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Major stressful life events and other risk factors for first admission with mania.

OBJECTIVES
To investigate whether first admission with mania is associated with the occurrence of death in the family or with major stressful life events and to explore whether the associations change with age.


METHODS
Case register study with linkage of the Danish Psychiatric Central Research Register, including data on all admissions at psychiatric wards in Denmark from 1981 to 1998, and the Civil Registration System, including data on death and on socio-demographic variables. All patients who got a diagnosis of mania/mixed episode at the first ever admission at a psychiatric ward and a random gender- and age-matched control group of subjects who had never been admitted to psychiatric ward were identified.


RESULTS
A total of 1565 patients and 31,300 control subjects were identified. Suicide of a mother or of a sibling was associated with a highly increased risk of being admitted for the first time ever at a psychiatric ward with a diagnosis of mania/mixed episode. Death of a relative by other causes than suicide was not associated with increased risk of getting hospitalized with mania. Recent unemployment, recent divorce, but also a recent marriage showed moderate effects. No interaction was found on the association between life events and the first admission with mania, totally, or for men or women, separately regarding ageing.


CONCLUSIONS
The occurrence of death in the family and the experience of major life events are associated with increased risk of first admission with bipolar disorder. The susceptibility to major life stressors of inducing mania does not seem to change throughout life.