Abstract
Stressful life events, although less serious than traumatic experiences, affect the clinical course of patients with bipolar disorder. We previously found that bipolarity in patients with major depression is related to the severity of psychological distress symptoms associated with onset-related events. Here, we investigated whether, and to what extent, bipolar patients perceive stressful events as psychological distress symptoms, specifically, intrusion, avoidance, and hyperarousal. Further, we investigated the relationship between the clinical features and the severity of psychological distress symptoms associated with stressful life events, according to mood states. We recruited 79 bipolar patients (depression group, n = 32; mania, n = 22; euthymia, n = 25) in this cross-sectional study. We adopted the Impact of Event Scale-Revised (IES-R) to assess the severity of psychological distress symptoms associated with past stressful events. We also evaluated the Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). The mean (standard deviation) IES-R scores of bipolar patients with a depressive episode (38.06 [16.56], p = 0.0005) and of those with a manic/hypomanic episode (44.56 [24.14], p = 0.004) were significantly higher than of those with euthymia (19.81 [12.86]). The HDRS, but not the YMRS, scores showed significant correlations with the IES-R scores, regardless of mood episodes (depression group, r = 0.42; mania, r = 0.64; euthymia, r = 0.70). This study demonstrates that bipolar patients with a manic/hypomanic or depressive episode perceive stressful life events as more severe psychological distress symptoms than do euthymic patients. Moreover, in patients with bipolar disorder, the severity of depressive symptoms, but not of manic symptoms, is positively correlated with that of the psychological distress symptoms, regardless of their mood episodes or euthymic state. Therefore, depressive symptoms may be closely related to the psychological distress symptoms associated with stressful past events in patients with bipolar disorder.
Highlights
It is well-recognized that stressful life events affect vulnerability, onset, and relapse or recurrence of bipolar disorder [1,2,3,4]
Our previous study reported that patients with treatment-refractory or non-remitting depression suffered from psychological distress symptoms (PDSs), such as intrusion and avoidance, associated with onset-related life events, which alone did not lead to fatal outcomes, compared to PDS combined with remitted depression [8]
Even though stressful life events occur more frequently, and are less serious than traumatic experiences that meet the diagnostic criteria for posttraumatic stress disorder (PTSD), bipolar patients with a manic/hypomanic episode or a depressive episode perceived their experience of such stressful life events, including their onset-related events, as more severe PDSs than those in a euthymic state
Summary
It is well-recognized that stressful life events affect vulnerability, onset, and relapse or recurrence of bipolar disorder [1,2,3,4]. The stressful life events severely affect onset; clinical exacerbation, including relapse; and prognosis of bipolar disorder, only a few studies have investigated how the patients are distressed by them, and to what extent they experience psychological symptoms with intrusive or unpleasant memories of such events. Our previous study reported that patients with treatment-refractory or non-remitting depression suffered from psychological distress symptoms (PDSs), such as intrusion and avoidance, associated with onset-related life events, which alone did not lead to fatal outcomes, compared to PDS combined with remitted depression [8]. Given that many patients with bipolar disorder, without comorbidity of PTSD or experience of traumatic events meeting the diagnostic criteria of PTSD, experience more stressful life events than healthy people [5]; recognition of PDSs associated with such cases is important for understanding the pathophysiology of the clinical features of bipolar disorder
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