: University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D000328:Adult; D017668:Age of Onset; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000235:genetics / Q000523:psychology; D010045:Outpatients; D010290:Parents / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D011795:Surveys and Questionnaires
keywords: Age of onset of bipolar disorder; Childhood abuse; Depression; Family history; Heat map; Substance abuse