Study findings show that people with bipolar disorder, also known as manic depression, who have a history of childhood abuse are likely to have a more severe disease course than bipolar patients without such history.

Dr George Brown, from East Tennessee State University in Johnson City, USA, and colleagues therefore recommend that "clinicians should routinely seek information regarding abuse and be aware that these patients may be more difficult to treat than bipolar patients who have no abuse histories."

The researchers examined data about exposure to childhood physical, sexual or combined abuse for 330 veterans with bipolar disorder, of whom 91% were male.

Childhood abuse was reported by 48.3% of the participants, 47.3% of whom were men. Sexual abuse without physical abuse was reported by 8% of the men, physical abuse without sexual abuse by 20.7% and both types of abuse by 18.7%.

Female veterans were more likely to report sexual abuse (27%) than men and less likely to report physical abuse (6.7%).

The researchers note in the Journal of Affective Disorders that bipolar patients with a history of childhood abuse tended to have worse outcomes than those without such a history.

Indeed, individuals who reported any childhood abuse were more likely to have post-traumatic stress disorder (PTSD), panic disorder and alcohol use disorders than those without childhood abuse.

Combined physical and sexual abuse, compared with no abuse, was associated with an increased risk of PTSD and lifetime diagnoses of alcohol use disorders, as well as a high number of episodes of major depression during a lifetime and an increased likelihood of attempting suicide at least once.

The researchers note that their findings suggest that "abuse histories, especially the combination of physical and sexual abuse later the course and presentation of bipolar disorder".

Dr Brown and co-workers now intend to evaluate whether healthcare delivery focused specifically at patients with bipolar disorder and a history of childhood abuse can improve their outcome.