Abstract
Bipolar disorder is an extremely devastating illness, and increasingly robust evidence indicates that it emerges during adolescence. Also during adolescence, peer relationships, particularly close friendships and romantic relationships, become a central mechanism for social maturation and emotional development. The consequences of mania on the development of peer relationships have received little attention. Thus, the purpose of the current study was to examine the association between mania and close peer relationship quality in a community sample of adolescents. Two types of close peer relationships, close friendships and romantic relationships, were evaluated. In addition, the current study examined two potential mediators of the association between mania and close relationship quality, social skills and social dominance. Due to the substantial overlap between symptoms of mania and Attention Deficit Hyperactivity Disorder (ADHD), and the documented peer relationship difficulties experienced by youth with ADHD, symptoms of ADHD were controlled in study analyses. Participants were 571 adolescents (57% female; 19% 10th grade, 30% 11th grade, 51% 12th grade; 66% Hispanic, 17% White, 7% African-American and Caribbean American, 4% Asian, and 6% mixed or other ethnicity) from 2 public high schools in the Southeastern United States. Adolescents completed self-report questionnaires during school. The Hypomanic Personality Scale (HPS) was used to assess adolescents' risk for mania. Adolescents reported on their social skills (empathy, cooperation, and assertion) using the Social Skills Rating System (SSRS). The Social Dominance Scale (SDS) was used to assess adolescents' tendency to be overly intrusive or dominant in social situations. The Conners-Wells' Adolescent Self-Report Scale (CASS) was used to assess adolescents' self-reported symptoms of ADHD. Parent-report was obtained for 50 adolescents by phone interview. Parent-reported symptoms of mania, social skills, and symptoms of ADHD were assessed. Four hypotheses guided study analyses. First, it was expected that greater levels of mania would be associated with fewer positive qualities and more negative qualities in a close friendship and romantic relationship. Second, it was hypothesized that more symptoms of mania would be associated with poorer social skills and greater levels of social dominance. Third, social skills and social dominance were expected to mediate the association between mania and close relationshp quality. Fourth, it was expected that the hypothesized relationships between mania, social skills, social dominance, and close relationship quality would remain significant after controlling for the association between mania and symptoms of ADHD. Gender was examined as a moderator in the main study analyses. Ethnicity and age were used as control variables. Data analyses were conducted using structural equation modeling with Mplus. Gender was found to be a moderator, and so all study analyses were examined separately for boys and girls. All adolescents reported having at least one close friend. Fifty-four percent (n = 307) of adolescents reported having a romantic partner. Analyses examining qualities of adolescents' romantic relationships were conducted using only those adolescents who reported having a romantic partner. In terms of the first hypothesis, for boys, higher levels of mania were directly associated with more positive qualities in a close friendship, and were also indirectly associated with more positive qualities in both a close friendship and romantic relationship. For girls, higher levels of mania were indirectly associated with more positive qualities in a close friendship, fewer negative qualities in both a close friendship and romantic relationship, and also more negative qualities in both a close friendship and romantic relationship. In terms of the second hypothesis, higher levels of mania were associated with greater empathy for both boys and girls. Higher levels of mania were also associated with more social dominance for both boys and girls. In terms of the third hypothesis, for boys, empathy mediated the association between mania and more positive qualities in a close friendship and romantic relationship. For girls, empathy mediated the association between mania and more positive qualities in a close friendship, and also mediated the association between mania and fewer negative qualities in a close friendship and romantic relationship. For girls, assertion also mediated the association between mania and fewer negative qualities in a close friendship. Finally, for girls, social dominance mediated the association between mania and more negative qualities in both a close friendship and romantic relationship. With regard to the fourth hypothesis, despite significant associations with some study variables, the associations described above remained significant with symptoms of ADHD entered as a control variable in the models. Findings suggest that empathy is an important strength associated with risk for mania in both boys and girls. Through empathy, close friendship and romantic relationship quality was positively associated with risk for mania in boys and girls. Social dominance was also strongly associated with risk for mania in both boys and girls, indicating that social dominance might be one way to differentiate emerging mania from other disorders, such as ADHD, in adolescents. Social dominance, however, was only associated with relationship quality for girls, and specifically, was associated with more negative qualities in both close friendships and romantic relationships. This may be one area, therefore, that girls at-risk for mania might be able to target in order to improve peer relationships. Future research might examine these associations longitudinally in order to determine causality. Additionally, studying close peer relationship quality in adolescents diagnosed with bipolar disorder would be of interest in future research.