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A Longitudinal Study of Family Functioning in Offspring of Parents Diagnosed With Bipolar Disorder.

Published on Oct 1, 2019in Journal of the American Academy of Child and Adolescent Psychiatry6.391
· DOI :10.1016/j.jaac.2018.10.011
Amit Shalev1
Estimated H-index: 1
(University of Pittsburgh),
John Merranko7
Estimated H-index: 7
(University of Pittsburgh)
+ 10 AuthorsBoris Birmaher93
Estimated H-index: 93
(University of Pittsburgh)
Abstract
Objective To compare the longitudinal course of family functioning in offspring of parents with bipolar disorder (BD), offspring of parents with non-BD psychopathology, and offspring of healthy control (HC) parents. Method Offspring of parents with BD (256 parents and 481 offspring), parents without BD (82 parents and 162 offspring), and HC parents (88 parents and 175 offspring) 7 to 18 years of age at intake, from the Bipolar Offspring Study (BIOS), were followed for an average of 4.3 years. Family functioning was evaluated using the child- and parent-reported Family Adaptability and Cohesion Scale–II and the Conflict Behavior Questionnaire. The data were analyzed using multivariate multilevel regression, generalized linear estimating equation models, and path analysis. Results Families of parents with BD and parents with non-BD psychopathology showed lower cohesion and adaptability and higher conflict compared with HC families. There were no significant differences in cohesion and adaptability between families of parents with psychopathology. The effect of parental psychopathology on family functioning was mediated by parental psychosocial functioning and, to a lesser extent, offspring disorders. In all 3 groups, parent-reported family conflict was significantly higher than child-reported conflict. Across groups, family cohesion decreased over follow-up, whereas conflict increased. Conclusion Any parental psychopathology predicted family impairment. These results were influenced by the offspring’s age and were mediated by parental psychosocial functioning and, to a lesser degree, by offspring psychopathology. These findings emphasize the need to routinely assess family functioning in addition to psychopathology and provide appropriate interventions to parents and offspring.
  • References (38)
  • Citations (3)
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References38
Newest
#1Deborah A. Perlick (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 33
#2Carlos T. Jackson (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 4
Last. David J. Miklowitz (UCLA: University of California, Los Angeles)H-Index: 63
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OBJECTIVES: Caregivers of people with bipolar disorder often have depression and health problems. This study aimed to evaluate the sustained effects of a 12-15 week psychoeducational intervention on the health and mental health of caregivers of persons with bipolar disorder. We also evaluated the effects of the intervention on patients' mood symptoms over 6 months post-treatment. METHODS: Caregivers of 46 persons with bipolar disorder were randomized to 12-15 weeks of a caregiver-only adaptation...
3 CitationsSource
#1David J. Miklowitz (UCLA: University of California, Los Angeles)H-Index: 63
#2Bowen Chung (UCLA: University of California, Los Angeles)H-Index: 10
Family-focused therapy (FFT) is an evidence-based intervention for adults and children with bipolar disorder (BD) and their caregivers, usually given in conjunction with pharmacotherapy after an illness episode. The treatment consists of conjoint sessions of psychoeducation regarding bipolar illness, communication enhancement training, and problem-solving skills training. This paper summarizes over 30 years of research on FFT and family processes in BD. Across eight randomized controlled trials ...
20 CitationsSource
#1Mariangeles Berutti (USP: University of São Paulo)H-Index: 5
#2Rodrigo da Silva Dias (USP: University of São Paulo)H-Index: 10
Last. Fabiano G. Nery (USP: University of São Paulo)H-Index: 25
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Abstract Objectives To investigate the association between history of suicide attempts (SA) and family functioning in bipolar disorder (BD) patients. Methods Thirty-one BD type I patients with lifetime history of SA, 31 BD type I with no lifetime history of SA, participating in the Outpatient Clinic of the Bipolar Disorder Program at the Institute of Psychiatry of the University of Sao Paulo Medical School were recruited for this study. We used the Family Assessment Device (FAD) to evaluate fami...
10 CitationsSource
Family conflict exacerbates the course of bipolar disorder (BP) among adults. However, few studies have examined family conflict among adolescents with BP, and fewer have looked at adolescent-reported and parent-reported family conflict separately.Subjects were 89 adolescents, aged 13 to 19 years, with a diagnosis of BP on the basis of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL). Subjects were divided into high-con...
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#1Hagai Maoz (University of Pittsburgh)H-Index: 2
#2Tina R. Goldstein (University of Pittsburgh)H-Index: 32
Last. Boris Birmaher (University of Pittsburgh)H-Index: 93
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#1Guilherme S. Ferreira (USP: University of São Paulo)H-Index: 4
#2Carolina Lavigne Moreira (USP: University of São Paulo)H-Index: 2
Last. Sheila C. CaetanoH-Index: 23
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Objective:Children of parents with bipolar disorder (BD) are at heightened risk for developing mood and other psychiatric disorders. We proposed to evaluate the environment of families with at least one parent with BD type I (BDF) with affected offspring (aBDF) and unaffected offspring (uBDF) compared with control families without a history of DSM-IV Axis I disorder (CF).Method:We used the Family Environment Scale (FES) to evaluate 47 BDF (aBDF + uBDF) and 30 CF. Parents were assessed through th...
