Polygenic Interactions with Environmental Adversity in the Aetiology of Major Depressive Disorder

Major depressive disorder (MDD) is a common and disabling condition with well-established heritability and environmental risk factors. Gene–environment interaction studies in MDD have typically investigated candidate genes, though the disorder is known to be highly polygenic. This study aims to test for interaction between polygenic risk and stressful life events (SLEs) or childhood trauma (CT) in the aetiology of MDD. The RADIANT UK sample consists of 1605 MDD cases and 1064 controls with SLE data, and a subset of 240 cases and 272 controls with CT data. Polygenic risk scores (PRS) were constructed using results from a mega-analysis on MDD by the Psychiatric Genomics Consortium. PRS and environmental factors were tested for association with case/control status and for interaction between them. PRS significantly predicted depression, explaining 1.1% of variance in phenotype (p = 1.9 × 10−6). SLEs and CT were also associated with MDD status (p = 2.19 × 10−4 and p = 5.12 × 10−20, respectively). No interactions were found between PRS and SLEs. Significant PRSxCT interactions were found (p = 0.002), but showed an inverse association with MDD status, as cases who experienced more severe CT tended to have a lower PRS than other cases or controls. This relationship between PRS and CT was not observed in independent replication samples. CT is a strong risk factor for MDD but may have greater effect in individuals with lower genetic liability for the disorder. Including environmental risk along with genetics is important in studying the aetiology of MDD and PRS provide a useful approach to investigating gene–environment interactions in complex traits.

Adverse Childhood Life Events and Postpartum Psychosis in Bipolar Disorder

Background Women with bipolar disorder are at increased risk of postpartum psychosis. Adverse childhood life events have been associated with depression in the postpartum period, but have been little studied in relation to postpartum psychosis. In this study we investigated whether adverse childhood life events are associated with postpartum psychosis in a large sample of women with bipolar I disorder. Methods Participants were 432 parous women with DSM-IV bipolar I disorder recruited into the Bipolar Disorder Research Network (www.BDRN.org). Diagnoses and lifetime psychopathology, including perinatal episodes, were obtained via a semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry; Wing et al., 1990) and case-notes. Adverse childhood life events were assessed via self-report and case-notes, and compared between women with postpartum psychosis (n=208) and those without a lifetime history of perinatal mood episodes (n=224). Results There was no significant difference in the rate of any adverse childhood life event, including childhood sexual abuse, or in the total number of adverse childhood life events between women who experienced postpartum psychosis and those without a lifetime history of perinatal mood episodes, even after controlling for demographic and clinical differences between the groups. Limitations Adverse childhood life events were assessed in adulthood and therefore may be subject to recall errors. Conclusions We found no evidence for an association between adverse childhood life events and the occurrence of postpartum psychosis. Our data suggest that, unlike postpartum depression, childhood adversity does not play a significant role in the triggering of postpartum psychosis in women with bipolar disorder.

Heroism and Adventurism: Can Applied Theatre Practices Give Participants the Experience of Being the Heroes and Heroines of Their Own Stories?

Move on Up! is part of a series of widening participation interactive Theatre in Education programmes at The University of Worcester, designed to raise educational aspirations. It was conceived for year 6 pupils about to go up to secondary school, to reflect on this transition and the challenges and pitfalls it presented to them. I searched for stimulus material to create the dynamic of an adventure story that reflected and generated the excitement and fear of change. The Mysterious Island by Jules Verne provided the structure of this classic genre with characters stranded on a desert island. Directing a team of four student actors and a stage manager I sought to promote the heroic ideal of using the skills needed to survive against adversity and to transpose it to a school context. The four characters discover talents and interests on the year 6 school trip and they endeavour to become the best version of themselves at their secondary school where these attributes have to be tested in a new environment. Using interactive voting software helped to determine whether pupils could achieve the sense of control and ownership outlined in Boal’s theatre practice. The programme provides a number of points of intervention where participants could vote and influence the shape of the character’s stories and perhaps create heroes or anti – heroes depending on the decisions they make. Boal wants participants to become the outspoken protagonists of their own stories or specactors. This paper will investigate whether applied theatre practice can give participants a heroic experience by exploring the process of creating Move on Up! and the response to the programme from year 6 pupils in West Midlands schools.