Association of sociocultural stressors with bipolar disorder onset in Puerto Rican youth growing up as members of a minoritized ethnic group: results from the Boricua Youth Longitudinal Study

Irene Falgas-Bague; Mario Cruz-Gonzalez; Jenny Zhen-Duan; Arundati Nagendra; Kiara Alvarez; Glorisa Canino; Cristiane S Duarte; Hector Bird; Pablo M De-Salazar; Margarita Alegría

doi:10.1016/j.lana.2023.100549

Association of sociocultural stressors with bipolar disorder onset in Puerto Rican youth growing up as members of a minoritized ethnic group: results from the Boricua Youth Longitudinal Study

Lancet Reg Health Am. 2023 Jul 13:24:100549. doi: 10.1016/j.lana.2023.100549. eCollection 2023 Aug.

Authors

Irene Falgas-Bague^{1

2

3}, Mario Cruz-Gonzalez^{1

2}, Jenny Zhen-Duan^{1

2

4}, Arundati Nagendra^{1

2

5}, Kiara Alvarez^{1

2

6}, Glorisa Canino⁷, Cristiane S Duarte⁸, Hector Bird⁸, Pablo M De-Salazar^{3

9}, Margarita Alegría^{1

2

4}

Affiliations

¹ Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA.
² Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
³ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 2 Kreutzstrasse, 4123, Allschwil, Switzerland.
⁴ Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA.
⁵ Schizophrenia and Psychosis Action Alliance, Alexandria, VA 22301, USA.
⁶ Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
⁷ Behavioral Sciences Research Institute, University of Puerto Rico Medical School, Office A928 9th Floor, Rio Piedras, 00935, Puerto Rico.
⁸ New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA.
⁹ Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Suite 506, 677 Huntington Avenue, Boston, MA 02115, USA.

Abstract

Background: The development of bipolar disorder is currently explained by a complex interaction of genetic and environmental factors. Less is known regarding the influence of sociocultural factors. This study aims to evaluate the incidence and impact of sociocultural factors on bipolar disorder onset in two comparable samples of youth growing up in different social settings.

Methods: We leveraged data from two urban population-based cohorts representative of Puerto Rican children growing up in either San Juan (Puerto Rico) or the South Bronx (NYC) and followed up for 17 years. Bipolar disorder diagnoses were based on retrospective self-reports on the World Health Organization Composite International Diagnostic Interview. We used a causal inference approach to estimate associations of sociocultural factors with bipolar disorder onset after adjusting for potential confounders.

Findings: We found that South Bronx children, who grew up as a minoritized group, had twice the risk of bipolar disorder onset as young adults, with an incidence rate of 2.22 new cases per 1000 person-years compared to 1.08 new cases in San Juan (incidence rate difference, 1.13; 95% CI, 0.09-1.20). After adjusting for potential confounders, South Bronx children had the same lifetime hazard of bipolar disorder onset compared to San Juan children. However, our analysis demonstrated that caregivers' exposure to societal cultural stress partially explained the increased risk of bipolar disorder onset in the South Bronx, in addition to the potential contribution of genetics.

Interpretation: Our results provide evidence that societal cultural stress can increase the risk of lifetime bipolar disorder onset in youth growing up as a minoritized group. Addressing stress in minoritized groups might reduce the risk of bipolar disorder onset.

Funding: The Boricua Youth Study has been supported by the National Institutes of HealthMH56401, MH098374, DA033172, and AA020191. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.

Keywords: Bipolar disorders; Environmental factors as risk factors for severe mental illnesses; Minoritized groups.

Grants and funding

K23 MH112841/MH/NIMH NIH HHS/United States