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A Preliminary Investigation

Susan Malkoff-Schwartz, PhD; Ellen Frank, PhD; Barbara Anderson, MS; Joel T. Sherrill, PhD; Lori Siegel, BA; Declan Patterson, MA; David J. Kupfer, MD

Arch Gen Psychiatry. 1998;55:702-707.

Background  The association between stressful life events and onset of bipolar episodes is unclear. The association between bipolar episode onset and types of life events that disrupt social routines, and potentially sleep, has not yet been investigated.

Methods  Thirty-nine bipolar patients with primarily manic (n=20) or depressed (n=19) index episodes were interviewed with the Bedford College Life Event and Difficulty Schedule to determine the presence of severe events during 8-week pre-onset and control periods. All life events were also rated for degree of social rhythm disruption (SRD).

Results  More bipolar subjects experienced at least 1 SRD event and severe event in the pre-onset vs control periods. When subjects were divided into those with manic or depressive onsets, the only significant pre-onset vs control difference was for manic patients with SRD events. Additionally, the proportion of subjects with a pre-onset SRD event was greater for manic than for depressed patients.

Conclusions  We found evidence that life events characterized by SRDs routines are associated with the onset of manic, but not depressive, episodes. Severe events seem to be related to onset of bipolar episodes, although it remains unclear whether severe events relate differentially to depressive and manic onsets.

From the Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pa.

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