Social rhythm disruption and stressful life events in the onset of bipolar and unipolar episodes
Abstract
Background. An association between social rhythm disruption (SRD) and onset of manic episodes has recently been observed. Whether other types of bipolar (depressive and cycling) or unipolar depressive episodes are similarly related to SRD is unclear, as is the association between severely threatening life events and onset of bipolar manic, depressed and cycling episodes. Methods. Bipolar patients with purely manic ( N = 21), purely depressed ( N = 21) and cycling ( N = 24) episodes, and 44 patients with recurrent unipolar depression, were interviewed with the Bedford College Life Events and Difficulties Schedule. The presence of severe and SRD events during the year prior to index episode onset was then determined. Results. More manic than cycling and unipolar subjects experienced SRD events during 8- and 20-week pre-onset periods, and severe events during 20-week pre-onset periods. Controlling for age and prior number of episodes left most findings unchanged. An earlier finding of more manic subjects with SRD events in an 8-week pre-onset versus control period was also replicated. Conclusions. It appears that manic onsets are influenced by stressful life events, especially those involving SRD, in a unique manner compared to onsets of other types of bipolar and unipolar episodes. Onset of bipolar cycling episodes, in contrast, seems to be relatively unaffected by SRD or severe life events. These findings refine the hypothesis that SRD may precipitate onset of affective episodes to be specific to manic onsets.
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A major social disruptive event is associated with inducing mania, but not depression, in bipolar disorder patients.
“A major social disruptive event is associated with inducing mania, but not depression in BD patients122.”
From Circadian rhythm disruption and mental health (2020) · cites this paper as [122]
Disruption of circadian social rhythms, such as social jet lag, may also induce bipolar episodes.
“Disruption of circadian social rhythms, such as social jet lag, may also induce bipolar episodes.”
From Circadian rhythm disruption and mental health (2020) · cites this paper as [122]
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Circadian rhythm disruption and mental health
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“Two other studies have examined the association of life events and social rhythm regularity in a clinical sample (Malkoff-Schwartz et al., 2000, 1998).”
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“When rates of life events pre-onset were compared to the rate of events among control participants, schedule-disrupting events were not more common before manic periods than they were in the general population (Malkoff-Schwartz et al., 2000).”
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“We subsequently demonstrated that life events characterized by disruption in daily routines are, indeed, associated with the onset of depression and, particularly, of mania (Malkoff-Schwartz et al., 2000; MalkoffSchwartz et al., 1998).”
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“Two efficacious behavioral therapies for BD sufferers, bright light exposure (phototherapy) [19–22] and social rhythm therapy [23, 24], both seek to maintain a fixed photoperiod/activity lengths.”
BackgroundDoes gene deletion of AMPA GluA1 phenocopy features of schizoaffective disorder?
Fitzgerald, P. J., Barkus, C., Feyder, M. J., Wiedholz, L. M., Chen, Y.-C., Karlsson, R., Machado‐Vieira, R., Graybeal, C., Sharp, T., Zarate, C. A., et al. (2010) · Neurobiology of Disease · doi:10.1016/j.nbd.2010.08.005 · Cited by 79 · see citing works
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Stressful life events in bipolar I and II disorder: Cause or consequence of mood symptoms?
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“…as prior studies demonstrating that low social rhythm regularity predicts recurrences of bipolar mood episodes in individuals with BSDs (Shen et al., 2008) and that life events that disrupt social rhythms precipitate bipolar mood episodes (Malkoff-Schwartz et al., 1998; 2000; Sylvia et al., 2009).”
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“Furthermore, stressful life events, particularly those that disrupt social rhythms (which is likely if people are confined to home), are often implicated in the onset and reoccurrence of mood disorders (30, 31).”
BackgroundChildhood Stressful Life Events and Bipolar Spectrum Disorders
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“More specifically, Malkoff–Schwartz et al. (2000) found that manic episodes, more so than depressive episodes, are associated with social rhythm disruption brought about by negative life events.”
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“Further, Malkoff-Schwartz et al. (1998, 2000) found that manic patients had significantly more preonset stressors characterized by social rhythm disruption (e.g., change in sleep–wake cycle) than did depressed patients with bipolar disorder.”
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“In fact, the etiology of depression has been tied to social zeitgebers since major life events are hypothesized to disrupt zeitgebers, which can dysregulate the circadian system and precipitate depressive episodes in vulnerable individuals (Ehlers et al., 1988; Haynes et al., 2006; Malkoff-Schwartz et al., 2000).”
BackgroundFunctional Impairment, Stress, and Psychosocial Intervention in Bipolar Disorder
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“It has long been known that manic episodes are often preceded by life events that interfere with sleep (eg, transatlantic flights, childbearing) [27–29].”
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“What is more, evidence suggests that disruptions to daily routin e, i cluding social interactions, caused by external events may trigger an onset of an episode in bipolar patients [5,10].”
