Life events in bipolar disorder: Towards more specific models

Abstract

This article reviews the evidence concerning life events as a predictor of symptoms within bipolar disorder. First, key methodological issues in this area are described, and criteria used for including studies in this review are defined. Then findings that negative life events predict worse outcomes within bipolar disorder are reviewed. Beyond general studies on relapse, it is important to differentiate predictors of depression from predictors of mania. When severe negative life events occur, they appear to trigger increases in bipolar depression. Nonetheless, many depressions are unrelated to negative life events and appear to be triggered by other variables. The strongest evidence suggests that negative life events do not trigger mania, except perhaps in certain contexts. Retrospective findings for schedule-disrupting life events as a trigger for manic symptoms await further assessment within a longitudinal study. Life events involving goal attainment do appear to trigger manic symptoms. Overall, it is time to differentiate among specific types of life events, as these different forms of events point towards mechanisms linking stressors with symptom expression. These mechanisms provide clues into ways to integrate the social environment with biological vulnerability (see Bipolar disorder is clearly a biological disorder. Nonetheless, over the past 15 years, a wealth of research has made it abundantly clear that psychosocial variables shape outcomes of this disorder. Much of this psychosocial research has focused on whether life events predict the timing and severity of symptoms within this disorder. This paper reviews the evidence that life events are related to symptom expression within bipolar disorder. This basic question has challenged researchers for over 20 years. Given the growing literature, this paper focus on addressing two more specific questions. Which types of symptoms are related to life events? What types of life events influence symptoms? Given the growing number of studies available on these issues, this review will focus on those studies with the most rigorous methodologies. To set the stage for this endeavor, it is important to first review the major methodological issues in research on life events and bipolar disorder, including issues related to design, measurement, and sampling.

Chronic Lithium Salt Treatment Reduces CRE/CREB-Directed Gene Transcription and Reverses Its Upregulation by Chronic Psychosocial Stress in Transgenic Reporter Gene Mice

“…The etiology of bipolar disorder has been linked to genetic factors (Craddock and Forty, 2006), which lead to a higher individual vulnerability. However, in addition, particularly environmental influences such as chronic stress are assumed to precipitate the disease (Johnson, 2005). Among the drugs recommended for the treatment of bipolar disorder, lithium salts are of prime importance (Gitlin, 2006).…”

An evolutionary model of low mood states

“…However, a recent review (Johnson, 2005) concludes that although there are some studies suggesting that manic symptoms increase after negative life events, the best evidence, which comes from comparing life events before and after manic episodes within the same individuals, have not found such a relationship. However, these studies do not separate euphoric from dysphoric mania, a distinction which the current model suggests might be useful to make.…”

Stressful life events and catechol-O-methyl-transferase (COMT ) gene in bipolar disorder

“…Stressful life events such as bereavement and divorce, have been associated with illness (Johnson, 2005) and episode onsets as well as symptom exacerbation (Hosang, Uher, Maughan, McGuffin, & Farmer, 2012;Johnson et al, 2008) in bipolar disorder. But not everyone who experiences stressful life events goes on to develop this illness or relapses (Johnson, 2005).…”

“…But not everyone who experiences stressful life events goes on to develop this illness or relapses (Johnson, 2005). Given the variation in response to stress, much research in bipolar disorder has been dedicated to exploring stress vulnerability factors, which include cognitive style (Reilly-Harrington, Alloy, Fresco, & Whitehouse, 1999) and social support (Cohen, Hammen, Henry, & Daley, 2004).…”