Stressful Life events that occur during adulthood are defined as particularly significant experiences that result in substantial changes to personal circumstances. These changes may be positive or they may be negative changes and can occur across all aspects of life, including health, education, employment, relationships, bereavement, housing, legal, and financial issues. These can all contribute to the development of mental health problems.

What is the evidence for adult life events as risk factors for bipolar disorder?

Moderate to high quality evidence suggests no differences in the number of stressful events experienced prior to onset of bipolar disorder compared to unipolar depression or people without a mental illness.

October 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

October 2021

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Childhood adversities encompass a range of childhood experiences, including loss of a close relative, bullying, physical abuse, sexual abuse, emotional abuse, and neglect. The nature, timing, severity, and duration of exposure are likely to influence mental health outcomes.

What is the evidence for childhood adversities in people with bipolar disorder?

Moderate quality evidence finds a small to medium-sized increased risk of bipolar disorder after exposure to any childhood adversity. There were significantly higher rates of childhood adversity in people with bipolar disorder compared to people without bipolar disorder and compared to people with major depression. No differences in rates of childhood adversity were found between people with bipolar disorder and people with schizophrenia.

The rate of childhood emotional abuse in adults with bipolar disorder is around 30.0% compared to a general population rate between 6.54% and 14.07%. The rate of childhood physical abuse in adults with bipolar disorder is around 18.0% compared to a general population rate between 6.69% and 12.0%. The rate of childhood sexual abuse in adults with bipolar disorder is around 22.0% compared to a general population rate between 6.2% and 9.46%. The rate of childhood emotional neglect in adults with bipolar disorder is around 31.0% compared to a general population rate between 13.3% and 16.19%. The rate of childhood physical neglect in bipolar disorder is around 30.0% (no population rate is reported for physical neglect).

Childhood adversity is associated with more symptom episodes and severity, rapid cycling, psychosis, anxiety, post-traumatic stress disorder, substance use, suicides, and an earlier age at onset.

October 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively we will endeavour to conduct our own review to fill this gap in the Library.

October 2021

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Some ethnic groups may show greater or less risk for bipolar disorder than others. Incidence refers to how many new cases there are per population in a specified time period, while prevalence refers to how many existing cases there are at a particular point in time. Differences in the incidence and prevalence across various ethnic groups can provide clues to possible causes of bipolar disorder.

What is the evidence for ethnicity and risk for bipolar disorder?

Moderate quality evidence finds a medium-sized increased risk of affective psychosis (including bipolar disorder) in Black African and Black Caribbean ethnic groups living in England. There were also small increases in South Asian and other White groups (Irish, Eastern European).

Moderate to low quality evidence finds a small increased risk of bipolar disorder in people living in the US who have a Caucasian mother, with no association with having an African American mother or a mother from another ethnic background.

October 2021

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Many disorders are the result of interaction between susceptibility genes and environmental influences. One example is cardiovascular disease; people with a family history of cardiovascular disease are more susceptible to heart problems, and environmental influences, such as diet, can increase this risk. Bipolar disorder is also a complex disorder that can arise from both genetic and environmental influences.

What is the evidence for familial risk?

Moderate to low quality evidence suggests a medium-sized increased risk of bipolar disorder in the offspring of people with bipolar disorder. There were also small effects of increased risk of depressive, anxiety, disruptive, substance use and attention-hyperactivity deficit disorders.

October 2021

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Exposure to infection is often cited as a risk factor for schizophrenia and has recently been investigated in bipolar disorder. This topic summarises the available evidence for the risk of developing bipolar disorder following exposure to influenza and other infectious agents, both before and after birth. The physiological mechanisms underlying any associations are largely unclear. Please also see the topic in Physical Features on markers for infectious agents in adults with bipolar disorder.

What is the evidence for infectious agents as risk factors for bipolar disorder?

Moderate to low quality evidence suggests a large effect of increased risk of bipolar disorder with exposure to meningitis or tuberculosis in childhood, and a medium-sized effect of lower risk of bipolar disorder with exposure to chicken pox in childhood.

There was a medium to large effect of increased risk of bipolar disorder with exposure to maternal influenza during pregnancy, although when trimesters were analysed separately, the effect remained significant only in the third trimester, and only in one study. There were no associations between risk of bipolar disorder and exposure to maternal urinary tract infections or herpes simplex virus 2.

October 2021

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Consumption of a balanced diet during pregnancy aids the development of a healthy fetus which may act as a preventative factor for the development of bipolar disorder in adulthood. In contrast, consumption of substances or poor diet during pregnancy can be harmful to the developing fetus.

What is the evidence for maternal diet during pregnancy?

Moderate to low quality evidence suggests a medium-sized effect of increased risk of bipolar disorder in offspring of mothers who smoked during pregnancy. There were no associations between alcohol or caffeine use during pregnancy and bipolar disorder in the offspring.

April 2022

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Illness during pregnancy, particularly involving infectious agents has been associated with brain and behavioural abnormalities in the offspring, and so have been investigated as possible risk factors for bipolar disorder.

What is the evidence for maternal illness during pregnancy as a risk factor for bipolar disorder?

Moderate to low quality evidence finds a medium to large increased risk of bipolar disorder after exposure to maternal influenza during pregnancy. However, when the trimesters were analysed separately, the effect remained significant only in the third trimester, and results were found in only one study.

There were no associations between risk of bipolar disorder and urinary tract infections, herpes simplex virus 2, hypertensive problems, or maternal diabetes.

October 2021

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The term “migrant” usually refers to first generation migrants – people with a foreign birth place, and studies have assessed whether migration is related to risk of bipolar disorder.

Any association observed between migrant status and increased risk of mental disorders has stimulated a great deal of explanatory hypotheses, including additional stress relating to migration and settling into a new country, and possible issues with discrimination. Other explanations include a tendency for at-risk individuals to migrate, and underlying genetic variances across cultures.

What is the evidence for migrant status as a risk factor for bipolar disorder?

Moderate quality evidence finds a small increase in the risk of bipolar disorder or affective psychosis after migration.

October 2021

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