Falgas-Bague Irene, Cruz-Gonzalez Mario, Zhen-Duan Jenny, Nagendra Arundati, Alvarez Kiara, Canino Glorisa, Duarte Cristiane S, Bird Hector, M De-Salazar Pablo, Alegría Margarita
Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA.
Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Lancet Reg Health Am. 2023 Jul 13;24:100549. doi: 10.1016/j.lana.2023.100549. eCollection 2023 Aug.
The development of bipolar disorder is currently explained by a complex interaction of genetic and environmental factors. Less is known regarding the influence of sociocultural factors. This study aims to evaluate the incidence and impact of sociocultural factors on bipolar disorder onset in two comparable samples of youth growing up in different social settings.
We leveraged data from two urban population-based cohorts representative of Puerto Rican children growing up in either San Juan (Puerto Rico) or the South Bronx (NYC) and followed up for 17 years. Bipolar disorder diagnoses were based on retrospective self-reports on the World Health Organization Composite International Diagnostic Interview. We used a causal inference approach to estimate associations of sociocultural factors with bipolar disorder onset after adjusting for potential confounders.
We found that South Bronx children, who grew up as a minoritized group, had twice the risk of bipolar disorder onset as young adults, with an incidence rate of 2.22 new cases per 1000 person-years compared to 1.08 new cases in San Juan (incidence rate difference, 1.13; 95% CI, 0.09-1.20). After adjusting for potential confounders, South Bronx children had the same lifetime hazard of bipolar disorder onset compared to San Juan children. However, our analysis demonstrated that caregivers' exposure to societal cultural stress partially explained the increased risk of bipolar disorder onset in the South Bronx, in addition to the potential contribution of genetics.
Our results provide evidence that societal cultural stress can increase the risk of lifetime bipolar disorder onset in youth growing up as a minoritized group. Addressing stress in minoritized groups might reduce the risk of bipolar disorder onset.
The Boricua Youth Study has been supported by the National Institutes of HealthMH56401, MH098374, DA033172, and AA020191. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.
双相情感障碍的发病目前被认为是遗传和环境因素复杂相互作用的结果。关于社会文化因素的影响，我们了解得较少。本研究旨在评估社会文化因素对在不同社会环境中成长的两个可比青年样本中双相情感障碍发病的发生率及影响。
我们利用了来自两个以城市人口为基础的队列的数据，这些数据代表了在圣胡安（波多黎各）或南布朗克斯（纽约市）成长的波多黎各儿童，并对其进行了17年的随访。双相情感障碍的诊断基于对世界卫生组织综合国际诊断访谈的回顾性自我报告。我们采用因果推断方法，在调整潜在混杂因素后，估计社会文化因素与双相情感障碍发病之间的关联。
我们发现，作为少数族裔群体成长起来的南布朗克斯儿童，成年后患双相情感障碍的风险是圣胡安儿童的两倍，发病率为每1000人年2.22例新病例，而圣胡安为每1000人年1.08例新病例（发病率差异为1.13；95%置信区间，0.09 - 1.20）。在调整潜在混杂因素后，南布朗克斯儿童与圣胡安儿童患双相情感障碍的终生风险相同。然而，我们的分析表明，除了遗传因素的潜在作用外，照顾者所面临的社会文化压力部分解释了南布朗克斯儿童双相情感障碍发病风险的增加。
我们的研究结果表明，社会文化压力会增加作为少数族裔群体成长起来的青年患双相情感障碍的终生风险。解决少数族裔群体的压力可能会降低双相情感障碍的发病风险。
波多黎各青年研究得到了美国国立卫生研究院MH56401、MH098374、DA033172和AA020191的支持。资助者在研究设计、数据收集和分析、决定发表或文章撰写方面没有参与。
