Childhood Trauma and Self-harm in Youths with Bipolar Disorders

Delfina      Janiri; Michelangelo      Di Luzio; Silvia      Montanari; Daniele      Hirsch; Alessio      Simonetti; Lorenzo      Moccia; Eliana      Conte; Ilaria      Contaldo; Chiara      Veredice; Eugenio      Mercuri; Gabriele      Sani

doi:10.2174/1570159X21666230213155249

Abstract

Background: Bipolar disorders (BD) in youth are associated with a high risk of self-harm behaviors. Childhood trauma (CT) is a relevant environmental stressor that is related to both BD diagnosis and self-harm in adulthood. It is not yet established whether CT may impact self-harm risk in youth. Therefore, the aim of this study was to investigate the distribution patterns of CT in youth BD with and without self-harm.

Methods: We assessed 273 participants (aged 13-25 years), 96 youths with BD according to DSM-5 criteria and 177 healthy controls (HC). History of CT was obtained using the Childhood Trauma Questionnaire (CTQ). The association between CT and self-harm was tested using multivariate statistical models.

Results: Over 45% of participants with BD reported lifetime self-harm. The BD Self-harm group reported more emotional abuse, emotional neglect, sexual abuse, and physical abuse than HC. The BD No-Self-harm group reported more emotional abuse than HC. The BD Self-harm group reported more emotional abuse and neglect than the BD No-Self-harm group. The BD Self-harm group also reported separated parents, hospitalizations, smoking, use of antiepileptics, antipsychotics and lithium. Emotional abuse was an independent predictor of self-harm in youths with BD.

Conclusion: Findings support the importance of assessing CT, in particular emotional abuse, in youth with BD at risk for self-harm.

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[1]
Griffin, E.; McMahon, E.; McNicholas, F.; Corcoran, P.; Perry, I.J.; Arensman, E. Increasing rates of self-harm among children, adolescents and young adults: A 10-year national registry study 2007–2016. Soc. Psychiatry Psychiatr. Epidemiol.,  2018, 53(7), 663-671.
 [http://dx.doi.org/10.1007/s00127-018-1522-1] [PMID: 29721594]

[2]
Madge, N.; Hewitt, A.; Hawton, K.; Wilde, E.J.; Corcoran, P.; Fekete, S.; Heeringen, K.; Leo, D.D.; Ystgaard, M. Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. J. Child Psychol. Psychiatry,  2008, 49(6), 667-677.
 [http://dx.doi.org/10.1111/j.1469-7610.2008.01879.x] [PMID: 18341543]

[3]
Hawton, K.; Saunders, K.E.A.; O’Connor, R.C. Self-harm and suicide in adolescents. Lancet,  2012, 379(9834), 2373-2382.
 [http://dx.doi.org/10.1016/S0140-6736(12)60322-5] [PMID: 22726518]

[4]
Brunner, R.; Kaess, M.; Parzer, P.; Fischer, G.; Carli, V.; Hoven, C.W. Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: A comparative study of findings in 11 European countries. J. Child. Psychol. Psychiatry. Allied. Discip.,  2014, 55(4), 337-348.

[5]
Baldessarini, R.J.; Tondo, L.; Vázquez, G.H.; Undurraga, J.; Bolzani, L.; Yildiz, A.; Khalsa, H.M.K.; Lai, M.; Lepri, B.; Lolich, M.; Maffei, P.M.; Salvatore, P.; Faedda, G.L.; Vieta, E.; Tohen, M. Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients. World Psychiatry,  2012, 11(1), 40-46.
 [http://dx.doi.org/10.1016/j.wpsyc.2012.01.006] [PMID: 22295008]

[6]
Moller, C.I.; Davey, C.G.; Badcock, P.B.; Wrobel, A.L.; Cao, A.; Murrihy, S. Correlates of suicidality in young people with depressive disorders: A systematic review. 2022.http://journals.sagepub.com/doi/10.1177/00048674221086498
 [http://dx.doi.org/10.1177/00048674221086498]

