Effect of the Type and Number of Adverse Childhood Experiences and the Timing of Adverse Experiences on Clinical Outcomes in Individuals with Bipolar Disorder.

Young-Min Park,Tatyana Shekhtman,John R Kelsoe

doi:10.3390/brainsci10050254

Abstract

Studies have reported an association between adverse childhood experiences (ACEs) and the clinical outcomes of bipolar disorder (BD). However, these studies have several limitations; therefore, we aimed to clarify the effect of the type and number of ACEs and the timing of adverse experiences on clinical outcomes in patients with BD. We analyzed the data of patients with BD (N = 2675) obtained from the National Institute of Mental Health: Bipolar Disorder Genetic Association Information Network, Translational Genomic Institute-I, and Translational Genomic Institute-II. All patients had been diagnosed using the Diagnostic Interview for Genetic Studies. ACEs were evaluated using the Childhood Life Events Scale (CLES). We analyzed the relationship between childhood trauma and clinical outcome in patients with and without exposure to ACEs. We found that ACEs had a robust negative effect on clinical outcomes, including earlier age at onset, presence of psychotic episodes, suicide attempts, mixed symptoms or episodes, substance misuse comorbidity, and worse life functioning. Specifically, the number of ACEs had the most significant effect on clinical outcomes; however, specific ACEs, such as physical abuse, had a considerable influence. Moreover, post-childhood adverse experiences had a weaker effect on clinical outcomes than ACEs did. There was an association of ACEs with negative clinical outcomes in patients with BD. This indicates the importance of basic and clinical research on ACEs in patients with BD.

Highlights

Adverse childhood experiences (ACEs) are potentially traumatic events that can have negative, lasting effects on health and well-being [1]
We aimed to clarify the relationship between ACEs and the clinical outcomes of bipolar disorder (BD)
We analyzed the effects of various ACE factors, including the number, type, and timing, on the clinical outcomes of BD

Summary

Introduction

Adverse childhood experiences (ACEs) are potentially traumatic events that can have negative, lasting effects on health and well-being [1]. There is evidence indicating ACEs as a risk for the development of BD and of worse outcomes for bipolar disorder (BD) [2]. A study conducted two decades ago reported a higher number of ACEs in patients with BD than in normal controls [3]. Adverse experiences, including childhood abuse and neglect, have been reported in more than half of the patients with BD [4]. There is a reported association between ACEs and the clinical outcomes of BD, including early age at onset (AAO), psychotic features, rapid cycling, a higher mood episode number, and suicidality [4,5,6,7]

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