Dysfunctional family environment in affected versus unaffected offspring of parents with bipolar disorder

Ferreira, Guilherme S.; Moreira, Carolina; Kleinman, Ana; Nader, Edmir C G P; Gomes, Bernardo Carramão; Teixeira, Ana Maria Aristimunho; Rocca, Cristiana Castanho A.; Nicoletti, Mark; Soares, Jair C.; Busatto, Geraldo F.; Lafer, Beny; Caetano, Sheila C.

doi:10.1177/0004867413506754

Cited by 37 publications

(25 citation statements)

References 33 publications

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“…Greater exposure to independent life events in OBD indicates that they were more likely to be exposed to stressors in which they did not have a direct role. This finding is in agreement with previous studies indicating greater conferred risk in adolescents with a parent with BD and with less family cohesion, 31–33 and may indicate need for early intervention to assist parents with BD in reducing environmental stressors for their offspring. The relationship between greater frequency of independent stressful life events and proband comorbid SUD for OBD is also worth noting.…”

Section: Discussionsupporting

confidence: 93%

“…Impaired family function and lower cohesion negatively impact outcome in youth BD, in particular. 33,38 Previous studies also have indicated greater risk for mood disorder in offspring exposed to parental BD, and a role for intervention in families with a bipolar parent. 39 In particular, comorbid SUD in BD probands was associated with a greater number of independent stressful life events for offspring.…”

Section: Discussionmentioning

confidence: 99%

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The Relationship Between Stressful Life Events and Axis I Diagnoses Among Adolescent Offspring of Probands With Bipolar and Non-Bipolar Psychiatric Disorders and Healthy Controls

Pan¹,

Goldstein²,

Rooks³

et al. 2017

J. Clin. Psychiatry

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Background Previous studies have explored the role of stressful life events in the development of mood disorders. We examined the frequency and nature of stressful life events as measured by the Stressful Life Events Scale(SLES) among three groups of adolescent offspring of probands: with bipolar(BD), with non-BD psychiatric disorders, and healthy control(HC). Furthermore, we examined the relationship between stressful life events and presence of DSM-IV Axis I disorders in these offspring. Stressful life events were characterized as dependent, independent, or uncertain (neither dependent or independent), and positive, negative, and neutral (neither positive or negative). Method Offspring of probands with BD aged 13–18 years(N=269), demographically-matched offspring of probands with non-BD Axis I disorders(N=88), and HC probands(N=81) from the Pittsburgh Bipolar Offspring Study were assessed from 2002–2007 with standardized instruments at intake. Probands completed the SLES for their offspring for life events within the prior year. Life events were evaluated with regard to current offspring Axis I diagnoses after adjusting for confounds. Results After adjusting for demographic and clinical between-group differences(in probands and offspring), offspring of BD probands had greater independent and neutral life events compared with HC offspring and greater number of more severe stressful life events than HC offspring, but not non-BD offspring. Offspring of BD probands with comorbid substance use disorder reported more independent stressful life events. Greater frequency and severity of stressful life events were associated with current Axis I disorder in offspring of both BD and non-BD affected probands regardless of dependency or valence. Greater frequency and severity of stressful life events were associated with greater current Axis I disorder in all offspring. Conclusions Offspring of BD probands have greater exposure to independent and neutral life events than HC offspring. Greater frequency and severity of stressful life events was associated with Axis I disorder in offspring of both BD and non-BD affected probands.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

The Relationship Between Stressful Life Events and Axis I Diagnoses Among Adolescent Offspring of Probands With Bipolar and Non-Bipolar Psychiatric Disorders and Healthy Controls