[7]
Janiri, D.; Moccia, L.; Conte, E.; Palumbo, L.; Chieffo, D.P.R.; Fredda, G.; Menichincheri, R.M.; Balbi, A.; Kotzalidis, G.D.; Sani, G.; Janiri, L. Emotional dysregulation, temperament and lifetime suicidal ideation among youths with mood disorders. J. Pers. Med.,  2021, 11(9), 865. https://www.mdpi.com/2075-4426/11/9/865
 [http://dx.doi.org/10.3390/jpm11090865] [PMID: 34575642]

[8]
Janiri, D.; Doucet, G.E.; Pompili, M.; Sani, G.; Luna, B.; Brent, D.A.; Frangou, S. Risk and protective factors for childhood suicidality: a US population-based study. Lancet Psychiatry,  2020, 7(4), 317-326.
 [http://dx.doi.org/10.1016/S2215-0366(20)30049-3] [PMID: 32171431]

[9]
MacPherson, H.A.; Weinstein, S.M.; West, A.E. Non-suicidal selfinjury in pediatric bipolar disorder: Clinical correlates and impact on psychosocial treatment outcomes. J. Abnorm. Child Psychol.,  2018, 46(4), 857-870. http://link.springer.com/10.1007/s10802-017-0331-4
 [http://dx.doi.org/10.1007/s10802-017-0331-4] [PMID: 28725956]

[10]
Esposito-Smythers, C.; Goldstein, T.; Birmaher, B.; Goldstein, B.; Hunt, J.; Ryan, N.; Axelson, D.; Strober, M.; Gill, M.K.; Hanley, A.; Keller, M. Clinical and psychosocial correlates of non-suicidal self-injury within a sample of children and adolescents with bipolar disorder. J. Affect. Disord.,  2010, 125(1-3), 89-97. http://linkinghub.elsevier.com/retrieve/pii/S016503271000008X
 [http://dx.doi.org/10.1016/j.jad.2009.12.029] [PMID: 20089313]

[11]
Llamocca, E.N.; Fristad, M.A.; Bridge, J.A.; Brock, G.; Steelesmith, D.L.; Axelson, D.A.; Fontanella, C.A. Correlates of deliberate self-harm among youth with bipolar disorder. J. Affect. Disord.,  2022, 302, 376-384. http://linkinghub.elsevier.com/retrieve/pii/S0165032722000957
 [http://dx.doi.org/10.1016/j.jad.2022.01.085] [PMID: 35066010]

[12]
Copeland, W.E.; Shanahan, L.; Hinesley, J.; Chan, R.F.; Aberg, K.A.; Fairbank, J.A.; van den Oord, E.J.C.G.; Costello, E.J. Association of childhood trauma exposure with adult psychiatric disorders and functional outcomes. JAMA Netw. Open,  2018, 1(7), e184493.
 [http://dx.doi.org/10.1001/jamanetworkopen.2018.4493] [PMID: 30646356]

[13]
Palmier-Claus, J.E.; Berry, K.; Bucci, S.; Mansell, W.; Varese, F. Relationship between childhood adversity and bipolar affective disorder: Systematic review and meta-analysis. Br. J. Psychiatry,  2016, 209(6), 454-459.
 [http://dx.doi.org/10.1192/bjp.bp.115.179655] [PMID: 27758835]

[14]
Hailes, H.P.; Yu, R. Europe PMC funders group long-term outcomes of childhood sexual abuse: An umbrella review. Lancet Psychiatry,  2020, 6(10), 830-839.

