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Affective lability mediates the association between childhood trauma and suicide attempts, mixed episodes and co-morbid anxiety disorders in bipolar disorders

Published online by Cambridge University Press:  29 November 2016

M. Aas ,
C. Henry ,
F. Bellivier ,
M. Lajnef ,
S. Gard ,
J.-P. Kahn ,
T. V. Lagerberg ,
S. R. Aminoff ,
T. Bjella  and
M. Leboyer
...Show all authors
M. Aas*
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
C. Henry
Affiliation:
AP-HP, Hôpitaux Universitaires Henri Mondor, Pôle de Psychiatry, DHU Pepsy, Créteil, France Faculté de Médecine, Université Paris Est Créteil Val de Marne, Créteil, France Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France Fondation Fondamental, Créteil, France ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France
F. Bellivier
Affiliation:
Fondation Fondamental, Créteil, France ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France AP-HP, Hôpital Fernand Widal, Pôle Addictologie-Toxicologie-Psychiatrie and Université Paris-7, and INSERM U1144, Paris, France
M. Lajnef
Affiliation:
Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France
S. Gard
Affiliation:
Fondation Fondamental, Créteil, France Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Service de psychiatrie adulte, Bordeaux, France
J.-P. Kahn
Affiliation:
Fondation Fondamental, Créteil, France Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les NancyFrance
T. V. Lagerberg
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway
S. R. Aminoff
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway Department of Specialized Inpatient Treatment, Division of Mental Health Services, Akershus University Hospital, Norway
T. Bjella
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
M. Leboyer
Affiliation:
AP-HP, Hôpitaux Universitaires Henri Mondor, Pôle de Psychiatry, DHU Pepsy, Créteil, France Faculté de Médecine, Université Paris Est Créteil Val de Marne, Créteil, France Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France Fondation Fondamental, Créteil, France ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France
O. A. Andreassen
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France
I. Melle
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
B. Etain
Affiliation:
Fondation Fondamental, Créteil, France ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France AP-HP, Hôpital Fernand Widal, Pôle Addictologie-Toxicologie-Psychiatrie and Université Paris-7, and INSERM U1144, Paris, France
*
*Address for correspondence: M. Aas, Ph.D., Division of Mental Health and Addiction, NORMENT, KG Jebsen Psychosis Research Centre, TOP study group, Institute of Clinical Medicine, Bygg 49, Ullevål sykehus, PO Box 4956 Nydalen, 0424 Oslo, Norway. (Email: [email protected])
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Abstract

Background

Many studies have shown associations between a history of childhood trauma and more severe or complex clinical features of bipolar disorders (BD), including suicide attempts and earlier illness onset. However, the psychopathological mechanisms underlying these associations are still unknown. Here, we investigated whether affective lability mediates the relationship between childhood trauma and the severe clinical features of BD.

Method

A total of 342 participants with BD were recruited from France and Norway. Diagnosis and clinical characteristics were assessed using the Diagnostic Interview for Genetic Studies (DIGS) or the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Affective lability was measured using the short form of the Affective Lability Scale (ALS-SF). A history of childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Mediation analyses were performed using the SPSS process macro.

Results

Using the mediation model and covariation for the lifetime number of major mood episodes, affective lability was found to statistically mediate the relationship between childhood trauma experiences and several clinical variables, including suicide attempts, mixed episodes and anxiety disorders. No significant mediation effects were found for rapid cycling or age at onset.

Conclusions

Our data suggest that affective lability may represent a psychological dimension that mediates the association between childhood traumatic experiences and the risk of a more severe or complex clinical expression of BD.

Keywords

Bipolar disorderschildhood maltreatmentclinical features
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 5 , April 2017 , pp. 902 - 912
Copyright
Copyright © Cambridge University Press 2016 

