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    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Johnson, Sheri L. Cuellar, Amy K. and Gershon, Anda 2016. The Influence of Trauma, Life Events, and Social Relationships on Bipolar Depression. Psychiatric Clinics of North America, Vol. 39, Issue. 1, p. 87.

    Passos, I. C. Mwangi, B. Vieta, E. Berk, M. and Kapczinski, F. 2016. Areas of controversy in neuroprogression in bipolar disorder. Acta Psychiatrica Scandinavica, Vol. 134, Issue. 2, p. 91.

    Kim, Hyun Joo Song, Wonyoung and Park, Jae Woo 2015. Differences in Trauma Experience Between Patients With Bipolar I Disorder, Patients With Major Depressive Disorder, and Healthy Controls. Journal of Trauma & Dissociation, Vol. 16, Issue. 4, p. 419.

    Passos, Ives C. Kapczinski, Natália S. Quevedo, João Kauer-Sant’Anna, Márcia and Kapczinski, Flávio 2015. Staging Models and Functional Outcomes in Bipolar Disorder: Clinical Implications. Current Treatment Options in Psychiatry, Vol. 2, Issue. 3, p. 205.

    Simhandl, Christian Radua, Joaquim König, Barbara and Amann, Benedikt L. 2015. The prevalence and effect of life events in 222 bipolar I and II patients: A prospective, naturalistic 4 year follow-up study. Journal of Affective Disorders, Vol. 170, p. 166.


Chronic stressors and trauma: prospective influences on the course of bipolar disorder

  • A. Gershon (a1), S. L. Johnson (a2) and I. Miller (a3)
  • DOI:
  • Published online: 18 February 2013

Exposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients.


One hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments).


Trauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance.


Overall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.

Corresponding author
*Address for correspondence: A. Gershon, Ph.D., Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305-5717, USA. (Email:
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Psychological Medicine
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