Offspring of parents with bipolar disorder (OBD) have been found to be at greater risk for later psychopathology, including affective disorders, compared to offspring of parents with no mental disorder (ONMD). The underlying physiological mechanisms that function to transmit risk from parents to offspring are not yet clear. Recently, increased attention has focused on the hypothalamic-pituitary-adrenal (HPA) axis. Dysfunction of the axis has been associated with mental health disorders, such as depression, across the lifespan. Furthermore, development of the axis is believed to be susceptible to the effects of early-life adversity. Given that parental bipolar disorder has been associated with parental neglect, elevated abuse, critical parenting, and family conflict, OBD are often confronted with elevated stress within the home. Such stress may subsequently alter development of the HPA axis, placing offspring at increased risk for later adverse outcomes. Prevention programs that target families of parents with bipolar disorder are scarce. Of those programs implemented, effect sizes are often small. As such, the present study will investigate data collected from the study Reducing Unwanted Stress in the Home (RUSH). RUSH incorporated a 12-week, skills-based program for OBD, while ONMD comprised an assessment-only control group.
The program integrated three modules, including communication, problem-solving, and structure and consistency in the home. Outcome data on offspring HPA axis functioning, measured through salivary cortisol concentrations, and internalizing and externalizing symptomatology measured through parent-report questionnaires, were collected at four time points: baseline, post-intervention, 3-months post-intervention, and 6-months post-intervention. The objectives of the present project will be to examine the effects of a skills-based prevention program, with respect to the trajectory of offspring HPA axis functioning and psychopathology, furthermore, the interaction between HPA axis functioning and symptomatology pre- to post-intervention in OBD and ONMD.