Childhood maltreatment and the medical morbidity in bipolar disorder: a case\u2013control study

Georgina M Hosang,Helen L Fisher,Rudolf Uher,Barbara Maughan,Sarah Cohen-Woods,Anne E Farmer,Peter Mcguffin

doi:10.1186/s40345-017-0099-z

Abstract

BackgroundChildhood maltreatment (abuse and neglect) can have long-term deleterious consequences, including increased risk for medical and psychiatric illnesses, such as bipolar disorder in adulthood. Emerging evidence suggests that a history of childhood maltreatment is linked to the comorbidity between medical illnesses and mood disorders. However, existing studies on bipolar disorder have not yet explored the specific influence of child neglect and have not included comparisons with individuals without mood disorders (controls). This study aimed to extend the existing literature by examining the differential influence of child abuse and child neglect on medical morbidity in a sample of bipolar cases and controls.MethodsThe study included 72 participants with bipolar disorder and 354 psychiatrically healthy controls (average age of both groups was 48 years), who completed the Childhood Trauma Questionnaire, and were interviewed regarding various medical disorders.ResultsA history of any type of childhood maltreatment was significantly associated with a diagnosis of any medical illness (adjusted OR = 6.28, 95% confidence intervals 1.70–23.12, p = 0.006) and an increased number of medical illnesses (adjusted OR = 3.77, 95% confidence intervals 1.34–10.57, p = 0.012) among adults with bipolar disorder. Exposure to child abuse was more strongly associated with medical disorders than child neglect. No association between childhood maltreatment and medical morbidity was detected among controls.ConclusionsTo summarise, individuals with bipolar disorder who reported experiencing maltreatment during childhood, especially abuse, were at increased risk of suffering from medical illnesses and warrant greater clinical attention.

Highlights

Childhood maltreatment can have long-term deleterious consequences, including increased risk for medical and psychiatric illnesses, such as bipolar disorder in adulthood
To address the methodological gaps in the literature, the current study aimed to investigate the association between a history of child maltreatment and the diagnosis of medical illnesses in adulthood among people with bipolar disorder compared to unaffected controls
All participants with bipolar disorder met DSM-IV criteria for bipolar I or bipolar II disorder ascertained via the schedules for clinical assessment in neuropsychiatry interview, and were Caucasian to control for population stratification since they were originally recruited from a genetic association study

Summary

Introduction

Childhood maltreatment (abuse and neglect) can have long-term deleterious consequences, including increased risk for medical and psychiatric illnesses, such as bipolar disorder in adulthood. Various side effects are associated with psychotropic medication, such as mood stabilisers and antipsychotics which are commonly used to treat bipolar disorder, the most pertinent to this context include weight gain and insulin resistance (Newcomer 2007) Such side effects are risk factors for diabetes and cardiovascular disease (Correll et al 2015) and may explain the high rates of these illnesses in people with bipolar disorder. Low rates of surgical interventions for coronary heart disease (e.g. stenting) and screening for metabolic abnormalities associated with diabetes are recorded for people with mental illnesses including bipolar disorder (De Hert et al 2011) This is despite the fact that such illnesses are highly prevalent in this population. Preliminary research suggests that the experience of childhood maltreatment may contribute to the medical morbidity observed in bipolar disorder (Post et al 2013), but these findings await replication and extension

Objectives

Methods

Results

Conclusion