Stressful life events and other associated factors in patients with bipolar disorder current episode depression – A cross-sectional study
DOI:
https://doi.org/10.30834/KJP.36.1.2023.347Keywords:
Stressful life events, bipolar disorder, depressionAbstract
Background: Bipolar disorder (BD) is a mental illness which leads to considerable difficulties and challenges. The neurobiology of BD has complex underpinnings of gene–environment interactions. One such environmental factor, stressful life events (SLEs) can have adverse impacts on the course and prognosis of BD, however, this is underexplored. Aims and objectives: 1) To estimate the frequency and severity of SLEs in patients with BD-current episode depression 2) To determine the association of severity of depression with SLE, sociodemographic and illness-related factors. Methods: This was a cross-sectional study done on 100 consecutive patients diagnosed to have BD-current episode of depression (ICD-10), attending Psychiatry department at Pushpagiri Medical College, Thiruvalla, Kerala. A semi-structured proforma, Hamilton Rating Scale for Depression, Presumptive Stressful Life Events Scale and Brief Psychiatric Rating Scale were used. Results: About 73% of patients reported SLEs – of which 65% had mild/moderate and 8% had severe stress. A statistically significant association was found between SLEs and ‘very severe’ depressive episode. Past suicide attempt, the first episode as depression and lesser duration of the last episode also showed a statistically significant association with severity of depression. Conclusion: As the stressful life experiences have been linked to 'very severe' depressive episodes in a major way, understanding the association of stressful life events and BD can help in predicting further relapses and complications like suicide. It can aid in both symptom reduction and improving quality of life as well.
References
Sagar R, Pattanayak RD. Potential biomarkers for bipolar disorder: where do we stand? Indian J Med Res 2017;145:7-16.
Ferrari AJ, Stockings E, Khoo JP, Erskine HE, Degenhardt L, Vos T, et al. The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013. Bipolar disorders. 2016;18:440-50.
Subramanian K, Sarkar S, Kattimani S. Bipolar disorder in Asia: illness course and contributing factors. Asian J Psychiatry 2017; 29:16-29.
Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W et al. Innovations and changes in the ICD?11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019;18:3-19.
Mathew BS, Thomas SP, Kallivayalil RA. Gender differences in bipolar disorder – a cross-sectional study in central Kerala. Kerala Journal of Psychiatry 2022;35(1):1-8.
Bergink V, Larsen JT, Hillegers MH, Dahl SK, Stevens H, Mortensen PB, et al. Childhood adverse life events and parental psychopathology as risk factors for bipolar disorder. Transl Psychiatry 2016;6:e929. Available from: doi: 10.1038/tp.2016.201.
Kumari A, Jahan M. Distressful life events in affective disorder. J Indian Acad Appl Psychol 2006;32:193-200.
Calabrese JR, Rapport DJ, Kimmel SE, Shelton MD. Controlled trials in bipolar I depression: focus on switch rates and efficacy. Eur Neuropsychopharmacol 1999;9 Suppl 4:S109?12.
Sato A, Hashimoto T, Kimura A, Niitsu T, Iyo M. Psychological distress symptoms associated with life events in patients with bipolar disorder: a cross-sectional study. Front Psychiatry 2018;9:200. Available from: doi: 10.3389/fpsyt.2018.00200.
Biddala OS, Kumar RS, Mohan PK, Bhavaraju S. Impact of stressful life events in mood disorders. Arch Ment Health 2020;21:43-9.
Aldinger F, Schulze TG. Environmental factors, life events, and trauma in the course of bipolar disorder. Psychiatry Clin Neurosci 2017;71:6-17.
Johnson SL, Miller I. Negative life events and time to recovery from episodes of bipolar disorder. J Abnorm Psychol 1997 ;106:449-57.
Glassner B, Haldipur CV, Dessauersmith J. Role loss and working-class manic depression. J Nerv Ment Dis 1979;167:530-41.
Miklowitz DJ, Goldstein MJ, Nuechterlein KH, Snyder KS, Mintz J. Family factors and the course of bipolar affective disorder. Arch Gen Psychiatry 1988;45:225-31.
Gershon A, Johnson SL, Miller I. Chronic stressors and trauma: prospective influences on the course of bipolar disorder. Psychol Med 2013;43:2583-92.
Christensen EM, Gjerris A, Larsen JK, Bendtsen BB, Larsen BH, Rolff H et al. Life events and onset of a new phase in bipolar affective disorder. Bipolar Disord 2003;5:356-61.
Yan-Meier L, Eberhart NK, Hammen CL, Gitlin M, Sokolski K, Altshuler L. Stressful life events predict delayed functional recovery following treatment for mania in bipolar disorder. Psychiatry Res 2011;186:267-71.
Hall KS, Dunner DL, Zeller G, Fieve RR. Bipolar illness: A prospective study of life events. Compr Psychiatry 1977;18:497-502.
Sclare P, Creed F. Life events and the onset of mania. Br J Psychiatry 1990;156:508-14.
Simhandl C, Radua J, König B, Amann BL. The prevalence and effect of life events in 222 bipolar I and II patients: a prospective, naturalistic 4 year follow-up study. J Affect Disord 2015;170:166-71.
