Patterns and predictors of family environment among adolescents at high and low risk for familial bipolar disorder

Emma K. Stapp, Rashelle J. Musci, Janice M. Fullerton, Anne L. Glowinski, Melvin McInnis, Philip B. Mitchell, Leslie A. Hulvershorn, Neera Ghaziuddin, Gloria M.P. Roberts, Kathleen R. Merikangas, John I. Nurnberger, Holly C. Wilcox

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Children's perceptions are important to understanding family environment in the bipolar disorder (BD)high-risk context. Our objectives were to empirically derive patterns of offspring-perceived family environment, and to test the association of family environment with maternal or paternal BD accounting for offspring BD and demographic characteristics. Participants aged 12–21 years (266 offspring of a parent with BD, 175 offspring of a parent with no psychiatric history)were recruited in the US and Australia. We modeled family environment using latent profile analysis based on offspring reports on the Conflict Behavior Questionnaire, Family Adaptability and Cohesion Evaluation Scales, and Home Environment Interview for Children. Parent diagnoses were based on the Diagnostic Interview for Genetic Studies and offspring diagnoses were based on the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Latent class regression was used to test associations of diagnosis and family environment. Two-thirds of all offspring perceived well-functioning family environment, characterized by nurturance, flexibility, and low conflict. Two ‘conflict classes’ perceived family environments low in flexibility and cohesion, with substantial separation based on high conflict with the father (High Paternal Conflict), or very high conflict and rigidity and low warmth with the mother (High Maternal Conflict). Maternal BD was associated with offspring perceiving High Maternal Conflict (OR 2.8, p = 0.025). Clinical care and psychosocial supports for mothers with BD should address family functioning, with attention to offspring perceptions of their wellbeing. More research is needed on the effect of paternal BD on offspring and family dynamics.

Original languageEnglish
Pages (from-to)153-160
Number of pages8
JournalJournal of Psychiatric Research
StatePublished - Jul 2019


  • Bipolar disorder
  • Father-child relations
  • Latent profile analysis
  • Mood disorders
  • Mother-child relations
  • Risk factors


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