Document Type : Research paper


1 Postgraduate Resident, Department of Psychiatry, Pushpagiri Institute of Medical Sciences & Research Centre, Thiruvalla, Kerala, India.

2 Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India


Background: The full impact of stressful life events and social support in the course of bipolar disorder is poorly understood and limited relevant research is available. Consequently, we intended to determine the impact of stressful life events and social support in patients with bipolar disorder attending a tertiary care centre during a period of one year.
Methods: 157 patients with bipolar disorder either in relapse or in remission according to DSM-5 diagnostic criteria were included in the study by consecutive sampling after taking informed consent. They were assessed using a semi-structured demographic proforma, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Presumptive Stressful Life Events Scale, and Oslo’s Social Support Scale.
Results: 56.7% (89/157) of the patients had a relapse episode and 43.3% (68/157) were in remission. 75.3% (67/89) of relapsed patients had stressful life events in the pre-onset period, among which 80.5% had mania and 12% had depression. Family conflicts (33.7%), marital conflicts (12.4%) and the death of a close family member (6.7%) were the most commonly reported stressful life events. Stressful life events and poor social support have statistically significant association with relapse of bipolar disorder – 70.58% (60/85) of patients with strong social support had no stress or mild stress and the difference is statistically significant when compared with those patients with poor and moderate social support (Kocalevent and others, 2018). Conclusion: Stressful life events and a greater severity of stress in the pre-onset period were risk factors for relapse, whereas strong social support helps in maintaining remission. Knowing the severity and impact of stressful life events and the strength of social support in the course of bipolar disorder helps in predicting further relapse and to modify the psychosocial factors, environmental factors, and social support systems.


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