Olden M, Rosenfeld B, Pessin H, Breitbart W. Measuring Depression at the End of Life: Is the Hamilton Depression Rating Scale a valid instrument? Assessment 2009;16:43–54.
Mannapur B, Dorle AS, Hiremath LD, Ghattargi CH, Ramadurg U, Kulkarni KR. A study of psychological stress in undergraduate medical students at SN Medical College, Bagalkot, Karnataka. Journal of Clinical and Diagnostic Research 2010;4:2869-74.
World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization; 1992. Available from: https://apps.who.int/iris/handle/10665/37958.
Tsuchiya KJ, Byrne M and Mortensen PB. Risk factors in relation to an emergence of bipolar disorder: a systematic review. Bipolar Disord 2003;5:231–42.
Pradip MA, Beevi KS, Kuttichira P, Antony JT. Cognitive impairment in euthymia - A comparative study of clinical and treatment variables between bipolar affective disorder patients and normal controls at a tertiary care centre in Kerala. Ann Indian Psychiatry 2019;3:32-8.
Bhagat RB. Emerging pattern of urbanisation in India. Economic & Political Weekly 2011;46:10-12. Available from:http://www.jstor.org/stable/23017782.
Sam SP, Nisha A, Varghese PJ. Stressful life events and relapse in bipolar affective disorder: a cross-sectional study from a tertiary care center of Southern India. Indian J Psychol Med 2019;41:61-7.
Koenders MA, Giltay EJ, Spijker AT, Hoencamp E, Spinhoven P, Elzinga BM. Stressful life events in bipolar I and II disorder: cause or consequence of mood symptoms? J Affect Disord 2014;161:55-64.
Johnson SL. Life events in bipolar disorder: Towards more specific models. Clin Psychol Rev 2005;25:1008–27.
Kenneson A, Funderburk JS and Maisto SA. Substance use disorders increase the odds of subsequent mood disorders. Drug Alcohol Depend 2013;133:338–43.
Faedda GL, Serra G, Marangoni C, Salvatore P, Sani G, Vázquez GH, et al. Clinical risk factors for bipolar disorders: a systematic review of prospective studies. J Affect Disord 2014;168:314-21.
Forty L, Ulanova A, Jones L, Gordon-Smith K, Fraser C, et al. Comorbid medical illness in bipolar disorder. Br J Psychiatry 2014;205:465-72.
Lex C, Bazner E and Meyer TD. Does stress play a significant role in bipolar disorder? A meta-analysis. J Affect Disord 2017;208:298–308.
Renn BN, Areán PA. Psychosocial treatment options for major depressive disorder in older adults. Curr Treat Options Psychiatry. 2017;4:1–12. Available from: doi: 10.1007/s40501-017-0100-6.
Low NC, Dugas E, O’Loughlin E, Rodriguez D, Contreras G, Chaiton M, et al. Common stressful life events and difficulties are associated with mental health symptoms and substance use in young adolescents. BMC Psychiatry 2012;12:116. Available from: https://doi.org/10.1186/1471-244X-12-116.
Kallivayalil RA, Enara A. Mental health in an unequal world - the role of social determinants. Indian J Soc Psychiatry 2022;38:3-6.
Kallivayalil RA, Enara A. Prioritizing rural and community mental health in India. Indian J Soc Psychiatry 2018;34:285-8
Sagar R, Pattanayak RD. Potential biomarkers for bipolar disorder: where do we stand? Indian J Med Res 2017;145:7-16.
Ferrari AJ, Stockings E, Khoo JP, Erskine HE, Degenhardt L, Vos T, et al. The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013. Bipolar disorders. 2016;18:440-50.
Subramanian K, Sarkar S, Kattimani S. Bipolar disorder in Asia: illness course and contributing factors. Asian J Psychiatry 2017; 29:16-29.
Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W et al. Innovations and changes in the ICD?11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019;18:3-19.
Mathew BS, Thomas SP, Kallivayalil RA. Gender differences in bipolar disorder – a cross-sectional study in central Kerala. Kerala Journal of Psychiatry 2022;35(1):1-8.
Bergink V, Larsen JT, Hillegers MH, Dahl SK, Stevens H, Mortensen PB, et al. Childhood adverse life events and parental psychopathology as risk factors for bipolar disorder. Transl Psychiatry 2016;6:e929. Available from: doi: 10.1038/tp.2016.201.
Kumari A, Jahan M. Distressful life events in affective disorder. J Indian Acad Appl Psychol 2006;32:193-200.
Calabrese JR, Rapport DJ, Kimmel SE, Shelton MD. Controlled trials in bipolar I depression: focus on switch rates and efficacy. Eur Neuropsychopharmacol 1999;9 Suppl 4:S109?12.
Sato A, Hashimoto T, Kimura A, Niitsu T, Iyo M. Psychological distress symptoms associated with life events in patients with bipolar disorder: a cross-sectional study. Front Psychiatry 2018;9:200. Available from: doi: 10.3389/fpsyt.2018.00200.
Biddala OS, Kumar RS, Mohan PK, Bhavaraju S. Impact of stressful life events in mood disorders. Arch Ment Health 2020;21:43-9.