InfluentialSleep impairment, mood symptoms, and psychosocial functioning in adolescent bipolar disorder
Lunsford‐Avery, J. R., Judd, C. M., Axelson, D., & Miklowitz, D. J. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.07.037 · Cited by 44 · see citing works
“…are similar to emerging evidence from the adult bipolar literature, which has indicated that sleep duration and variability are prospectively associated with severity of mania and depression symptoms, constituting candidate targets for treatment (Malkoff-Schwartz et al., 2000; Gruber et al., 2010).”
BackgroundResultPsychiatric symptoms during the COVID‐19 outbreak in older adults with bipolar disorder
Orhan, M., Korten, N. C. M., Paans, N. P. G., de Walle, B., Kupka, R., van Oppen, P., Kok, A. A. L., Sonnenberg, C., Schouws, S. N. T. M., & Dols, A. (2020) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5489 · Cited by 44 · see citing works
“More in general, previous studies reported that life events characterized by disruption of daily routines are associated with the onset of depression and mania in adults.(28,29) An explanation for this discrepancy between younger patients and our results in older adults can be found in the maturation‐hypothesis, stati…”
ResultMorningness – eveningness and treatment response in major depressive disorder
Corruble, E., Frank, E., Gressier, F., Courtet, P., Bayle, F., Llorca, P., Vaïva, G., & Gorwood, P. A. P. M. (2013) · Chronobiology International · doi:10.3109/07420528.2013.834924 · Cited by 43 · see citing works
“, 1986), social circadian rhythms have only recently become a focus of interest in MDD (Ehlers et al., 1988; Malkoff-Schwartz et al., 2000).”
BackgroundSelf-citationLife-event specificity: bipolar disorder compared with unipolar depression
Hosang, G. M., Korszun, A., Jones, L. A., Jones, I. R., McGuffin, P., & FARMER, A. E. (2012) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.112.111047 · Cited by 41 · see citing works
Affective Disruption From Social Rhythm and Behavioral Approach System (BAS) Sensitivities
Boland, E. M., Stange, J. P., LaBelle, D. R., Shapero, B. G., Weiss, R. B., Abramson, L. Y., & Alloy, L. B. (2015) · Clinical Psychological Science · doi:10.1177/2167702615603368 · Cited by 42 · see citing works
Murray, G., Gottlieb, J. F., & Swartz, H. A. (2020) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720957825 · Cited by 40 · see citing works
The Importance of Routine for Preventing Recurrence in Bipolar Disorder
Frank, E., Gonzalez, J. M., & Fagiolini, A. M. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.6.981 · Cited by 38 · see citing works
Self-citationDisrupted circadian rhythms and mental health
Walker, W. H., Walton, J. C., & Nelson, R. J. (2021) · Handbook of clinical neurology · doi:10.1016/b978-0-12-819975-6.00016-9 · Cited by 45 · see citing works
Delayed Bedtimes and Obsessive–Compulsive Symptoms
Coles, M. E., Schubert, J. R., & Sharkey, K. M. (2012) · Behavioral Sleep Medicine · doi:10.1080/15402002.2011.634939 · Cited by 38 · see citing works
“For example, disruptions in daily routines associated with life events have been associated with mania ( Malkoff-Schwartz et al, 2000 ) and children with anxiety disorders have later bedtimes than their peers ( Hudson, Gradisar, Gamble, Schniering, & Rebelo, 2009 ).”
BackgroundCircadian rhythms and sleep in bipolar disorder
Soreca, I. (2014) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000108 · Cited by 38 · see citing works
“[9], in their seminal study, found that the onset of manic episodes was preceded”
BackgroundPsychiatric epidemiology: Challenges and opportunities
Kessler, R. C. (2007) · International Review of Psychiatry · doi:10.1080/09540260701564914 · Cited by 36 · see citing works
“Such studies might be even more valuable, though, in providing information about potentially modifiable environmental triggers of episode recurrence (Malkoff-Schwartz et al., 2000; Monroe et al., 2006).”
BackgroundA review of potential cognitive and environmental risk markers in children of bipolar parents
Jones, S. H., & Bentall, R. P. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2008.03.002 · Cited by 35 · see citing works
Childhood adverse life events and parental psychopathology as risk factors for bipolar disorder
Bergink, V., Larsen, J. T., Hillegers, M. H. J., Dahl, S. K., Stevens, H., Mortensen, P. B., Petersen, L. V., & Munk‐Olsen, T. (2016) · Translational Psychiatry · doi:10.1038/tp.2016.201 · Cited by 35 · see citing works
Nomura, K., Castañón‐Cervantes, O., Davidson, A. J., & Fukuhara, C. (2008) · Life Sciences · doi:10.1016/j.lfs.2008.03.024 · Cited by 35 · see citing works
“It has been suggested that affected circadian rhythm generation (sleep–wake cycles) and the development of certain mental illnesses, such as depression, bipolar disorders, and seasonal affective disorders are somehow correlated (Ehlers et al., 1988; Malkoff-Schwartz et al., 2000; Grandin et al., 2006; Lader, 2007; McC…”
BackgroundInfluentialThe Association of Bipolar Spectrum Disorders and Borderline Personality Disorder
Antoniadis, D., Samakouri, M. A., & Livaditis, M. (2012) · Psychiatric Quarterly · doi:10.1007/s11126-012-9214-6 · Cited by 35 · see citing works
“(i) Its appearance in BPD is related to stimuli by the environment [25, 26], which is uncommon in BD [27].”
