Social and environmental variables as predictors of mania: a review of longitudinal research findings

Abstract

Considerable evidence suggests that psychosocial variables can shape the course of bipolar disorder. Here, though, we focus on the more specific idea that the social environment can predict the course of mania. We systematically review evidence from longitudinal studies concerning how social support, family interactions, traumatic life events, and recent life events relate to the age of onset, the frequency of episode recurrence, and the severity of manic symptoms. Although we find some evidence that the course of mania can be worsened by social environmental factors, the links are specific. Among social variables, some studies indicate that conflict and hostility are predictive, but more general social relationship qualities have not been found to predict mania. Some research indicates that childhood trauma, and recent life events involving goal attainment or sleep disruption can predict mania. Taken together, the profile of variables involving recent exposure that are most predictive include those that are activating, reward-related, or sleep-disrupting, which fits with general psychological hypotheses of behavioral activation and sleep disruption as important for mania. We discuss gaps in the literature, and we note future directions for research, including the need for more integrative, longitudinal research on a fuller range of social and biological risk variables.

Racial differences in pathways to care preceding first episode mania or psychosis: a historical cohort prodromal study

“…Finally, while 51% of our non-White FEP patients were born outside of the U.S., and recognizing that migration and forced displacement are well-known social risk factors for psychosis and mood disorders and that immigrants and refugees are at higher risk of marginalization and cumulative trauma, among other environmental stressors, we did not conducted a detailed assessment of this cases (i.e., country of birth, age at migration, type of displacement, etc.) that might have helped examine the ways in which risk of severe mental illness intersects with race and migration ( 45 , 46 ). Our findings suggest race differences in the pathways to care and patterns of psychotropic utilization preceding a first episode of mania or psychosis, specifically an overall lower use of health services and psychotropic medications in non-White patients.…”

A mediator between childhood trauma and clinical symptoms in females with bipolar disorder: social support

“…For instance, childhood trauma predicted depressive symptoms (70). Childhood trauma is a risk factor of multiple negative outcomes including high severity of mania, depression, and psychosis, high risk of comorbidity, rapid cycling, and suicide attempt, early onset of BD, and greater number of manic and depressive episodes (71,72).…”

Diagnosis and management of bipolar disorders

“…32 35 Perhaps uniquely in bipolar disorder, evidence also indicates that positive life events associated with goal attainment can also increase the risk of developing elevated states. 36 Comorbidity Bipolar disorder rarely manifests in isolation, with comorbidity rates indicating elevated lifetime risk of several co-occurring symptoms and comorbid disorders, particularly anxiety, attentional disorders, substance misuse disorders, and personality disorders. 37 38 The causes of such comorbidity can be varied and complex: they could reflect a mixed presentation artifactually separated by current diagnostic criteria; they might also reflect independent illnesses; or they might represent the downstream effects of one disorder increasing the risk of developing another disorder.…”

“…The effects of such adverse events are complex, but on a broad level have been associated with earlier onset of bipolar disorder, a worse illness course, greater prevalence of psychotic symptoms,34 substance misuse and psychiatric comorbidities, and a higher risk of suicide attempts 3235. Perhaps uniquely in bipolar disorder, evidence also indicates that positive life events associated with goal attainment can also increase the risk of developing elevated states 36…”