Chronic Stress in Bipolar Disorders Across the Different Clinical States: Roles of HPA Axis and Personality

Figures & data

Figure 1 Flow chart of the study design.

Table 1 Demographic Characteristics, Clinical Features, and HPA Axis of Patients with BD at Baseline (N= 813)

Variables	Manic Group [1]	Mixed Group [2]	Remission Group [3]	Depression Group [4]	F/χ2	p	Eta	Post-hoc
	N=227	N=80	N=40	N=466
Age (years)	33.91(14.10)	33.65(11.96)	32.35(14.34)	35.62(14.17)	1.37	0.251	0.07	-
Gender M/F	112/115	41/39	18/22	116/330	46.22	<0.001***	-	-
Family history	18	11	4	45	2.35	0.504	-	-
The age of onset	27.71(12.41)	25.91(7.70)	24.08(9.50)	27.60(11.71)	1.53	0.205	0.08	-
Number of affective episodes	3.41(2.78)	4.00(1.73)	2.88(0.83)	3.14(3.31)	3.10	0.026*	0.11	-
Duration time for diagnosis (month)	15.67(21.73)	20.24(23.16)	29.28(29.51)	20.60(23.96)	4.35	0.005**	0.13	1<3
YMRS	26.22 (10.29)	21.01 (8.37)	4.90 (5.48)	4.14 (6.13)	466.11	<0.001***	0.79	3/4<2<1
MADRS	8.55 (9.36)	26.84 (9.76)	8.78 (8.24)	26.46(8.68)	239.37	<0.001***	0.69	3/1<2/4
CGI	4.28 (1.20)	4.16 (1.16)	2.15 (0.74)	4.58 (0.88)	72.99	<0.001***	0.46	3 <1/2< 4
ACTH	32.05 (18.29)	29.22 (16.93)	30.57 (22.76)	29.07 (16.86)	1.52	0.207	0.08	-
CORT	380.67 (192.69)	423.64 (155.29)	452.74 (212.82)	405.29 (183.94)	2.417	0.065	0.09	-

Notes: *p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001.

Table 2 The Independent Correlates of HPA According to the Multiple Linear Regression (N=170)

Variables	ACTH			CORT
	β	t	p	β	t	P
Neuroticism	−0.111	−1.622	0.106	−0.223	−2.340	0.021*
Extroversion	0.001	0.021	0.984	−0.311	−3.290	0.001**
Openness	−0.081	−1.158	0.248	−0.163	−2.041	0.043*
Agreeableness	0.025	0.336	0.737	−0.041	−0.509	0.611
Conscientiousness	−0.271	−3.418	0.000***	0.078	0.948	0.345
YMRS	0.115	0.991	0.323	0.112	1.363	0.175
MADRS	−0.009	−0.119	0.905	−0.036	−0.441	0.660
CGI	0.072	0.885	0.378	−0.057	−0.713	0.477
Age	0.079	0.991	0.323	0.064	0.790	0.431
The age of onset	0.033	0.417	0.667	0.074	0.908	0.365
Number of affective episodes	−0.038	0.417	0.667	0.088	1.111	0.269
Duration time for diagnosis	−0.136	−1.723	0.087	0.005	0.059	0.953

Notes: *p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001.

Figure 2 K-means subtyping via dynamic time warping (DTW) algorithm.

Notes: Green means manic symptom trajectory cluster 1; golden represents manic symptom trajectory cluster 2.

Figure 3 Symptom profiles of the two clusters.

Notes: **p ≤ 0.01, ***p ≤ 0.001; green means cluster 1; golden represents cluster 2.

Figure 4 Mediation effects of personality on the relationship between ACTH levels and symptoms (N = 170).

Notes: *P<0.05, **P<0.01, ***P<0.001. The ACTH – Conscientiousness – CGI changing scores mediation model showed good model fit index: CMIN/DF=5.843, p=0.001; RMSEA=0.169. ACTH was negatively related to conscientiousness (βa=−0.264, p<0.001). In turn, conscientiousness was negatively related to CGI changing scores (βb=−0.147, p=0.041). Indirect effect of ACTH on therapeutic efficacy measured by CGI changing scores through conscientiousness (ab)= 0.039, direct effect (c’) = 0.065 (p=0.411), total effect (c) = 0.103 (p=0.001).