Childhood adversity raises comorbidity risk in bipolar disorder

Jan 29 2013

By Liam Davenport, medwireNews Reporter

Childhood adversity, including verbal, physical, or sexual abuse, is associated with the later development of multiple medical comorbidities in patients with bipolar disorder, researchers report.

"The current findings of an increased burden of medical comorbidities in those subjects with bipolar disorder who have higher tCAS [total childhood adversity score] scores suggest the importance of discriminating the differential contributions of bipolar illness itself and that of a history of childhood adversity on the incidence of various medical comorbidities and their ultimate impact on functional impairment, disability, and mortality," says the team, led by Robert Post, from the Bipolar Collaborative Network in Bethesda, Maryland, USA.

The researchers add in the Journal of Affective Disorders: "Since recurrence of stressors, substances of abuse, and episodes of affective illness each have been postulated to yield sensitization effects as well as cross-sensitization to the others in part via epigenetic mechanisms, the findings further highlight the importance of early intervention and prevention."

For the study, a series of questionnaires on the occurrence of verbal, physical, or sexual abuse in childhood, the presence of parent mood or substance abuse disorder, and history of suicidality were administered to outpatients with bipolar disorder. In addition, the tCAS was completed, and data on the presence of one or more of 30 medical conditions was assessed.

Information for all parameters was available for 904 individuals. The most common medical conditions were allergies, migraine, headache, and head injury, which were found in 22.0%-37.2% of patients. Conditions with a prevalence of 12%-16% included hypertension, chronic menstrual irregularities, hypothyroidism, head injury without loss of consciousness, irritable bowel syndrome, arthritis, and asthma.

Overall, 19% of patients scored zero on the tCAS, while 47% had a score of 4 or higher. Multinomial logistic regression revealed that significant predictors for having at least four versus one to three medical conditions were higher tCAS score, US nationality, and female gender, while significant predictors for having one to three medical conditions versus no conditions were higher tCAS score, increased age, and female gender.

The results also showed that the prevalence of 16 medical conditions was significantly increased with increasing tCAS score, and included allergies, arthritis, asthma, chronic fatigue syndrome, chronic menstrual irregularities, fibromyalgia, head injury without loss of consciousness, hypertension, hypotension, irritable bowel syndrome and migraine headache.

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