Original Article Social support in elderly patients with bipolar disorder Although genetic and biological factors play a powerful role in bipolar disorder, social and psychological factors also significantly influence the onset, course, and recurrence of this illness. These factors have primarily been divided into two broad categories: stressful life events and social support. Stressful life events have been associated with the precipitation of manic and depressive episodes, especially in the early stages of the disease (1–5). The role of social support in bipolar disorder is less well understood. Studies of adults have dem- onstrated that bipolar patients perceive less social support than normal controls (6, 7), and actually receive less support than medical or normal con- trols (4, 7). The brief literature suggests that the effect of poor social support in bipolar illnesses can be particularly hazardous. Doi (8) and Speer (7) demonstrated that bipolar patients report less family support and a greater likelihood of living in a residential facility than do patients with a major depressive disorder. Patients with bipolar disorder have been shown to have low social interactions, high expressed emotion in the home, and increased family dysfunction and interpersonal conflict (9, 10). O’Connell et al. (11), in a study that included older subjects, found that limited social support was associated with increased mood symp- toms during the year following hospitalization, while Johnson et al. (12) found that social support Beyer JL, Kuchibhatla M, Looney C, Engstrom E, Cassidy F, Krishnan KRR. Social support in elderly patients with bipolar disorder. Bipolar Disord 2003: 5: 22–27. ª Blackwell Munksgaard, 2003 Objective: The role of social support in bipolar disorder is poorly understood. It is known that young and middle-aged patients with impaired social support are more likely to be treatment resistant and have increased hospitalization. However, the role of social support in elderly patients with bipolar disorder has not been studied. Our purpose was to evaluate social support in older adults with bipolar disorder compared with peer controls and younger bipolar patients. In addition, we looked at the role of social support in the age of illness onset. Methods: We evaluated social support of 29 older subjects with bipolar disorder (age 50 or older) and 56 younger subjects with bipolar disorder using the Duke Social Support Index, comparing them to non- psychiatric, peer controls. Using logistic regression we then examined the relationship of demographic, social support factors, and age of onset. Results: Both older and younger bipolar subjects perceived their social support as inadequate (OR ¼ 14.98; OR ¼ 9.05) compared with similar aged controls. Younger bipolar subjects also had less social interactions than younger controls (OR ¼ 4.63). These findings remained significant when controlled for gender, marital status, race, and education. No significant differences were noted between early-onset and late-onset bipolar subjects. Conclusions: Older and younger bipolar patients have decreased perceptions of social support than older controls. No effect was found based on the age of illness onset. In addition, younger subjects had less social interactions than peer controls. John L Beyer, Maragatha Kuchibhatla, Chris Looney, Elena Engstrom, Frederick Cassidy and K Ranga R Krishnan Duke University Medical Center, Department of Psychiatry, Durham, NC, USA Key words: age of onset – bipolar disorder – elderly – social support Received 30 April 2002, revised and accepted for publication 21 August 2002 Corresponding author: John L. Beyer MD, Associate Clinical Professor of Psychiatry, Duke University Medical Center, Box 3519 DUMC, Durham, NC 27710, USA. Fax: (919) 681 7421; e-mail: beyer001@mc.duke.edu Bipolar Disorders 2003: 5: 22–27 Copyright ª Blackwell Munksgaard 2003 BIPOLAR DISORDERS ISSN 1398-5647 22