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Negative Life Events in Children and Adolescents With Bipolar Disorder

Soledad Romero, MD; Boris Birmaher, MD; David A. Axelson, MD; Ana-Maria Iosif, PhD; Douglas E. Williamson, PhD; Mary Kay Gill, MSN; Benjamin I. Goldstein, MD; Michael A. Strober, PhD; Jeffrey Hunt, MD; Tina R. Goldstein, PhD; Christianne Esposito-Smythers, PhD; Satish Iyengar, PhD; Neal D. Ryan, MD; and Martin Keller, MD

Published: October 15, 2009

Article Abstract

Objective: To study the relationship between negative life events and demographic and clinical variables in youth with bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified (NOS), as well as to compare the rates of life events in youth with bipolar disorder, depressive and/or anxiety disorders (DEP-ANX), and healthy controls.

Method: Subjects included 446 youth, aged 7 to 17 years, meeting DSM-IV criteria for bipolar I, bipolar II, or an operationalized definition of bipolar disorder NOS, and were enrolled in the Course and Outcome of Bipolar Illness in Youth study. Subjects completed the Life Events Checklist. Sixty-five DEP-ANX and 65 healthy youth were obtained from previous studies using similar methodology. The study was conducted from October 2000 to July 2006.

Results: Older age, lower socioeconomic status, living with nonintact family, non-Caucasian race, anxiety, and disruptive disorders were associated with greater number of total negative life events. Specifically, increased independent, dependent, and uncertain negative life events were associated with lower socioeconomic status, nonintact family, and comorbid disruptive disorders. Increased independent negative life events were additionally associated with non-Caucasian race and comorbid anxiety disorders. Increased dependent and uncertain negative life events were also associated with older age. DEP-ANX youth reported a similar rate of negative life events as bipolar youth, and both groups had more negative life events than the healthy controls. Bipolar youth reported fewer total and dependent positive life events compared to DEP-ANX and healthy youths.

Conclusions: Similar to DEP-ANX youth, bipolar youth are exposed to excessive negative independent and dependent life events, which may have implications in the long-term outcome and negative consequences associated with this disorder.


Submitted: December 12, 2008; accepted April 24, 2009.

Corresponding author: Soledad Romero, MD, Hospital Clinic University of Barcelona, Institute Clinic of Neuroscience, Villarroel 170, Barcelona, Catalonia 08036, Spain (

Volume: 70

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