Children of Parents with Bipolar Disorder in the United States are at High Risk for Depression, Anxiety, and Multiple other Disorders: Implications for Research, Monitoring, Treatment, and Prevention

In the United States (US) some two thirds of bipolar disorder in adults begins in childhood and adolescence compared to one third in Europeans. Two major risk factors for early onset include genetic/ familial loading and psychosocial adversity in childhood. There is a higher incidence of both of these factors in the US than in many other European countries. The parents, grandparents, and offspring of the US patients also have a higher incidence of illness than the Europeans, including more depression, bipolar disorder, alcohol and substance abuse, and “other” illness. Parents with mood disorders convey increased risk of mood and other childhood psychiatric disorders to their offspring via both genetic and epigenetic mechanisms. The incidence and earlier onset of these illnesses in childhood also appears to be increasing in the general population based on a cohort effect. Early onset bipolar disorder and depression have a more difficult course and prognosis than adult onset illness, in part related to a longer duration of the lag from illness onset to first treatment; yet this is a remedial risk factor. Increased vigilance for early onset mood and behavioral disorders based on the known clinical risk factors and more systematic monitoring of symptom emergence and response to treatment may help with earlier psychotherapeutic and pharmacotherapy interventions and help ameliorate the long term adverse consequences of childhood onset mood disorders. New research, clinical treatment, and public health initiatives are desperately needed.