[15]
Janiri, D.; Sani, G.; Rossi, P.D.; Piras, F.; Iorio, M.; Banaj, N.; Giuseppin, G.; Spinazzola, E.; Maggiora, M.; Ambrosi, E.; Simonetti, A.; Spalletta, G. Amygdala and hippocampus volumes are differently affected by childhood trauma in patients with bipolar disorders and healthy controls. Bipolar Disord.,  2017, 19(5), 353-362.
 [http://dx.doi.org/10.1111/bdi.12516] [PMID: 28699182]

[16]
Janiri, D.; De Rossi, P.; Kotzalidis, G.D.; Girardi, P.; Koukopoulos, A.E.; Reginaldi, D.; Dotto, F.; Manfredi, G.; Jollant, F.; Gorwood, P.; Pompili, M.; Sani, G. Psychopathological characteristics and adverse childhood events are differentially associated with suicidal ideation and suicidal acts in mood disorders. Eur. Psychiatry,  2018, 53, 31-36.
 [http://dx.doi.org/10.1016/j.eurpsy.2018.05.009] [PMID: 29879623]

[17]
Wrobel, A.L.; Jayasinghe, A.; Russell, S.E.; Marx, W.; Alameda, L.; Dean, O.M.; Cotton, S.M.; Berk, M.; Turner, A. The influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder: A systematic review and meta-analysis. J. Affect. Disord.,  2022, 296, 350-362.
 [http://dx.doi.org/10.1016/j.jad.2021.09.103] [PMID: 34606813]

[18]
Marchand, W.R.; Laurel Wirth, B.S.; Cindy Simon, M.S.W. Adverse life events and pediatric bipolar disorder in a community mental health setting. Community Ment. Health J.,  2005, 41(1), 67-75.
 [http://dx.doi.org/10.1007/s10597-005-2600-x] [PMID: 15932053]

[19]
Cazala, F.; Bauer, I.E.; Meyer, T.D.; Spiker, D.E.; Kazimi, I.F.; Zeni, C.P.; Zunta-Soares, G.B.; Soares, J.C. Correlates of childhood trauma in children and adolescents with bipolar disorder spectrum: A preliminary study. J. Affect. Disord.,  2019, 247, 114-119.
 [http://dx.doi.org/10.1016/j.jad.2018.12.007] [PMID: 30660020]

[20]
Romero, S.; Birmaher, B.; Axelson, D.; Goldstein, T.; Goldstein, B.I.; Gill, M.K.; Iosif, A.M.; Strober, M.A.; Hunt, J.; Esposito-Smythers, C.; Ryan, N.D.; Leonard, H.; Keller, M. Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder. J. Affect. Disord.,  2009, 112(1-3), 144-150.
 [http://dx.doi.org/10.1016/j.jad.2008.04.005] [PMID: 18538857]

[21]
Goldstein, T.R.; Birmaher, B.; Axelson, D.; Ryan, N.D.; Strober, M.A.; Gill, M.K.; Valeri, S.; Chiappetta, L.; Leonard, H.; Hunt, J.; Bridge, J.A.; Brent, D.A.; Keller, M. History of suicide attempts in pediatric bipolar disorder: Factors associated with increased risk. Bipolar Disord.,  2005, 7(6), 525-535.
 [http://dx.doi.org/10.1111/j.1399-5618.2005.00263.x] [PMID: 16403178]

[22]
Baldessarini, R.J.; Bolzani, L.; Cruz, N.; Jones, P.B.; Lai, M.; Lepri, B.; Perez, J.; Salvatore, P.; Tohen, M.; Tondo, L.; Vieta, E. Onset-age of bipolar disorders at six international sites. J. Affect. Disord.,  2010, 121(1-2), 143-146.
 [http://dx.doi.org/10.1016/j.jad.2009.05.030] [PMID: 19560827]

[23]
Bernstein, D.P.; Stein, J.A.; Newcomb, M.D.; Walker, E.; Pogge, D.; Ahluvalia, T.; Stokes, J.; Handelsman, L.; Medrano, M.; Desmond, D.; Zule, W. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl.,  2003, 27(2), 169-190.
 [http://dx.doi.org/10.1016/S0145-2134(02)00541-0] [PMID: 12615092]

[24]
Wang, M.; Peng, C.; Chang, H.; Yu, M.; Rong, F.; Yu, Y. Interaction between Sirtuin 1 (SIRT1) polymorphisms and childhood maltreatment on aggression risk in Chinese male adolescents. J. Affect. Disord.,  2022, 309, 37-44.

