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Aust N Z J Psychiatry. 2019 Feb;53(2):129-135. doi: 10.1177/0004867418761577. Epub 2018 Mar 14.

Coping strategies and self-esteem in the high-risk offspring of bipolar parents.

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1 Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
2 Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
3 Spectrum Centre for Mental Health Research, Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
4 Department of Epidemiology, School of Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
5 Department of Psychiatry, Queen's University Student Wellness Services, Kingston, Ontario, Canada.



This study investigated whether there were differences in coping strategies and self-esteem between offspring of parents with bipolar disorder (high-risk) and offspring of unaffected parents (control), and whether these psychological factors predicted the onset and recurrence of mood episodes.


High-risk and control offspring were followed longitudinally as part of the Flourish Canadian high-risk bipolar offspring cohort study. Offspring were clinically assessed annually by a psychiatrist using semi-structured interviews and completed a measure of coping strategies and self-esteem.


In high-risk offspring, avoidant coping strategies significantly increased the hazard of a new onset Diagnostic and Statistical Manual of Mental Disorders, 4th Edition twice revised mood episode or recurrence (hazard ratio: 1.89, p = 0.04), while higher self-esteem significantly decreased this hazard (hazard ratio: 2.50, p < 0.01). Self-esteem and avoidant coping significantly interacted with one another ( p < 0.05), where the risk of a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition twice revised new onset mood episode or recurrence was only significantly increased among high-risk offspring with both high avoidant coping and low self-esteem.


A reduction of avoidant coping strategies in response to stress and improvement of self-esteem may be useful intervention targets for preventing the new onset or recurrence of a clinically significant mood disorder among individuals at high familial risk.


High risk; coping; longitudinal; mood disorders; risk factors; self-esteem


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