Background

Lower socioeconomic status (SES) is associated with symptomatic severity, comorbidity, and functional impairment in adults with bipolar disorder (BD). Little is known about clinical correlates of SES in adolescents with BD.

Methods

Participants included 195 adolescents, 13–20 years old, with BD type I, II or not otherwise specified (NOS). Diagnoses were determined by standardized semi-structured interviews. Based on the Hollingshead scale, participants were divided into “low” (SES 1–3) and the “high” (SES 4–5) SES groups. Demographic and clinical correlates of SES were evaluated in univariate analyses; significant variables were evaluated in a logistic regression model.

Results

Compared to participants in the high SES group (n = 150), participants in the low SES group (n = 45) were significantly younger, less likely to be of Caucasian race and living with natural parents. In the logistic regression model, controlling for age and race, the low SES group had higher risk of police contact or arrest (OR = 2.41, 95% CI:1.14–5.11, p = 0.022), less treatment with stimulants(OR = 0.20 95% CI: 0.06–0.67, p = 0.009), and more post-traumatic stress disorder (PTSD) (OR = 4.08, 95% CI:1.33–12.46, p = 0.014) compared to the high SES group. In sensitivity analyses that further controlled for intact family, the finding of higher rates of police contact or arrest was no longer significant.

Limitations

Cross-sectional design; higher-skewed SES sample.

Conclusions

Lower SES in adolescent BD is associated with higher legal risk, increased PTSD, and under-treatment of attention-deficit/hyperactivity disorder (ADHD). Future studies are needed to evaluate the inter-relationships of these correlates, using prospective designs that can evaluate the direction of these associations. Further studies incorporating neurobiological markers are also needed to explore mechanisms underlying SES-related differences in BD.

中文翻译：

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青少年双相情感障碍的社会经济状况的临床相关性。

背景

较低的社会经济地位（SES）与双相情感障碍（BD）成人的症状严重程度，合并症和功能障碍有关。关于青少年与BD的SES的临床相关性知之甚少。

方法

参与者包括195名13至20岁的青少年，患有BD型I，II或未另行规定（NOS）。诊断是通过标准化的半结构化访谈来确定的。根据Hollingshead量表，参与者分为“低”（SES 1-3）和“高”（SES 4-5）SES组。在单因素分析中评估了SES的人口统计学和临床​​相关性。在逻辑回归模型中评估了显着变量。

结果

与高SES组（n  = 150）的参与者相比，低SES组（n  = 45）的参与者年轻得多，不太可能是白种人，与自然父母生活在一起。在控制年龄和种族的逻辑回归模型中，低SES组的警察接触或逮捕的风险较高（OR = 2.41，95％CI：1.14-5.11，p  = 0.022），使用兴奋剂的治疗较少（OR = 0.20） 与高SES组相比，95％CI：0.06-0.67，p  = 0.009），以及更多的创伤后应激障碍（PTSD）（OR = 4.08，95％CI：1.33-12.46，p = 0.014）。在对完整家庭进行进一步控制的敏感性分析中，发现更高的警察联系或逮捕率不再重要。

局限性

横断面设计；偏斜度较高的SES样本。

结论

青少年BD中较低的SES与较高的法律风险，增加的PTSD以及注意力不足/多动症（ADHD）的治疗不足有关。需要使用能够评估这些关联的方向的前瞻性设计，进行未来的研究以评估这些关联的相互关系。还需要结合神经生物学标志物的进一步研究，以探索BD中SES相关差异的潜在机制。