Research report
Psychosocial functioning of adolescents with and without paediatric bipolar disorder

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Abstract

Background

While there has been a growing interest in the presentation of Bipolar Disorder (BD) in children and adolescents, few studies have investigated the psychosocial functioning of these individuals and its relationship to trauma and suicidal ideation.

Methods

63 adolescents aged 13–17 participated: 39 controls and 24 with Bipolar Disorder (BD). Group allocation and histories of trauma and suicidal ideation were obtained using the K-SADS-PL and WASH-U-KSADS. Adolescents completed questionnaires covering negative life events, self-esteem, hopelessness, regulation of anger, locus of control and coping.

Results

More traumatic events and negative life experiences were reported by the BD group with over 50% of the BD sample indicating a history of trauma compared with 10% of the controls. The BD group reported lower self-esteem, more hopelessness, more negative life events, a more external locus of control and greater difficulties regulating emotion in anger-provoking situations. They were also found to have poorer coping strategies than the controls. Histories of trauma did not differentiate those with and without psychosocial problems. Further, hopelessness was found to be the best predictor of those BD adolescents reporting suicidal ideation. Comorbidity could not account for the differences found.

Limitations

The sample was small and therefore disallowed comparisons among subtypes of BD. Cross-sectional design limited the ability to investigate causal relationships.

Conclusions

This is the first study to document the widespread psychosocial difficulties facing youth with BD, highlighting these issues as important ones to explore during assessment and treatment, particularly in management of affective storms and suicidal risk.

Introduction

Paediatric Bipolar Disorder (BD) has been the focus of a growing body of research but there have been few investigations into the psychosocial functioning of young people diagnosed with BD. Given the chronic nature of the illness, the alarmingly high rate of suicides in the BD population, and the well documented role that stress can have on triggering the onset of the illness, particularly in younger bipolar patients (Hays et al., 1998), knowledge about psychosocial issues facing BD adolescents will be essential in both documenting likely triggers and aiding clinicians with designing effective interventions (McClure et al., 2002).

Our knowledge of paediatric BD is largely driven by the adult literature. While genetic and biological factors undeniably play a role in the onset and maintenance of the disorder, they cannot fully account for the variability in frequency of symptoms, response to medications, treatment adherence, and expression of the disorder. A few studies have investigated psychosocial variables in adult patients with BD. For example, cognitive styles, such as attributional styles, dysfunctional attitudes and negative self-referent information, have been found to interact with life events to predict increases in manic symptoms (Reilly-Harrington et al., 1999). Another sample of BD adults showed greater difficulties finding solutions to social problems and showed higher levels of dysfunctional attitudes and sociotropy as compared with controls (Scott et al., 2000). A further study found that BD individuals with severe negative life events have been found to take longer to recover from episodes than those without severe life events (Johnson and Miller, 1997). Life stressors have also been found to frequently precede the first episode of an affective disorder (Johnson et al., 2000).

To date, there has been only one study investigating the psychosocial functioning of BD youth. Geller et al. (2000) compared the psychosocial functioning of an early adolescent BD sample with an ADHD sample and a community control sample. They found that the subjects with BD had significantly greater impairment in maternal and peer relationships as compared with the other two groups.

This is the first study to explore intra-individual psychosocial variables, including self-esteem, coping strategies, locus of control, hopelessness, impact of stressful life events, and regulation of anger in a group of BD adolescents compared with a community control group. The relationship between these variables and trauma histories and suicidal behaviours was also investigated in the BD group. This focus on intra-individual variables as opposed to external psychosocial variables (such as relationships, stressors) serves to begin the documentation of the psychological vulnerabilities in this population that could be included in treatment plans.

Section snippets

Method

The final sample consisted of 63 participants: 39 controls (17 males, 22 females), and 24 Bipolar Disorder (10 males, 14 females). Participants were aged 13 to 17. Younger and male adolescents assessed for the control group were randomly excluded from a larger sample (N = 70) in order to obtain a comparable match with the BD group on age and gender. Thirty-five (89.7%) of the control group and 20 (83.3%) of the BD group were European New Zealanders. Two (5.1%) of the control group and 3 (12.5%)

Sample characteristics

There was no group difference in age (F (1, 61) = 1.605, ns), ethnicity (χ2 (2, N = 63) = 1.116, ns), family constellation (i.e,, single versus intact families; χ2 (1, N = 63) = 1.484, ns) and sex distribution (χ2 (1, N = 63) = .881, ns). The mean age of the NC group was 15.41 (1.09) and 15.74 (1.58) for the BD group. There were group differences on SES (F (1, 61) = 5.443, ns), with the NC group having a higher SES than the BD group; and estimated IQ (F (1, 61) = 9.964, p < .01) with the BD group having a lower IQ

Discussion

Research on psychosocial variables and BD has been limited not only to adults but also to variables external to individuals, such as social support, relationships and stressors. This study investigated the more intra-individual psychosocial variables such as self-esteem, coping and affect regulation, particularly anger. Similar to other studies, this study showed that BD adolescents are reporting more negative life events as well as more trauma in the past as compared with the control group.

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