Abstract

It is well known that the offspring of parents with bipolar disorder (OBD) are at heightened risk of developing mental disorders, particularly the affective disorders. However, we have much less information about deleterious non-psychiatric outcomes, such a health-risk behaviors, and the family-environmental risk factors associated with negative outcomes in the OBD. It has been proposed that the OBD, through genetic mechanisms and early family interactions, develop a heightened sensitivity to stress, maladaptive coping, and dysregulated behavior, which ultimately increases the risk for affective disorders. The current dissertation was designed to test parts of this model by conducting a comprehensive assessment of social risk factors, personality, and mental health in the OBD, and to examine putative antecedents of negative outcomes in the OBD using 10-year longitudinal data. The first study within this dissertation assessed different psychosocial and health-related outcomes in the OBD, including mental health, personality, coping style, smoking, suicidality, high-risk sexual behaviors, criminality, and mental health. These factors were compared across affected and unaffected offspring in order to differentiate potential prodromal markers from correlates of mood episodes. It was found that unaffected OBD engaged in less task-oriented and more avoidant coping strategies than controls. Furthermore, after controlling for current affective disorders, the OBD were more likely than controls to engage in sexual risk behaviors (SRBs). In the second study, parents’ personality, specifically high neuroticism, was assessed to determine whether it predicted SRBs among the offspring 10 years later, and whether the relationship between parents’ personality and offspring SRBs was mediated by behavioral problems in middle childhood. High neuroticism, low agreeableness, and low extraversion in the parents predicted SRBs in their offspring in late adolescence-early adulthood. The offspring’s externalizing problems in middle childhood partly mediated the association between parents’ personality and offspring SRBs. The findings highlight a risk profile in the OBD characterized by poor stress coping and engagement in risky sexual behaviors. Furthermore, SRBs were related to a developmental trajectory that included markers of family stress and early externalizing problems. Together, these studies highlight the importance of behavior problems as markers of vulnerability in the OBD. Importantly, this pattern of results emphasizes the need for targeted, early interventions aimed at increasing familial stability and stress management before the development of behavioral problems.