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References

Aas, M, Aminoff, SR, Vik, LT, Etain, B, Agartz, I, Andreassen, OA, Melle, I (2014 a). Affective lability in patients with bipolar disorders is associated with high levels of childhood trauma. Psychiatry Research 218, 252–255.Google Scholar
Aas, M, Etain, B, Bellivier, F, Henry, C, Lagerberg, T, Ringen, A, Agartz, I, Gard, S, Kahn, JP, Leboyer, M, Andreassen, OA, Melle, I (2014 b). Additive effects of childhood abuse and cannabis abuse on clinical expressions of bipolar disorders. Psychological Medicine 44, 1653–1662.Google Scholar
Aas, M, Pedersen, G, Henry, C, Bjella, T, Bellivier, F, Leboyer, M, Kahn, JP, Cohen, RF, Gard, S, Aminoff, SR, Lagerberg, TV, Andreassen, OA, Melle, I, Etain, B (2015). Psychometric properties of the Affective Lability Scale (54- and 18-item version) in patients with bipolar disorder, first-degree relatives, and healthy controls. Journal of Affective Disorders 172, 375–380.Google Scholar
Agnew-Blais, J, Danese, A (2016). Childhood maltreatment and unfavourable clinical outcomes in bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry 3, 342–349.Google Scholar
Aminoff, SR, Jensen, J, Lagerberg, TV, Hellvin, T, Sundet, K, Andreassen, OA, Melle, I (2012). An association between affective lability and executive functioning in bipolar disorder. Psychiatry Research 198, 58–61.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text rev.). Washington, DC: American Psychiatric Association.Google Scholar
Baron, RM, Kenny, DA (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations . Journal of Personality and Social Psychology 51, 1173–1182.Google Scholar
Bernstein, DP, Fink, L (1998). Childhood Trauma Questionnaire. A retrospective Self- Report. The Psychological Corporation: San Antonio, Texas.Google Scholar
Bernstein, DP, Fink, L, Handelsman, L, Foote, J, Lovejoy, M, Wenzel, K, Sapareto, E, Ruggiero, J (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. Americal Journal of Psychiatry 151, 1132–1136.Google ScholarPubMed
Birmaher, B, Goldstein, BI, Axelson, DA, Monk, K, Hickey, MB, Fan, J, Iyengar, S, Ha, W, Diler, RS, Goldstein, T, Brent, D, Ladouceur, CD, Sakolsky, D, Kupfer, DJ (2013). Mood lability among offspring of parents with bipolar disorder and community controls. Bipolar Disorder 15, 253–263.CrossRefGoogle ScholarPubMed
Coccaro, EF, Ong, AD, Seroczynski, AD, Bergeman, CS (2012). Affective intensity and lability: heritability in adult male twins. Journal of Affective Disorders 136, 1011–1016.Google Scholar
Colom, F, Vieta, E (2009). The road to DSM-V. Bipolar disorder episode and course specifiers. Psychopathology 42, 209–218.CrossRefGoogle ScholarPubMed
Daruy-Filho, L, Brietzke, E, Lafer, B, Grassi-Oliveira, R (2011). Childhood maltreatment and clinical outcomes of bipolar disorder. Acta Psychiatrica Scandinavica 124, 427–434.Google Scholar
Erten, E, Funda, UA, Saatcioglu, O, Ozdemir, A, Fistikci, N, Cakmak, D (2014). Effects of childhood trauma and clinical features on determining quality of life in patients with bipolar I disorder. Journal of Affective Disorders 162, 107–113.CrossRefGoogle ScholarPubMed
Etain, B, Aas, M, Andreassen, OA, Lorentzen, S, Dieset, I, Gard, S, Kahn, JP, Bellivier, F, Leboyer, M, Melle, I, Henry, C (2013 a). Childhood trauma is associated with severe clinical characteristics of bipolar disorders. Journal of Clinical Psychiatry 74, 991–998.CrossRefGoogle ScholarPubMed
Etain, B, Henry, C, Bellivier, F, Mathieu, F, Leboyer, M (2008). Beyond genetics: childhood affective trauma in bipolar disorder. Bipolar Disorders 10, 867–876.Google Scholar
Etain, B, Mathieu, F, Henry, C, Raust, A, Roy, I, Germain, A, Leboyer, M, Bellivier, F (2010). Preferential association between childhood emotional abuse and bipolar disorder. Journal of Trauma Stress 23, 376–383.Google Scholar