BackgroundJones, S. H., Sellwood, W., & McGovern, J. (2005) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00157.x · Cited by 34 · see citing works
Social rhythm interventions for bipolar disorder: a systematic review and rationale for practice
Crowe, M., Beaglehole, B., & Inder, M. (2015) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12271 · Cited by 32 · see citing works
Sam, S. P., Nisha, A., & Varghese, P. J. (2018) · Indian Journal of Psychological Medicine · doi:10.4103/ijpsym.ijpsym_113_18 · Cited by 32 · see citing works
Clinical importance of inter-episode symptoms in patients with bipolar affective disorder
Morriss, R. K. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00340-3 · Cited by 31 · see citing works
The role of loss and danger events in symptom exacerbation in bipolar disorder
Hosang, G. M., Uher, R., Maughan, B., McGuffin, P., & FARMER, A. E. (2012) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.07.009 · Cited by 29 · see citing works
“(2003) found that individuals with BD were exposed to significantly more independent SLEs 3 months prior to a BD depressive but not a manic episode compared to a euthymic phase; although other studies fail to detect this association (Malkoff-Schwartz et al., 2000).”
BackgroundResultBipolar disorder: Improving diagnosis and optimizing integrated care
Culver, J. L., Arnow, B. A., & Ketter, T. A. (2006) · Journal of Clinical Psychology · doi:10.1002/jclp.20333 · Cited by 29 · see citing works
“The impact of life events and stressors on the onset and relapse of bipolar disorder (Johnson & Miller, 1997; Johnson & Roberts, 1995; Malkoff-Schwartz et al., 2000) suggests a potential role for psychosocial intervention in its management (Jones, 2004; Kahn et al.”
BackgroundPain and the Brain: Diabetic Neuropathic Pain
Jain, R. K. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.0808e22 · Cited by 27 · see citing works
Kalkman, H. O. (2019) · Pharmaceuticals · doi:10.3390/ph12030113 · Cited by 28 · see citing works
“Stressors like family or romantic conflicts and legal or disciplinary problems can trigger suicidal behaviors [17] and manic episodes [18,19].”
BackgroundLifestyle regularity and cyclothymic symptomatology
Shen, G. H. C., Sylvia, L. G., Alloy, L. B., Barrett, F. S., Kohner, M., Iacoviello, B. M., & Mills, A. (2008) · Journal of Clinical Psychology · doi:10.1002/jclp.20440 · Cited by 27 · see citing works
Classification of Mood Disorders in DSM-V and DSM-VI
Joyce, P. R. (2008) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670802363667 · Cited by 24 · see citing works
Triggers for acute mood episodes in bipolar disorder: A systematic review
Cordeiro, C. R., Côrte‐Real, B., Saraiva, R., Frey, B. N., Kapczinski, F. P., & Cardoso, T. D. A. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.03.008 · Cited by 24 · see citing works
Levy, B., Medina, A. M., Manove, E. E., & Weiss, R. D. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2011.01.005 · Cited by 24 · see citing works
Chronobiology of Mood Disorders: The Role of the Biological Clock in Depression and Bipolar Disorder
Geoffroy, P. A., & Maruani, J. (2025) · Biological Psychiatry · doi:10.1016/j.biopsych.2025.05.005 · Cited by 29 · see citing works
- Authors
- MALKOFF-SCHWARTZ, S., FRANK, E., ANDERSON, B. P., HLASTALA, S. A., LUTHER, J. F., SHERRILL, J. T., HOUCK, P. R., & KUPFER, D. J.
- Affiliations
- University of Pittsburgh (US)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2000-09
- Volume
- 30
- Issue
- 5
- Pages
- 1005-1016
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2085710201
- Cited by
- 234
- References
- 0
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 10 · 2023: 15 · 2022: 9 · 2021: 6 · 2020: 10 · 2019: 5 · 2018: 10 · 2017: 7 · 2016: 8 · 2015: 15 · 2014: 8 · 2013: 11 · 2012: 9
- FWCI
- 2.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH 29618, MH30915)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- life events, bipolar disorder, major depressive disorder
- MeSH terms
- Adult, Aged, Bipolar Disorder, Major Depressive Disorder, Female, Humans, Life Change Events, Male, Middle Aged, Recurrence, Risk Factors
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