A Comparison of Family Environment Among Famies Raising Children with Bipolar or Unipolar Disorder and Families Raising Healthy Chidlren
This study presents a quantitative secondary analysis of the effect of family environmental factors on 143 families divided into 3 diagnostic groups: 54 families raising children with bipolar disorder, 44 families raising children with unipolar disorder, and 45 families raising healthy control children. The research question was: Do the family environments of children with bipolar disorder, depressive disorder, and families with children with no diagnosis differ? Family environment is an essential element in understanding and treating bipolar disorder in children; however, this element has received limited attention in the study of mood disorders. Families lack the support required to understand and help their dependent children with this disorder.
Methods
Participants in the original study were enrolled in CERT-BD, a multi-site NIMH study in which the Principal Investigator, conducted several studies of bipolar disorder, The primary focus was to examine how the brain works in children with bipolar disorder by using functional MRI In addition, extensive data were collected regarding the symptoms of the child experiencing bipolar disorder, the family environment, and other family characteristics including demographic information. For the purpose of confirming the diagnosis of bipolar disorder or major depressive disorder, both the child identified as having the disorder and one of the child’s parents were interviewed separately. The Kiddie-SADS-Present and Lifetime Version (K-SADS-PL; Kaufman et al., 1997), with supplemental items from the Washington University Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS; Geller et al., 2001), was used to determine whether the participants met the criteria for bipolar or unipolar depression. The Family Environment Scale was administered to a parent and results in a subscale score for 10 subscales (Achievement Orientation, Active recreational orientation, Cohesion, Conflict, Control, Expressiveness, Independence, Intellectual cultural Orientation, Moral religious emphasis, Organization.) For this study, ANCOVA was calculated for each FES subscale score by diagnostic group.
Results
Findings show families raising children with bipolar or unipolar disorder report significantly lower FES Subscale scores for family cohesion, expressiveness, active recreational orientation ( all p<.0001) , intellectual–cultural orientation, independence and higher levels of conflict as compared with healthy control families. The results of the ANOVA analysis suggest that families raising a child with bipolar or unipolar disorder differ from families raising a child without a diagnosed disorder in terms of characteristics of interpersonal/social relationships and in select areas of the personal growth domain. In terms of the family system maintenance domain (i.e., organization and control subscales), no significant differences were found among the three groups of families.
Surprisingly, only one subscale—the expressiveness subscale—showed a difference in mean scores between the unipolar and bipolar groups. On the FES measure of expressiveness, families raising a child with unipolar disorder had a lower mean score than families raising a child with bipolar disorder.
Conclusions and Implications
Implications of this research underscore importance of addressing family environmental factors when treating families raising a child with bipolar or unipolar disorder and using family strengths identified in this study.