Interpersonal functioning in adolescent offspring of parents with bipolar disorder

Abstract

Background

Poor interpersonal functioning may represent a putative prodromal feature of major affective disorder. However, no studies have examined the naturalistic patterns of social behaviours among the offspring of parents with a major affective disorder. The present study assessed daily social interactions among 25 offspring of parents with bipolar disorder and 23 control participants in late adolescence and young adulthood.

Methods

Using event-contingent recording procedures, interpersonal behaviours and perceptions were assessed along four scales (quarrelsomeness, agreeableness, dominance, and submissiveness) and were measured during specific social interactions over 14 days.

Results

Multilevel modeling analyses revealed no group differences on any of the four scales, but gender by group interactions were was observed. High-risk males reported higher mean levels of quarrelsome behaviour and lower mean levels of agreeable behaviour than high-risk females, whereas low-risk males and females reported comparable levels of affiliative behaviours. High-risk participants reported more externalizing, but not internalizing, problems on the Achenbach Youth Self-Report Form than low-risk participants.

Limitations

Although event-contingent recording reduces the self-report bias associated with self-report questionnaires, participants may have been biased in the selection of interactions they chose to record.

Conclusions

Overall, the offspring of parents with BD, relative to controls, report no deficits in social functioning in the natural environment. However, high-risk youth displayed elevated externalizing problems and gender-specific patterns of social functioning that may precede the development of major affective disorder.

Introduction

Different areas of occupational and interpersonal functioning are impaired in depression and bipolar disorder (BD; Hammen and Cohen, 2004), and these deficits persist during periods of clinical remission (Goldberg and Harrow, 2005). Moreover, cross-sectional and longitudinal research have found a relationship between interpersonal problems and the development of major depression (Eberhart and Hammen, 2006, Goldberg and Harrow, 2005). Thus, poor interpersonal functioning may be both a correlate of a major affective disorder and a causal factor in its etiology. Few studies have examined the role of interpersonal functioning in the offspring of parents with BD. This population presents a unique opportunity to examine the developmental antecedents of major affective disorders because the offspring of parents with BD are four times more likely to develop a major affective disorder than offspring of parents with no mental disorder (NMD; Lapalme et al., 1997). Having a parent with BD confers a robust genetic predisposition for the development of mood disorders (McGuffin et al., 2003). Social and environmental variables likely also play a significant role, both directly (Ellenbogen and Hodgins, 2004) and through gene–environment interactions (Taylor et al., 2006).

With regards to early interpersonal influences, children of parents with BD exhibit emotional and behavioural problems from an early age, including more hostility, maladaptive patterns of aggression when interacting with peers, difficulties in empathy or role taking, and behavioural problems than their control counterparts (Zahn-Waxler et al., 1988). They continue to exhibit more disruptive problems in middle and late childhood, and in adolescence relative to the offspring of parents with NMD (Ellenbogen et al., 2006). In one study, externalizing problems during middle childhood were more severe among the offspring of parents with BD exposed to poor parenting practices and a wide range of environmental risk factors associated with parental neuroticism (Ellenbogen and Hodgins, 2004). This line of research suggests that problem behaviours displayed during preschool in the offspring of parents with BD tend to persist into childhood and adolescence.

Few studies have examined social functioning in youth at risk for BD, and the results of these studies have been inconsistent. In the Camberwell Collaborative Psychosis study, youth who developed BD in adulthood were reported to have more social impairment than controls participants (Cannon et al., 1997). However, other studies have found little evidence of impairment in the premorbid interpersonal functioning of patients with BD or of high-risk youth having at least one first-degree relative with BD (Anderson and Hammen, 1993, Kutcher et al., 1998, Petti et al., 2004, Reichart et al., 2007). Research in this area to date has mostly focused on measuring interpersonal problems using questionnaire-based assessments from different informants (i.e., parents, teachers, participants). Although these methods are informative, they have important limitations. For instance, depressed mothers appear to have a tendency to focus on the negative aspects of their children's behaviour (Boyle and Pickles, 1997). Some studies have used laboratory-based observations. While these provide more objective behavioural measurements, target behaviours are assessed in artificial situations and at singular points in time, which may not be representative of how participants behave in the natural environment. No study to date has examined how interpersonal behaviours are manifested within naturally occurring social situations among youth at high risk for major affective disorders.

The aim of the present study was to circumvent the methodological limitations of previous studies by sampling everyday social interactions using an event-contingent recording method developed by Moskowitz (1994). Event-contingent recording is a reliable and validated method in which participants record their behaviours, affect, and perceptions of others' behaviours during naturally occurring social interactions. Interpersonal behaviours are measured along two independent axes of behaviour. The “status” axis encompasses submissive and dominant behaviours whereas the “affiliation” axis includes quarrelsome and agreeable behaviours. On the “status” axis of behaviour, measures of dominance and submissiveness have a Pearson correlation r = 0.41. On the “affiliation” axis of behaviour, measures of quarrelsomeness and agreeableness have a Pearson correlation of r = 0.32. The two axes are not significantly correlated with one another (Moskowitz, 1994). A major advantage of this technique is that it is not subject to the retrospective biases associated with self-report questionnaires (Reis et al., 2000). As such, over a period of 14 days, we examined the interpersonal functioning of offspring of parents with BD, now in late adolescence and early adulthood, in comparison to an age- and sex-matched control group of offspring of parents with NMD.

Because we observed increased internalizing and externalizing problems among the offspring of parents with BD at an earlier assessment (Ellenbogen et al., 2006), and that submissive behaviours tend to be associated with depressive symptoms (Allan and Gilbert, 1997), we expected that adolescent offspring of parents with BD would display higher mean levels of quarrelsome and submissive behaviours and lower mean levels of agreeable and dominant behaviours than the offspring of parents with NMD. We also predicted that adolescent offspring of parents with BD would report significantly higher mean levels of negative affect and lower positive ratings of others during social interactions than control participants. Finally, it was expected that the adolescent offspring of parents with BD would have higher internalizing and externalizing scores on the Achenbach Youth Self-Report than controls.