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Individual and Familial Risk Factors for Bipolar Affective Disorders in Denmark
Preben Bo Mortensen, DrMedSc;
C. B. Pedersen, MSc;
M. Melbye, DrMedSc;
O. Mors, PhD;
H. Ewald, DrMedSc
Arch Gen Psychiatry. 2003;60:1209-1215.
Background Few population-based studies have addressed risk factors for bipolar affective disorder.
Objective To study the possible association between bipolar affective disorder and history of mental illness in a parent or sibling; urbanicity of birth place; season of birth; sibship characteristics, including birth order; influenza epidemics during pregnancy; and early parental loss.
Design We used a population-based cohort of 2.1 million individuals based on data from the Danish Civil Registration System linked with the Danish Psychiatric Central Register.
Setting Nationwide population-based sample of all individuals hospitalized or in outpatient clinic contact for the first time with bipolar affective disorder.
Patients Overall, 2299 individuals were first diagnosed with bipolar affective disorder during the 31.8 million person-years of follow-up.
Results Risk of bipolar affective disorder was associated with a history of bipolar affective disorder as well as other psychiatric disorders, including schizophrenia and schizoaffective disorder, in parents or siblings. People with a first-degree relative with bipolar affective disorder had a 13.63-fold (95% confidence interval, 11.81-15.71) increased risk of bipolar affective disorder. No other consistent associations were found with the exception of an association between early parental loss, in particular maternal, and bipolar affective disorder. Children who experienced maternal loss before their fifth birthday had a 4.05 (95% confidence interval, 1.68-9.77) increased risk of bipolar affective disorder.
Conclusions Early parental loss may represent both environmental and genetic risk factors for bipolar affective disorder. Most of the risk factors included in our study that previously have been associated with schizophrenia were not associated with bipolar affective disorder, supporting that the 2 disorders may be at least partially separate etiological entities.
From the National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark (Drs Mortensen and Pedersen); the Danish Epidemiology Science Centre, Statens Seruminstitut, Copenhagen, Denmark (Dr Melbye); and the Institute for Basic Psychiatric Research, Psychiatric Hospital, University Hospital, Aarhus (Drs Mors and Ewald).
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