(New York, NY - May 30, 2008) -- Primary-care patients with bipolar spectrum disorder (BD) are particularly likely to have seen or experienced an assault, according to research led by Yuval Neria, Ph.D., a NARSAD 2003 Young Investigator. Dr. Neria and his colleagues, including several with NARSAD ties, also found that individuals whose BD is accompanied by post-traumatic stress disorder (PTSD) carry an extra-heavy burden of illness.

Prior studies prompted the NARSAD team to suspect that exposure to traumatic events, particularly physical or sexual assault, raises the risk of developing BD and aggravates the disorder in people who already have it. Extreme trauma can also cause PTSD, which afflicts an estimated 11 to 40 percent of people with BD. To investigate these possible links, Dr. Neria, of Columbia University and New York State Psychiatric Institute, and his associates compared rates of trauma exposure and PTSD in people with and without BD.

Their paper in the June issue of Bipolar Disorders presented data from interviews of 977 patients, all between 18 and 70 years old, who sought treatment at an internal medicine practice in New York City. Most of the patients reported Hispanic ethnicity and low income. Such “poor and ethnic minority populations tend to avoid seeking or receiving treatment from mental health specialists, and disproportionately rely on primary care services for the provision of their mental health care,” the researchers noted.

The study found that patients who screened positive for BD reported exposure to trauma at the same rate as others did. On the other hand, they were 2.6 times likelier than patients who screened negative for BD to report exposure to physical or sexual assault, based on analyses that neutralized the impact of age, income, depression, substance use disorder, and PTSD. “The relation of BD to trauma is substantial and characterized primarily by interpersonal trauma such as physical and sexual assault,” Dr. Neria and colleagues wrote.

In parallel findings, the researchers confirmed a connection between BD and PTSD. Specifically, they found that 32 percent of those with, but only 9 percent of those without, BD screened positive for PTSD.

Associations do not prove causality, however, as Dr. Neria and colleagues pointed out. Future studies will have to clarify whether trauma contributes to BD, or whether the disorder or something related to it increases the probability of traumatic events.

In any case, the scientists found evidence that patients who have PTSD as well as BD comprise an “especially vulnerable clinical population.” Compared to those with BD alone, patients who screened positive for both disorders were more likely to show significant impairment in their interpersonal relationships, to have lost at least a week of work in the past month, and to report poorer health-related quality of life.

“Taken together, these findings highlight overlooked clinical needs for patients with BD and PTSD,” the researchers concluded. To help forestall long-term disability, they urged physicians and mental health professionals to gather a “detailed trauma history” from primary-care patients as a first step toward providing timely treatment.

Other NARSAD scientists who worked on the study included Mark Olfson, M.D., M.P.H., a 2005 Distinguished Investigator; Helen Verdeli, Ph.D., a 2000 Young Investigator; Raz Gross, M.D., M.P.H., a 2001 and 2004 Young Investigator; and Myrna M. Weissman, Ph.D., a 1991, 2000, and 2005 Distinguished Investigator. All are affiliated with Columbia University.