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Childhood adversity in bipolar disorder and psychosis
[Thesis]. Manchester, UK: The University of Manchester; 2015.
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Abstract
The relationship between childhood adversity and bipolar disorder remains unclear. The authors statistically synthesised the available literature in order to understand the size of this effect. In line with the review protocol (PROSPERO reference: CRD42015017201), search terms relating to childhood adversity and bipolar disorder were entered into four electronic databases (Medline, Embase, PsychInfo, and Web of Science). Eligible studies included a sample formally diagnosed with bipolar disorder, a comparison sample (non-clinical, major depression or schizophrenia) and a quantitative measure of childhood adversity. Effect sizes were calculated and converted to odds ratios before being meta-analysed. From the 5395 identified articles, 13 case-control and six epidemiological studies were included in the main analysis. Childhood adversity was 2.63 (CI: 1.99 – 3.47, p<.001) times more likely to have occurred in bipolar disorder when compared to non-clinical controls. The effect sizes were similar for the case control (2.88; CI: 2.03 – 4.08) and epidemiological (2.24, CI: 1.41 – 3.55) studies. Emotional abuse showed the greatest effect size for any form of adversity with an odds ratio of 4.04 (CI: 3.12-5.22). Rates of childhood adversity in bipolar disorder were comparable to those in schizophrenia and unipolar depression. The findings suggest that childhood adversity, particularly emotional abuse, may play a key role in the development of bipolar disorder, comparable to that of other psychiatric conditions. This has implications for both the detection and treatment of bipolar symptomatology. There is a need for prospective cohort design research to better elucidate the causal nature of this relationship.