Etain, B, Mathieu, F, Liquet, S, Raust, A, Cochet, B, Richard, JR, Gard, S, Zanouy, L, Kahn, JP, Cohen, RF, Bougerol, T, Henry, C, Leboyer, M, Bellivier, F (2013 b). Clinical features associated with trait-impulsiveness in euthymic bipolar disorder patients. Journal of Affective Disorders 144, 240–247.Google Scholar
Faedda, GL, Marangoni, C, Serra, G, Salvatore, P, Sani, G, Vázquez, GH, Tondo, L, Girardi, P, Baldessarini, RJ, Koukopoulos, A (2015). Precursors of bipolar disorders: a systematic literature review of prospective studies. Journal of Clinical Psychiatry 76, 614–624.Google Scholar
Fisher, HL, Craig, TK, Fearon, P, Morgan, K, Dazzan, P, Lappin, J, Hutchinson, G, Doody, GA, Jones, PB, McGuffin, P, Murray, RM, Leff, J, Morgan, C (2011). Reliability and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophrenia Bulletin 37, 546–553.Google Scholar
Fountoulakis, KN, Kontis, D, Gonda, X, Yatham, LN (2013). A systematic review of the evidence on the treatment of rapid cycling bipolar disorder. Bipolar Disorders 15, 115–137.Google Scholar
Gerson, AC, Gerring, JP, Freund, L, Joshi, PT, Capozzoli, J, Brady, K, Denckla, MB (1996). The Children's Affective Lability Scale: a psychometric evaluation of reliability. Psychiatry Research 65, 189–198.Google Scholar
Goodman, M, Weiss, DS, Koenigsberg, H, Kotlyarevsky, V, New, AS, Mitropoulou, V, Silverman, JM, O'Flynn, K, Siever, LJ (2003). The role of childhood trauma in differences in affective instability in those with personality disorders. CNS Spectrum 8, 763–770.CrossRefGoogle ScholarPubMed
Hafeman, DM, Merranko, J, Axelson, D, Goldstein, BI, Goldstein, T, Monk, K, Hickey, MB, Sakolsky, D, Diler, R, Iyengar, S, Brent, D, Kupfer, D, Birmaher, B (2016). Toward the definition of a bipolar prodrome: dimensional predictors of bipolar spectrum disorders in at-risk youths. American Journal of Psychiatry 173, 695–704.Google Scholar
Harvey, PD, Greenberg, BR, Serper, MR (1989). The affective lability scales: development, reliability, and validity. Journal of Clinical Psychology 45, 786–793.Google Scholar
Hayes, AF (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling. Retrieved from http://www.afhayes.com/ Google Scholar
Henry, C, Mitropoulou, V, New, AS, Koenigsberg, HW, Silverman, J, Siever, LJ (2001). Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. Journal of Psychiatry Research 35, 307–312.Google Scholar
Henry, C, Van den Bulke, D, Bellivier, F, Roy, I, Swendsen, J, M'Bailara, K, Siever, LJ, Leboyer, M (2008). Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period. Psychiatry Research 159, 1–6.Google Scholar
Joslyn, C, Hawes, DJ, Hunt, C, Mitchell, PB (2016). Is age of onset associated with severity, prognosis, and clinical features in bipolar disorder? A meta-analytic review. Bipolar Disorders 18, 389–403.CrossRefGoogle ScholarPubMed
Kim-Spoon, J, Cicchetti, D, Rogosch, FA (2013). A longitudinal study of emotion regulation, emotion lability-negativity, and internalizing symptomatology in maltreated and non-maltreated children. Child Development 84, 512–527.Google Scholar
Kraemer, HC, Kiernan, M, Essex, M, Kupfer, DJ (2008). How and why criteria defining moderators and mediators differ between the Baron & Kenny and MacArthur approaches. Health Psychology 27, S101–S108.Google Scholar
Leopold, K, Ritter, P, Correll, CU, Marx, C, Ozgurdal, S, Juckel, G, Bauer, M, Pfennig, A (2012). Risk constellations prior to the development of bipolar disorders: rationale of a new risk assessment tool. Journal of Affective Disorders 136, 1000–1010.Google Scholar
Links, PS, Boggild, A, Sarin, N (2000). Modeling the relationship between affective lability, impulsivity, and suicidal behavior in patients with borderline personality disorder. Journal of Psychiatry Practice 6, 247–255.Google Scholar
Look, AE, Flory, JD, Harvey, PD, Siever, LJ (2010). Psychometric properties of a short form of the Affective Lability Scale (ALS-18). Personality and Individual Differences 49, 187–191.Google Scholar