[25]
Angelakis, I.; Gillespie, E.L.; Panagioti, M. Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis. Psychol. Med.,  2019, 49(7), 1057-1078.
 [http://dx.doi.org/10.1017/S0033291718003823] [PMID: 30608046]

[26]
Gladstone, G.L.; Parker, G.B.; Mitchell, P.B.; Malhi, G.S.; Wilhelm, K.; Austin, M.P. Implications of childhood trauma for depressed women: An analysis of pathways from childhood sexual abuse to deliberate self-harm and revictimization. Am. J. Psychiatry,  2004, 161(8), 1417-1425.
 [http://dx.doi.org/10.1176/appi.ajp.161.8.1417] [PMID: 15285968]

[27]
Russell, A.E.; Heron, J.; Gunnell, D.; Ford, T.; Hemani, G.; Joinson, C.; Moran, P.; Relton, C.; Suderman, M.; Mars, B. Pathways between early‐life adversity and adolescent self‐harm: The mediating role of inflammation in the avon longitudinal study of parents and children. J. Child Psychol. Psychiatry,  2019, 60(10), 1094-1103.
 [http://dx.doi.org/10.1111/jcpp.13100] [PMID: 31486089]

[28]
Aas, M.; Bellivier, F.; Bettella, F.; Henry, C.; Gard, S.; Kahn, J.P.; Lagerberg, T.V.; Aminoff, S.R.; Melle, I.; Leboyer, M.; Jamain, S.; Andreassen, O.A.; Etain, B. Childhood maltreatment and polygenic risk in bipolar disorders. Bipolar Disord.,  2020, 22(2), 174-181.
 [http://dx.doi.org/10.1111/bdi.12851] [PMID: 31628696]

[29]
Dimick, M.K.; Hird, M.A.; Sultan, A.A.; Mitchell, R.H.B.; Sinyor, M.; MacIntosh, B.J.; Goldstein, B.I. Resting-state functional connectivity indicators of risk and resilience for self-harm in adolescent bipolar disorder. Psychol. Med.,  2022, 1-10.
 [http://dx.doi.org/10.1017/S0033291721005419] [PMID: 35256032]

[30]
Teicher, M.H.; Samson, J.A. Annual research review: Enduring neurobiological effects of childhood abuse and neglect. J. Child Psychol. Psychiatry,  2016, 57(3), 241-266.
 [http://dx.doi.org/10.1111/jcpp.12507] [PMID: 26831814]

[31]
Simonetti, A.; Saxena, K.; Koukopoulos, A.E.; Janiri, D.; Lijffijt, M.; Swann, A.C.; Kotzalidis, G.D.; Sani, G. Amygdala structure and function in paediatric bipolar disorder and high-risk youth: A systematic review of magnetic resonance imaging findings. World J. Biol. Psychiatry,  2022, 23(2), 103-126.
 [http://dx.doi.org/10.1080/15622975.2021.1935317] [PMID: 34165050]

[32]
Janiri, D.; Kotzalidis, G.D.; De Chiara, L.; Koukopoulos, A.E.; Aas, M.; Sani, G. The ring of fire. Psychiatr. Clin. North Am.,  2020, 43(1), 69-82.
 [http://dx.doi.org/10.1016/j.psc.2019.10.007] [PMID: 32008689]

[33]
Peh, C.X.; Shahwan, S.; Fauziana, R.; Mahesh, M.V.; Sambasivam, R.; Zhang, Y.; Ong, S.H.; Chong, S.A.; Subramaniam, M. Emotion dysregulation as a mechanism linking child maltreatment exposure and self-harm behaviors in adolescents. Child Abuse Negl.,  2017, 67, 383-390.
 [http://dx.doi.org/10.1016/j.chiabu.2017.03.013] [PMID: 28371647]

