Stressful Life Events and Social Rhythm Disruption in the Onset of Manic and Depressive Bipolar Episodes

Background: The association between stressful life events and onset of bipolar episodes is unclear. The association between bipolar episode onset and types of life events that disrupt social routines, and potentially sleep, has not yet been investigated. Methods: Thirty-ninebipolarpatientswithprimarilymanic (n = 20) or depressed (n = 19) index episodes were interviewed with the Bedford College Life Event and Difficulty Schedule to determine the presence of severe events during8-weekpre-onsetandcontrolperiods.Alllifeeventswere also rated for degree of social rhythm disruption (SRD). Results: More bipolar subjects experienced at least 1 SRD event and severe event in the pre-onset vs control periods. When subjects were divided into those with manic or depressive onsets, the only significant pre-onset vs control difference was for manic patients with SRD events. Additionally, the proportion of subjects with a preonset SRD event was greater for manic than for depressed patients. Conclusions: We found evidence that life events characterized by SRDs routines are associated with the onset of manic, but not depressive, episodes. Severe events seem to be related to onset of bipolar episodes, although it remains unclear whether severe events relate differentially to depressive and manic onsets. Arch Gen Psychiatry. 1998;55:702-707