Abstract Background Comorbid anxiety disorders and a history of childhood maltreatment are important determinants of outcome in bipolar disorder, but the relationship between these two factors is ...unclear. Methods In 174 outpatients with bipolar disorder, we assessed history of childhood maltreatment with the Childhood Trauma Questionnaire (CTQ) and lifetime diagnosis of anxiety disorders with the M.I.N.I. International Neuropsychiatric Interview. We used ordinary logistic regressions to test associations between childhood maltreatment and the number of comorbid anxiety disorders, controlling for age, sex and the type of bipolar disorder. Results Ninety (51.7%) participants had no anxiety disorder, 50 (28.7%) had one anxiety disorder and 34 (19.5%) had two or more anxiety disorders. Childhood maltreatment, indexed by a higher CTQ total score, was associated with more lifetime anxiety disorders (OR=1.5; 95% CI=1.01 to 2.14; p =0.04). Of the CTQ subscales, emotional abuse (OR=1.68; 95% CI=1.13 to 2.49; p =0.01) and physical abuse (OR=1.43; 95% CI=1.02 to 2.01; p =0.04) were associated with anxiety disorders. Of the anxiety disorders, panic disorder was most strongly associated with childhood maltreatment (OR=2.27; 95% CI=1.28 to 4.02; p =0.01). Limitations The study is limited by a moderate sample size and the retrospective assessment of childhood maltreatment. Conclusions Exposure to maltreatment in childhood is associated with comorbid anxiety disorders among individuals living with bipolar disorder. Bipolar disorder with comorbid anxiety may constitute a separate aetiological type with a greater contribution of early environment.
Poor sleep in children predicts mental and physical disorders later in life. Identifying and changing modifiable factors associated with sleep problems in young children may improve their health ...trajectory. Our aim was to establish whether overprotective parenting was associated with problems sleeping in children. Parents of children aged 2–6 years completed questionnaires about their own anxiety, parenting style, and about their children's sleep. We obtained 307 reports on 197 children from 240 parents. Using mixed-effects linear regression, we found that maternal (beta = 0.26, 95% CI 0.11 to 0.41, p = 0.001) and paternal (beta = 0.35, 95% CI 0.17 to 0.53, p < 0.001) overprotection were associated with impaired sleep in children. This relationship remained unchanged when controlling for parental anxiety. Decreasing parents’ overprotection may improve children’s sleep, and reduce the risk of physical and mental disorders later in their life.
Attention-deficit hyperactivity disorder (ADHD) and anxiety disorders have been proposed as precursors of bipolar disorder, but their joint and relative roles in the development of bipolar disorder ...are unknown.AimsTo test the prospective relationship of ADHD and anxiety with onset of bipolar disorder.
We examined the relationship between ADHD, anxiety disorders and bipolar disorder in a birth cohort of 2 409 236 individuals born in Denmark between 1955 and 1991. Individuals were followed from their sixteenth birthday or from January 1995 to their first clinical contact for bipolar disorder or until December 2012. We calculated incidence rates per 10 000 person-years and tested the effects of prior diagnoses on the risk of bipolar disorder in survival models.
Over 37 394 865 person-years follow-up, 9250 onsets of bipolar disorder occurred. The incidence rate of bipolar disorder was 2.17 (95% CI 2.12-2.19) in individuals with no prior diagnosis of ADHD or anxiety, 23.86 (95% CI 19.98-27.75) in individuals with a prior diagnosis of ADHD only, 26.05 (95% CI 24.47-27.62) in individuals with a prior diagnosis of anxiety only and 66.16 (95% CI 44.83-87.47) in those with prior diagnoses of both ADHD and anxiety. The combination of ADHD and anxiety increased the risk of bipolar disorder 30-fold (95% CI 21.66-41.40) compared with those with no prior ADHD or anxiety.
Early manifestations of both internalising and externalising psychopathology indicate liability to bipolar disorder. The combination of ADHD and anxiety is associated with a very high risk of bipolar disorder.Declaration of interestNone.
The long-term outcomes of bipolar disorder range from lasting remission to chronic course or frequent recurrences requiring admissions. The distinction between bipolar I and II disorders has limited ...utility in outcome prediction. It is unclear to what extent the clinical course of bipolar disorder predicts long-term outcomes.
A representative sample of 191 individuals diagnosed with bipolar I or II disorder was recruited and followed for up to 5 years using a life-chart method. We previously described the clinical course over the first 18 months with dimensional course characteristics and latent classes. Now we test if these course characteristics predict long-term outcomes, including time ill (time with any mood symptoms) and hospital admissions over a second non-overlapping follow-up period in 111 individuals with available data from both 18 months and 5 years follow-ups.
Dimensional course characteristics from the first 18 months prospectively predicted outcomes over the following 3.5 years. The proportion of time depressed, the severity of depressive symptoms and the proportion of time manic predicted more time ill. The proportion of time manic, the severity of manic symptoms and depression-to-mania switching predicted a greater likelihood of hospital admissions. All predictions remained significant after controlling for age, sex and bipolar I v. II disorder.