[34]
Johnson, J.G.; Cohen, P.; Gould, M.S.; Kasen, S.; Brown, J.; Brook, J.S. Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood. Arch. Gen. Psychiatry,  2002, 59(8), 741-749.
 [http://dx.doi.org/10.1001/archpsyc.59.8.741] [PMID: 12150651]

[35]
Steinhoff, A.; Bechtiger, L.; Ribeaud, D.; Eisner, M.; Shanahan, L. Self-, other-, and dual-harm during adolescence: A prospective-longitudinal study of childhood risk factors and early adult correlates. Psychol. Med.,  2022, 1-9.
 [http://dx.doi.org/10.1017/S0033291722000666] [PMID: 35297361]

[36]
Klosinski, G. Psychological maltreatment in the context of separation and divorce. Child Abuse Negl.,  1993, 17(4), 557-563.
 [http://dx.doi.org/10.1016/0145-2134(93)90030-9] [PMID: 8402258]

[37]
Centorrino, F.; Fogarty, K.V.; Sani, G.; Salvatore, P.; Cimbolli, P.; Baldessarini, R.J. Antipsychotic drug use: McLean Hospital, 2002. Hum. Psychopharmacol.,  2005, 20(5), 355-358.
 [http://dx.doi.org/10.1002/hup.700] [PMID: 15957153]

[38]
Musenga, A.; Saracino, M.; Sani, G.; Raggi, M. Antipsychotic and antiepileptic drugs in bipolar disorder: The importance of therapeutic drug monitoring. Curr. Med. Chem.,  2009, 16(12), 1463-1481.
 [http://dx.doi.org/10.2174/092986709787909604] [PMID: 19355900]

[39]
Daruy-Filho, L.; Brietzke, E.; Lafer, B.; Grassi-Oliveira, R. Childhood maltreatment and clinical outcomes of bipolar disorder. Acta Psychiatr. Scand.,  2011, 124(6), 427-434.
 [http://dx.doi.org/10.1111/j.1600-0447.2011.01756.x] [PMID: 21848703]

[40]
Woolway, G.E.; Smart, S.E.; Lynham, A.J.; Lloyd, J.L.; Owen, M.J.; Jones, I.R. Schizophrenia polygenic risk and experiences of childhood adversity: A systematic review and meta-analysis. Schizophr Bull, 
 [http://dx.doi.org/10.1093/schbul/sbac049]

[41]
Doba, K.; Saloppé, X.; Choukri, F.; Nandrino, J.L. Childhood trauma and posttraumatic stress symptoms in adolescents and young adults: The mediating role of mentalizing and emotion regulation strategies. Child Abuse Negl.,  2022, 132, 105815.
 [http://dx.doi.org/10.1016/j.chiabu.2022.105815] [PMID: 35914329]

[42]
Rienecke, R.D.; Johnson, C.; Le Grange, D.; Manwaring, J.; Mehler, P.S.; Duffy, A.; McClanahan, S.; Blalock, D.V. Adverse childhood experiences among adults with eating disorders: Comparison to a nationally representative sample and identification of trauma profiles. J. Eat. Disord.,  2022, 10(1), 72.
 [http://dx.doi.org/10.1186/s40337-022-00594-x] [PMID: 35596196]

[43]
Kuzminskaite, E.; Vinkers, C.H.; Milaneschi, Y.; Giltay, E.J.; Penninx, B.W.J.H. Childhood trauma and its impact on depressive and anxiety symptomatology in adulthood: A 6-year longitudinal study. J. Affect. Disord.,  2022, 312, 322-330.
 [http://dx.doi.org/10.1016/j.jad.2022.06.057] [PMID: 35760192]

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DOI https://dx.doi.org/10.2174/1570159X21666230213155249	Print ISSN 1570-159X
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