1 Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
2 Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
Aust N Z J Psychiatry. 2019 Feb;53(2):129-135. doi: 10.1177/0004867418761577. Epub 2018 Mar 14.
This study investigated whether there were differences in coping strategies and self-esteem between offspring of parents with bipolar disorder (high-risk) and offspring of unaffected parents (control), and whether these psychological factors predicted the onset and recurrence of mood episodes.
High-risk and control offspring were followed longitudinally as part of the Flourish Canadian high-risk bipolar offspring cohort study. Offspring were clinically assessed annually by a psychiatrist using semi-structured interviews and completed a measure of coping strategies and self-esteem.
In high-risk offspring, avoidant coping strategies significantly increased the hazard of a new onset Diagnostic and Statistical Manual of Mental Disorders, 4th Edition twice revised mood episode or recurrence (hazard ratio: 1.89, p = 0.04), while higher self-esteem significantly decreased this hazard (hazard ratio: 2.50, p < 0.01). Self-esteem and avoidant coping significantly interacted with one another ( p < 0.05), where the risk of a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition twice revised new onset mood episode or recurrence was only significantly increased among high-risk offspring with both high avoidant coping and low self-esteem.
A reduction of avoidant coping strategies in response to stress and improvement of self-esteem may be useful intervention targets for preventing the new onset or recurrence of a clinically significant mood disorder among individuals at high familial risk.
本研究旨在探讨父母患有双相障碍（高风险）的子女与未受影响父母的子女（对照组）之间的应对策略和自尊是否存在差异，以及这些心理因素是否预测情绪发作的发生和复发。
高风险和对照组子女作为加拿大 Flourish 高风险双相障碍子女队列研究的一部分进行纵向随访。通过精神科医生使用半结构化访谈对子女进行年度临床评估，并完成应对策略和自尊的测量。
在高风险子女中，回避应对策略显著增加了新出现的符合《精神障碍诊断与统计手册》第 4 版修订版（Diagnostic and Statistical Manual of Mental Disorders, 4th Edition revised，DSM-IV-TR）的心境发作或复发的风险（危险比：1.89，p=0.04），而较高的自尊显著降低了这种风险（危险比：2.50，p<0.01）。自尊和回避应对策略之间存在显著的交互作用（p<0.05），仅在高回避应对策略和低自尊的高风险子女中，DSM-IV-TR 新出现的心境发作或复发的风险才显著增加。
减少应对压力的回避策略和提高自尊可能是预防高家族风险个体新出现临床显著心境障碍的有用干预目标。
