Journal
PSYCHOLOGICAL MEDICINE
Volume 44, Issue 8, Pages 1653-1662Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0033291713002316
Keywords
Bipolar disorder; cannabis abuse; childhood abuse; clinical characteristics
Categories
Funding
- INSERM (Institut national de la sante et de la recherche medicale)
- Assistance publique - Hopitaux de Paris (AP-HP)
- Agence Nationale pour la Recherche (ANR)
- Fondation pour la Recherche sur le Cerveau (FRC)
- Eastern Norway Health Authority [2004123, 2006258]
- Research Council of Norway [167153/V50]
- INSERM
- AP-HP
- ENBREC (European Network of Bipolar Research Expert Centre)
- RTRS Sante Mentale (Fondation Fondamental)
- ANR
- FRC
- National Alliance for Research on Schizophrenia and Depression (NARSAD)
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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 ((2)=8.63, p=0.003 and (2)=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 ((2)=11.16, p=0.001) and a trend for rapid cycling ((2)=3.45, p=0.06). Alcohol dependence was associated with suicide attempt ((2)=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: r(2)=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: r(2)=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.
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