Differential associations with long-term outcomes suggest that course characteristics may facilitate care planning with greater predictive validity than established types of bipolar disorders. A clinical course dominated by depressive symptoms predicts a greater proportion of time ill. A clinical course characterized by manic episodes predicts hospital admissions.
Cross-sectional studies report high levels of depressive symptoms during the COVID-19 pandemic, especially in youth and females. However, longitudinal research comparing depressive symptoms before ...and during the pandemic is lacking. Little is known about how the pandemic affected individuals with familial history of mental illness. The present study examines the impact of the pandemic on youth depressive symptoms, including offspring of parents with major mood and psychotic disorders.
Between March 2018 and February 2020, we measured depressive symptoms in 412 youth aged 5-25 years. We measured depressive symptoms again in 371 (90%) of these youth between April 2020 and May 2022. Two thirds (249) participants had a biological parent with a major mood or psychotic disorder. We tested the effect of the pandemic by comparing depression symptoms before and after March 2020. We examined age, sex, and family history as potential moderators.
We found an overall small increase in youth depressive symptoms (
= 0.07, 95% CI -0.01 to 0.15,
= 0.062). This was driven by an increase in female youth without familial history of mental illness (
= 0.35, 95% CI 0.14 to 0.56,
= 0.001). There was no change in depressive symptoms among offspring of parents with mental illness or males.
Our results provide reassurance about the wellbeing of children of parents with mental illness during a period of restricted access to resources outside the family. Rather than increasing symptoms in established risk groups, the pandemic led to a redistribution of depression burden towards segments of the youth population that were previously considered to be low-risk.
Comorbid anxiety disorders and childhood maltreatment have each been linked with unfavourable outcomes in people with bipolar disorder. Because childhood maltreatment is associated with anxiety ...disorders in this population, their respective predictive value remains to be determined.
In 174 adults with bipolar disorder, we assessed childhood maltreatment using the Childhood Trauma Questionnaire and lifetime anxiety disorders with the MINI International Neuropsychiatric Interview. We constructed an overall index of severity of bipolar disorder as a sum of six indicators (unemployment, psychotic symptoms, more than five manic episodes, more than five depressive episodes, suicide attempt, and hospital admission). We tested the relationship between childhood maltreatment, the number of anxiety disorders and the overall severity index using ordered logistic regression.
The number of lifetime anxiety disorders was associated with the overall severity index (OR = 1.43, 95%CI = 1.01–2.04, p = 0.047). This relationship was only slightly attenuated when controlled for childhood maltreatment (OR = 1.39, 95%CI = 0.97–2.00, p = 0.069). The relationship between childhood maltreatment and the overall severity index was not statistically significant (OR = 1.26, 95%CI = 0.92–1.74, p = 0.151). Secondary analyses revealed that childhood maltreatment was associated with suicide attempts (OR = 1.70, 95%CI = 1.15–2.51, p = 0.008) and obsessive compulsive disorder was associated with the overall severity index (OR = 9.56, 95%CI = 2.20–41.47, p = 0.003).
This was a cross-sectional study with a moderate-sized sample recruited from a specialist program.
While comorbid anxiety disorders are associated with the overall severity of bipolar disorder, childhood maltreatment is specifically associated with suicide attempts. Clinicians should systematically assess both factors. Interventions to improve outcomes of people with bipolar disorder with comorbid anxiety disorders and history of childhood maltreatment are needed.
•Anxiety disorders are associated with unfavourable outcome in bipolar disorder.•Obsessive compulsive disorder is most strongly associated with adverse outcome.•Childhood maltreatment is specifically associated with suicide attempts.
Cognitive impairment is a feature of severe mental illness (SMI; schizophrenia, bipolar disorder, major depressive disorder). Psychotic forms of SMI may be associated with greater cognitive ...impairment, but it is unclear if this differential impairment pre-dates illness onset or whether it reflects a consequence of the disorder. To establish if there is a developmental impairment related to familial risk of psychotic SMI, we investigated cognition in offspring of parents with psychotic and non-psychotic SMI.
Participants included 360 children and youth (mean age 11.10, SD 4.03, range 6–24), including 68 offspring of parents with psychotic SMI, 193 offspring of parents with non-psychotic SMI, and 99 offspring of control parents. The cognitive battery assessed a range of functions using standardized tests and executive function tasks from the Cambridge Automated Neuropsychological Test Battery.
Compared to controls, offspring of parents with psychotic SMI performed worse on overall cognition (β = −0.32; p < 0.001) and 6 of 15 cognitive domains, including verbal intelligence, verbal working memory, processing speed, verbal learning and memory, verbal fluency, and sustained attention. Offspring of parents with non-psychotic SMI performed worse than controls on 3 of the 15 domain specific cognitive tests, including verbal intelligence, visual memory and decision-making.
Widespread mild-to-moderate cognitive impairments are present in young offspring at familial risk for transdiagnostic psychotic SMI. Offspring at familial risk for non-psychotic SMI showed fewer and more specific impairments in the domains of verbal intelligence, visual memory and decision-making.
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