ABSTRACT

Despite strong genetic contributions to bipolar disorder (Vehmanen, Kaprio, & Loennquivst, 1995), several studies have shown that the social environment could be important to the course of the disorder. For example, longitudinal studies using interview-based measures of life events showed that people with bipolar disorder who experienced a negative life event had more than four times the risk of relapse compared to individuals without a life event (Ellicott, Hammen, Gitlin, Brown, & Jamison, 1990). Other research has demonstrated a strong role for family levels of expressed emotion in predicting bipolar relapse (Miklowitz, Goldstein, & Neuchterlein, 1987; Miklowitz, Simoneau, Sachs-Ericsson, Warner, & Sudath, 1996; Priebe, Wildgrube, & Muller-Oerlinghausen, 1989). In short, early studies suggested a potentially strong role for the social environment in this biologically based disorder, but many questions remained unanswered (Johnson & Roberts, 1995).