Pan¹,

Goldstein²,

Rooks³

et al. 2017

J. Clin. Psychiatry

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“…Families of children at risk and who actually have BPSD show dysfunctional interactions, including high levels of: conflict (Barron et al, 2014; Belardinelli et al, 2008; Chang, Blasey, Ketter, & Steiner, 2001; Ferreira et al, 2013; Nader et al, 2013); control (Ferreira et al, 2013; Nader et al, 2013); aggression (Keenan-Miller et al, 2012); quarreling (Schenkel, West, Harral, Patel, & Pavuluri, 2008); forceful punishment (Schenkel et al, 2008); parental tension (Nader et al, 2013); and negative expressed emotion (Nader et al, 2013). These families also demonstrate low levels of: warmth, affection, and intimacy (Schenkel et al, 2008); cohesion (Belardinelli et al, 2008; Chang et al, 2001; Ferreira et al, 2013; Nader et al, 2013); expressiveness (Barron et al, 2014; Belardinelli et al, 2008); organization (Barron et al, 2014; Belardinelli et al, 2008; Chang et al, 2001; Ferreira et al, 2013; Nader et al, 2013); intellectual-cultural orientation (Barron et al, 2014; Belardinelli et al, 2008; Ferreira et al, 2013); active-recreational orientation (Barron et al, 2014; Belardinelli et al, 2008; Ferreira et al, 2013); moral-religious emphasis (Ferreira et al, 2013); and positive expressed emotion (Nader et al, 2013). In addition, worse longitudinal course of BPSD is predicted by impaired family characteristics, such as: low maternal warmth (Geller et al, 2008); chronic stress in family, romantic, and peer relationships (Kim, Miklowitz, Biuckians, & Mullen, 2007; Siegel et al, 2015); frequency and severity of independent family stressful life events (Kim et al, 2007); low levels of cohesion and adaptability (Sullivan, Judd, Axelson, & Miklowitz, 2012); and high levels of conflict (Sullivan et al, 2012).…”

Section: Families Of Children With Bpsdmentioning

confidence: 99%

Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders

Algorta

MacPherson

Youngstrom

et al. 2017

Journal of Clinical Child & Adolescent Psychology

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Objective Caregivers of psychiatrically impaired children experience considerable parenting stress. However, no research has evaluated parenting stress within the context of pediatric bipolar spectrum disorders (BPSD). Thus, the aim of this investigation was to identify predictors and moderators of stress among caregivers in the Longitudinal Assessment of Manic Symptoms (LAMS) study. Method Participants included 640 children and their caregivers in the LAMS cohort. Children had a mean age of 9.4±1.9 years (68% male, 23% BPSD); parents had a mean age of 36.5±8.3 years (84% mothers). Results Children with BPSD had more service utilization, psychiatric diagnoses, mood and anxiety symptoms, and functional impairment, but fewer disruptive behavior disorders. Caregivers of children with BPSD were more likely than caregivers of children without BPSD to have a partner, elevated depressive symptoms, antisocial tendencies, and parenting stress (Cohen’s d=.49). For the whole sample, higher child IQ, mania, anxiety, disruptive behavior, and caregiver depression predicted increased parenting stress; maternal conduct disorder predicted lower stress. Child anxiety and disruptive behavior were associated with elevated caregiver stress only for non-BPSD children. Conclusions Caregivers of children with BPSD experience significant burden and thus require specialized, family-focused interventions. As stress was also elevated, to a lesser degree, among depressed caregivers of children with higher IQ, mania, anxiety, and disruptive behavior, these families may need additional supports as well. Though parents with conduct/antisocial problems evidenced lower stress, these difficulties should be monitored. Thus, parenting stress should be evaluated and addressed in the treatment of childhood mental health problems, especially BPSD.

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“…), and on the symptomatic and functional recovery of patients with BPD (Ferreira et al . ; McCann et al . ; Reinares et al .…”

Section: Discussionmentioning

confidence: 99%

“…A poorly‐functioning family has been associated with severe psychopathology and low psychosocial functioning in patients with BPD (Ferreira et al . ; Sullivan et al . ).…”

Section: Introductionmentioning

confidence: 99%

Randomized, controlled trial of a brief family‐centred care programme for hospitalized patients with bipolar disorder and their family caregivers

Lee

Lin

Chen

et al. 2016

Int J Mental Health Nurs

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Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients' symptoms and health; however, the effects of family interventions on family function and caregivers' health-related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family-centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60-min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90-min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem-solving (P = 0.04), but there were no significant interaction effects on the caregivers' perceived health status and caregivers' burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.

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Dysfunctional family environment in affected versus unaffected offspring of parents with bipolar disorder

Cited by 37 publications

References 33 publications

The Relationship Between Stressful Life Events and Axis I Diagnoses Among Adolescent Offspring of Probands With Bipolar and Non-Bipolar Psychiatric Disorders and Healthy Controls

The Relationship Between Stressful Life Events and Axis I Diagnoses Among Adolescent Offspring of Probands With Bipolar and Non-Bipolar Psychiatric Disorders and Healthy Controls

Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders

Randomized, controlled trial of a brief family‐centred care programme for hospitalized patients with bipolar disorder and their family caregivers

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