Stressful Life Events and Social Rhythm Disruption in the Onset of Manic and Depressive Bipolar Episodes

Authors:
  • EFEllen Frank
    Ellen Frank
  • BABarbara Anderson
    Barbara Anderson
  • JSJoel T. Sherrill
    Joel T. Sherrill
  • LSLori Siegel
    Lori Siegel
  • DPDeclan Patterson
    Declan Patterson
  • DKDavid J. Kupfer
    David J. Kupfer
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Abstract
WHILE GENETIC and biologic factors are known to play a major role in the etiology of bipolar disorder, psychosocial factors are gaining increasing attention in explaining the timing, type, and outcome of bipolar episodes.1 In particular, many studies have identified an association between stressful life events and bipolar episode onset.2-19 The nature of this association, however, is unclear, as abundant methodologic limitations render overall conclusions tenuous (see Johnson and Roberts20 for review). Yet even among investigations that employed self-report questionnaires and/or semistructured interviews to determine occurrence of severely threatening life events, dated episodes from symptom onset, omitted events that were likely to have been illness-related, and used adequate control groups, results are inconsistent.5,7,14,18,21 Further, although it has been well documented that severe life events are provoking agents for the onset of unipolar depression,22,23 depressive onsets in addition to manic onsets have been investigated in only 2 of these studies.14,21

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