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Additive effects of childhood abuse and cannabis abuse on clinical expressions of bipolar disorders

Published online by Cambridge University Press:  13 September 2013

M. Aas ,
B. Etain ,
F. Bellivier ,
C. Henry ,
T. Lagerberg ,
A. Ringen ,
I. Agartz ,
S. Gard ,
J.-P. Kahn  and
M. Leboyer
...Show all authors
M. Aas*
Affiliation:
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:
AP-HP, Hôpital H. Mondor – A. Chenevier, Pôle de Psychiatry, Créteil, France Inserm, U955, Créteil, France Fondation Fondamental, Créteil, France ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France
F. Bellivier
Affiliation:
Inserm, U955, Créteil, France Fondation Fondamental, Créteil, France ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France AP-HP, GH Saint-Louis – Lariboisière – Fernand Widal, Pôle Neurosciences, Paris, France Université Paris 7, Denis Diderot, Paris, France
C. Henry
Affiliation:
AP-HP, Hôpital H. Mondor – A. Chenevier, Pôle de Psychiatry, Créteil, France Inserm, U955, Créteil, France Fondation Fondamental, Créteil, France ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France Université Paris Est, Faculté de Médecine, Créteil, France
T. Lagerberg
Affiliation:
Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
A. Ringen
Affiliation:
Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
I. Agartz
Affiliation:
KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
S. Gard
Affiliation:
Fondation Fondamental, Créteil, France Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Service de Psychiatrie Adulte, Pôle 3-4-7, Bordeaux, France
J.-P. Kahn
Affiliation:
Fondation Fondamental, Créteil, France Service de Psychiatrie et Psychologie Clinique, Université de Lorraine et CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy, France
M. Leboyer
Affiliation:
AP-HP, Hôpital H. Mondor – A. Chenevier, Pôle de Psychiatry, Créteil, France Inserm, U955, Créteil, France Fondation Fondamental, Créteil, France ENBREC, European Network of Bipolar Research Expert Centres (ENBREC), Paris, France Université Paris Est, Faculté de Médecine, Créteil, France
O. A. Andreassen
Affiliation:
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:
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
*
*Address for correspondence: M. Aas, Ph.D., KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, Bygg 49, Ullevål sykehus, PO Box 4956 Nydalen, 0424 Oslo, Norway. (Email: [email protected])
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Abstract

Background

Previous studies of bipolar disorders indicate that childhood abuse and substance abuse are associated with the disorder. Whether both influence the clinical picture, or if one is mediating the association of the other, has not previously been investigated.

Method

A total of 587 patients with bipolar disorders were recruited from Norway and France. A history of childhood abuse was obtained using the Childhood Trauma Questionnaire. Diagnosis and clinical variables, including substance abuse, were based on structured clinical interviews (Structured Clinical Interview for DSM-IV Axis I disorders or French version of the Diagnostic Interview for Genetic Studies).

Results

Cannabis abuse was significantly associated with childhood abuse, specifically emotional and sexual abuse (χ2 = 8.63, p = 0.003 and χ2 = 7.55, p = 0.006, respectively). Cannabis abuse was significantly associated with earlier onset of the illness (z = −4.17, p < 0.001), lifetime history of at least one suicide attempt (χ2 = 11.16, p = 0.001) and a trend for rapid cycling (χ2 = 3.45, p = 0.06). Alcohol dependence was associated with suicide attempt (χ2 = 10.28, p = 0.001), but not with age at onset or rapid cycling. After correcting for possible confounders and multiple testing, a trend was observed for an interaction between cannabis abuse and childhood abuse and suicide attempt (logistic regression: r2 = 0.06, p = 0.039). Significant additive effects were also observed between cannabis abuse and childhood abuse on earlier age at onset (p < 0.001), increased rapid cycling and suicide attempt (logistic regression: r2 = 0.03–0.04, p < 0.001). No mediation effects were observed; childhood abuse and cannabis abuse were independently associated with the disorder.

Conclusions

Our study is the first to demonstrate significant additive effects, but no mediation effects, between childhood abuse and cannabis abuse on increased clinical expressions of bipolar disorders.

Keywords

Bipolar disordercannabis abusechildhood abuseclinical characteristics
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 8 , June 2014 , pp. 1653 - 1662
Copyright
Copyright © Cambridge University Press 2013 

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