Malhi, GS, Bargh, DM, Cashman, E, Frye, MA, Gitlin, M (2012). The clinical management of bipolar disorder complexity using a stratified model. Bipolar Disorders 14 (Suppl. 2), 66–89.CrossRefGoogle ScholarPubMed
Marwaha, S, Gordon-Smith, K, Broome, M, Briley, PM, Perry, A, Forty, L, Craddock, N, Jones, I, Jones, L (2016). Affective instability, childhood trauma and major affective disorders. Journal of Affective Disorders 190, 764–771.Google Scholar
Marwaha, S, He, Z, Broome, M, Singh, SP, Scott, J, Eyden, J, Wolke, D (2014). How is affective instability defined and measured? A systematic review. Psychological Medicine 44, 1793–1808.Google Scholar
McLaughlin, KA, Hatzenbuehler, ML, Mennin, DS, Nolen-Hoeksema, S (2011). Emotion dysregulation and adolescent psychopathology: a prospective study. Behaviour Research and Therapy 49, 544–554.Google Scholar
Nurnberger, JI Jr, Blehar, MC, Kaufmann, CA, York-Cooler, C, Simpson, SG, Harkavy-Friedman, J, Severe, JB, Malaspina, D, Reich, T (1994). Diagnostic interview for genetic studies. Rationale, unique features, and training. NIMH Genetics Initiative. Archives of General Psychiatry 51, 849–859.CrossRefGoogle ScholarPubMed
Oliver, MN, Simons, JS (2004). The affective lability scales: development of a short-form measure. Personality and Individual Differences 37, 1279–1288.CrossRefGoogle Scholar
Paquette, D, Laporte, L, Bigras, M, Zoccolillo, M (2004). Validation of the French version of the CTQ and prevalence of the history of maltreatment. Santé mentale au Québec 29, 201–220.CrossRefGoogle ScholarPubMed
Parmentier, C, Etain, B, Yon, L, Misson, H, Mathieu, F, Lajnef, M, Cochet, B, Raust, A, Kahn, JP, Wajsbrot-Elgrabli, O, Cohen, R, Henry, C, Leboyer, M, Bellivier, F (2012). Clinical and dimensional characteristics of euthymic bipolar patients with or without suicidal behavior. European Psychiatry 27, 570–576.Google Scholar
Posner, K, Brown, GK, Stanley, B, Brent, DA, Yershova, KV, Oquendo, MA, Currier, GW, Melvin, GA, Greenhill, L, Shen, S, Mann, JJ (2011). The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry 168, 1266–1277.Google Scholar
Post, RM (2010). Mechanisms of illness progression in the recurrent affective disorders. Neurotoxicity Research 18, 256–271.Google Scholar
Read, J, Fraser, A (1998). Staff response to abuse histories of psychiatric inpatients. The Australian and New Zealand Journal of Psychiatry 32, 206–213.Google Scholar
Reich, DB, Zanarini, MC, Fitzmaurice, G (2012). Affective lability in bipolar disorder and borderline personality disorder. Comprehensive Psychiatry 53, 230–237.Google Scholar
Richard-Lepouriel, H, Etain, B, Hasler, R, Bellivier, F, Gard, S, Kahn, JP, Prada, P, Nicastro, R, Ardu, S, Dayer, A, Leboyer, M, Aubry, JM, Perroud, N, Henry, C (2016). Similarities between emotional dysregulation in adults suffering from ADHD and bipolar patients. Journal of Affective Disorders 198, 230–236.Google Scholar
Schwandt, ML, Heilig, M, Hommer, DW, George, DT, Ramchandani, VA (2013). Childhood trauma exposure and alcohol dependence severity in adulthood: mediation by emotional abuse severity and neuroticism. Alcoholism: Clinical and Experimental Research 37, 984–992.Google Scholar
Shannon, C, Hanna, D, Tumelty, L, Waldron, D, Maguire, C, Mowlds, W, Meenagh, C, Mulholland, C (2016). Reliability of reports of childhood trauma in bipolar disorder: a test-retest study over 18 months. Journal of Trauma Dissociation 17, 511–519.Google Scholar
Thompson, RJ, Berenbaum, H, Bredemeier, K (2011). Cross-sectional and longitudinal relations between affective instability and depression. Journal of Affective Disorders 130, 53–59.Google Scholar
Van Dam, DS, Korver-Nieberg, N, Velthorst, E, Meijer, CJ, de Haan, L, for Genetic Risk and Outcome in Psychosis (GROUP) (2014). Childhood maltreatment, adult attachment and psychotic symptomatology: a study in patients, siblings and controls. Social Psychiatry and Psychiatric Epidemiology 49, 1759–1767.Google Scholar
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