The impact of child sexual abuse on the course of bipolar disorder: a systematic review
Version of Record online: 24 JAN 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Volume 15, Issue 4, pages 341–358, June 2013
How to Cite
Maniglio, R. (2013), The impact of child sexual abuse on the course of bipolar disorder: a systematic review. Bipolar Disorders, 15: 341–358. doi: 10.1111/bdi.12050
- Issue online: 3 JUN 2013
- Version of Record online: 24 JAN 2013
- Received 19 February 2012, revised and accepted for publication 15 November 2012
- bipolar disorder;
- child sexual abuse;
- posttraumatic stress disorder;
- risk factors;
- substance-related disorders;
Maniglio R. The impact of child sexual abuse on the course of bipolar disorder: a systematic review. Bipolar Disord 2013: 15: 341–358. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Objectives: The aim of this review was to elucidate the impact of child sexual abuse on all clinical phenomena that occur after the onset of bipolar disorder, including associated clinical features that are not part of the diagnostic criteria for the disorder.
Methods: Five databases were searched and supplemented with a hand search of reference lists from retrieved papers. Study quality was assessed using a validated quality assessment tool. Blind assessments of study eligibility and quality were conducted by two independent researchers to reduce bias, minimize errors, and enhance the reliability of findings. Disagreements were resolved by consensus.
Results: Eighteen studies that included a total of 2996 adults and youths with bipolar disorder and met the minimum quality criteria necessary to ensure objectivity and not invalidate results were analyzed. Across studies, child sexual abuse was strongly (and perhaps directly) associated with posttraumatic stress disorder; whereas it was less strongly (and perhaps indirectly) related to suicide attempts, alcohol and/or drug abuse or dependence, psychotic symptoms, and an early age of illness onset. In regard to the association between child sexual abuse and other clinical variables concerning the course of bipolar disorder, evidence was scant or conflicting.
Conclusions: Child sexual abuse is associated (either directly or indirectly) with some clinical phenomena that represent a more severe form of bipolar disorder. Although such a traumatic experience may directly affect the development of posttraumatic stress disorder, the effects of early sexual abuse on later suicidal behavior, substance abuse, and psychotic symptoms may operate through the mediating influences of certain psychopathological or neurobiological variables.