18 CitationsSource
#1Edmir C. G. P. Nader (USP: University of São Paulo)H-Index: 2
#2Ana Kleinman (USP: University of São Paulo)H-Index: 6
Last. Sheila C. Caetano (USP: University of São Paulo)H-Index: 23
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Abstract Background Children and adolescents with bipolar disorder (BD) live in family environments with high levels of expressed emotion (EE), conflict, and tension; as well as low maternal warmth and cohesion. These family characteristics have been evaluated in research settings using different scales. Nonetheless, empirically supported assessment instruments are not always feasible to be used in clinical settings. Our aim was to identify the best characteristics that discriminate BD families ...
15 CitationsSource
#1Aimee E. Sullivan (CU: University of Colorado Boulder)H-Index: 3
#2Charles M. Judd (CU: University of Colorado Boulder)H-Index: 61
Last. David J. Miklowitz (Semel Institute for Neuroscience and Human Behavior)H-Index: 63
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Abstract The symptoms of bipolar disorder affect and are affected by the functioning of family environments. Little is known, however, about the stability of family functioning among youth with bipolar disorder as they cycle in and out of mood episodes. This study examined family functioning and its relationship to symptoms of adolescent bipolar disorder, using longitudinal measures of family cohesion, adaptability, and conflict. Parent- and adolescent-reported symptom and family functioning dat...
37 CitationsSource
#1Tina R. Goldstein (University of Pittsburgh)H-Index: 32
#2Mihaela Obreja (University of Pittsburgh)H-Index: 10
Last. Boris Birmaher (University of Pittsburgh)H-Index: 93
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The objective of the study was to examine rates and identify risk factors for suicidal ideation among offspring of parents with bipolar disorder. Subjects included 388 offspring of parents with bipolar disorder and 250 offspring of matched community controls enrolled in the Pittsburgh Bipolar Offspring Study (BIOS). Offspring of bipolar probands displayed greater rates of lifetime suicidal ideation than offspring of controls (33% versus 20%). Factors most strongly associated with lifetime suicid...
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#1David H. Olson (UMN: University of Minnesota)H-Index: 32
Family Adaptability and Cohesion Evaluation Scale (FACES) IV was developed to tap the full continuum of the cohesion and flexibility dimensions from the Circumplex Model of Marital and Family Systems. Six scales were developed, with two balanced scales and four unbalanced scales designed to tap low and high cohesion (disengaged and enmeshed) and flexibility (rigid and chaotic). The six scales in FACES IV were found to be reliable and valid. High levels of concurrent, construct, and discriminant ...
329 CitationsSource
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#1Emma Stapp (Johns Hopkins University)H-Index: 2
#2Tamar Mendelson (Johns Hopkins University)H-Index: 22
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#1Giselli Scaini (University of Texas Health Science Center at Houston)H-Index: 22
#2Samira S. Valvassori (Unesc: Universidade do Extremo Sul Catarinense)H-Index: 31
Last. João QuevedoH-Index: 61
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Bipolar disorder (BD) is a chronic mental illness characterized by changes in mood that alternate between mania and hypomania or between depression and mixed states, often associated with functional impairment. Although effective pharmacological and non-pharmacological treatments are available, several patients with BD remain symptomatic. The advance in the understanding of the neurobiology underlying BD could help in the identification of new therapeutic targets as well as biomarkers for early ...
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#1M.A. Koenders (LEI: Leiden University)H-Index: 5
#2Esther Mesman (EUR: Erasmus University Rotterdam)
Last. Manon H.J. Hillegers (EUR: Erasmus University Rotterdam)H-Index: 5
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OBJECTIVES: Studies in children of patients affected with bipolar disorder (BD; bipolar offspring) are at high risk to develop mood disorders. Our aim is to investigate how environmental factors such as childhood trauma and family functioning relate to the development of mood disorders in offspring at familial risk for BD. DESIGN: The current study is part of a longitudinal prospective cohort study among offspring of parents with BD. METHODS: The current study is part of the Dutch Bipolar Offspr...
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#1Tara S. Peris (Semel Institute for Neuroscience and Human Behavior)H-Index: 23
#2Michelle Rozenman (DU: University of Denver)H-Index: 11
Last. Emily J. Ricketts (Semel Institute for Neuroscience and Human Behavior)H-Index: 1
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Abstract Pediatric trichotillomania (TTM) is an understudied condition that can be highly impairing; little is known about family environmental features that shape its development and course. We examined family functioning among age and gender-matched groups of youth with primary TTM (n = 30; mean age = 12.87), obsessive compulsive disorder (OCD; n = 30; mean age = 12.70), and no psychiatric history (healthy controls; HC; n = 30; mean age = 12.46). An additional group of n = 25 TTM cases was emp...
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