Aldinger F, Schulze TG. Environmental factors, life events, and trauma in the course of bipolar disorder. Psychiatry Clin Neurosci 2017;71:6-17.
Johnson SL, Miller I. Negative life events and time to recovery from episodes of bipolar disorder. J Abnorm Psychol 1997 ;106:449-57.
Glassner B, Haldipur CV, Dessauersmith J. Role loss and working-class manic depression. J Nerv Ment Dis 1979;167:530-41.
Miklowitz DJ, Goldstein MJ, Nuechterlein KH, Snyder KS, Mintz J. Family factors and the course of bipolar affective disorder. Arch Gen Psychiatry 1988;45:225-31.
Gershon A, Johnson SL, Miller I. Chronic stressors and trauma: prospective influences on the course of bipolar disorder. Psychol Med 2013;43:2583-92.
Christensen EM, Gjerris A, Larsen JK, Bendtsen BB, Larsen BH, Rolff H et al. Life events and onset of a new phase in bipolar affective disorder. Bipolar Disord 2003;5:356-61.
Yan-Meier L, Eberhart NK, Hammen CL, Gitlin M, Sokolski K, Altshuler L. Stressful life events predict delayed functional recovery following treatment for mania in bipolar disorder. Psychiatry Res 2011;186:267-71.
Hall KS, Dunner DL, Zeller G, Fieve RR. Bipolar illness: A prospective study of life events. Compr Psychiatry 1977;18:497-502.
Sclare P, Creed F. Life events and the onset of mania. Br J Psychiatry 1990;156:508-14.
Simhandl C, Radua J, König B, Amann BL. The prevalence and effect of life events in 222 bipolar I and II patients: a prospective, naturalistic 4 year follow-up study. J Affect Disord 2015;170:166-71.
Olden M, Rosenfeld B, Pessin H, Breitbart W. Measuring Depression at the End of Life: Is the Hamilton Depression Rating Scale a valid instrument? Assessment 2009;16:43–54.
Mannapur B, Dorle AS, Hiremath LD, Ghattargi CH, Ramadurg U, Kulkarni KR. A study of psychological stress in undergraduate medical students at SN Medical College, Bagalkot, Karnataka. Journal of Clinical and Diagnostic Research 2010;4:2869-74.
World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization; 1992. Available from: https://apps.who.int/iris/handle/10665/37958.
Tsuchiya KJ, Byrne M and Mortensen PB. Risk factors in relation to an emergence of bipolar disorder: a systematic review. Bipolar Disord 2003;5:231–42.
Pradip MA, Beevi KS, Kuttichira P, Antony JT. Cognitive impairment in euthymia-A comparative study of clinical and treatment variables between bipolar affective disorder patients and normal controls at a tertiary care centre in Kerala. Ann Indian Psychiatry 2019;3:32-8.
Bhagat RB. Emerging pattern of urbanisation in India. Economic & Political Weekly 2011;46:10-12. Available from:http://www.jstor.org/stable/23017782.
Sam SP, Nisha A, Varghese PJ. Stressful life events and relapse in bipolar affective disorder: a cross-sectional study from a tertiary care center of Southern India. Indian J Psychol Med 2019;41:61-7.
Koenders MA, Giltay EJ, Spijker AT, Hoencamp E, Spinhoven P, Elzinga BM. Stressful life events in bipolar I and II disorder: cause or consequence of mood symptoms? J Affect Disord 2014;161:55-64.
Johnson SL. Life events in bipolar disorder: Towards more specific models. Clin Psychol Rev 2005;25:1008–27.
Kenneson A, Funderburk JS and Maisto SA. Substance use disorders increase the odds of subsequent mood disorders. Drug Alcohol Depend 2013;133:338–43.
Faedda GL, Serra G, Marangoni C, Salvatore P, Sani G, Vázquez GH, et al. Clinical risk factors for bipolar disorders: a systematic review of prospective studies. J Affect Disord 2014;168:314-21.
Forty L, Ulanova A, Jones L, Gordon-Smith K, Fraser C, et al. Comorbid medical illness in bipolar disorder. Br J Psychiatry 2014;205:465-72.
Lex C, Bazner E and Meyer TD. Does stress play a significant role in bipolar disorder? A meta-analysis. J Affect Disord 2017;208:298–308.
Renn BN, Areán PA. Psychosocial treatment options for major depressive disorder in older adults. Curr Treat Options Psychiatry. 2017;4:1–12. Available from: doi: 10.1007/s40501-017-0100-6.
Low NC, Dugas E, O’Loughlin E, Rodriguez D, Contreras G, Chaiton M, et al. Common stressful life events and difficulties are associated with mental health symptoms and substance use in young adolescents. BMC Psychiatry 2012;12:116. Available from: https://doi.org/10.1186/1471-244X-12-116.
Kallivayalil RA, Enara A. Mental health in an unequal world - the role of social determinants. Indian J Soc Psychiatry 2022;38:3-6.
Kallivayalil RA, Enara A. Prioritizing rural and community mental health in India. Indian J Soc Psychiatry 2018;34:285-8
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