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More illness in offspring of bipolar patients from the U.S. compared to Europe
Robert M Post1, Lori L Altshuler2, Ralph Kupka3
1Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington D.C., USA.
Insights
Children of US patients with bipolar disorder (BD) show higher rates of depression and other illnesses compared to European counterparts. This increased burden in offspring suggests a need for targeted prevention and treatment strategies.
Area of Science:
- Psychiatry
- Genetics
- Public Health
Background:
- Bipolar disorder (BD) in the US is associated with earlier onset and a more severe illness course.
- US BD patients report greater family psychiatric burden and childhood adversity.
- These factors may contribute to a higher illness burden in the offspring of US BD patients.
Purpose of the Study:
- To investigate if the offspring of US patients with bipolar disorder exhibit a greater burden of psychiatric illness compared to offspring of European patients.
Main Methods:
- Surveyed 968 adult outpatients with bipolar illness (average age 41) about their family history.
- Collected data on offspring diagnoses including depression, bipolar disorder, substance abuse, and suicide attempts.
- Compared offspring illness rates between patients from the US (n=356) and Europe (n=132).
Main Results:
- Offspring of US bipolar patients had significantly higher rates of depression, bipolar disorder, drug abuse, and other illnesses (p<0.001).
- Illness in offspring correlated with parental US origin, childhood adversity, >20 prior episodes, and parental psychiatric illness.
Conclusions:
- Findings suggest a higher burden of psychiatric illness in offspring of US bipolar patients compared to European counterparts.
- Self-reported data limitations are acknowledged, but results align with interview-based studies.
- The elevated illness burden necessitates novel prevention and treatment approaches for affected families.
Background:
Evidence suggests that patients with bipolar disorder from the United States have an earlier age of onset and a more difficult course of illness than those from Germany and the Netherlands. These characteristics were related to a greater family burden of psychiatric illness and the experience of more psychosocial adversity in childhood. We hypothesized that this greater illness burden would extend to the offspring of the US patients.
Methods:
968 outpatients (average age 41) with bipolar illness gave informed consent for participation in a treatment outcome network and filled out a detailed questionnaire about their illness and family history of illness, including whether their offspring had a diagnosis of depression, bipolar disorder, alcohol or substance abuse, suicide attempt or "other" illness. Of those with children, 356 were from the US and 132 were from Europe.
Results:
Compared to the Europeans, offspring of patients from the US had significantly (p<0.001) more depression, bipolar disorder, drug abuse, and "other" illnesses. The number of illnesses in the offspring was related to the bipolar parent being from the US, having had childhood adversity, more than 20 prior episodes, and more parental psychiatric illness.
Conclusions:
While the findings are limited by their basis on self report, the distribution of the percentages in the US offspring are similar to those of Axelson et al. (2015) who used direct interviews. The higher burden of illness in the offspring and their in direct progenitors from the US compared to Europe warrant new attempts at better treatment and prevention.
