scholarly journals Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey among women in Switzerland

2020 ◽  
Author(s):  
Stephan Oelhafen ◽  
Manuel Trachsel ◽  
Settimio Monteverde ◽  
Luigi Raio ◽  
Eva Cignacco Müller
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Postpartum Depression ◽  
Cesarean Section ◽  
Health Care Professionals ◽  
Vaginal Birth ◽  
Migrant Background ◽  
Risk Pregnancy ◽  
Increased Risk ◽  
Informal Coercion

AbstractBackgroundIn many countries, the increase in facility births is accompanied by a high rate of obstetric interventions. Lower birthrates or elevated risk factors such as women’s higher age at childbirth and thus a higher need for control and security cannot entirely explain this rise in obstetric interventions. Another potential factor is that women feel coerced to agree to interventions; however, the prevalence of coercive interventions is unknown.MethodsIn a nationwide cross-sectional online survey, we assessed mothers’ satisfaction with childbirth and the prevalence of informal coercion during childbirth and of women at risk for postpartum depression. We used multivariable logistic regression to estimate the risk associated with multiple individual and contextual factors. Women at least 18 years old who gave birth in Switzerland within the previous 12 months were recruited online via Facebook ads or offline via various channels.ResultsA total of 6’054 women completed the questionnaire (drop-out rate 16.2%). An estimated 26.7% experience some form of informal coercion during childbirth. Having a cesarean section or instrumental vaginal birth was associated with an increased risk to experience informal coercion (all risk ratios > 1.5). The risk was also increased for women with a migrant background, women living in more urban regions and women with a risk pregnancy. Also, women to whom having a self-determined vaginal birth is important reported on informal coercion more often. Being at risk for postpartum depression was mostly associated with having an emergency cesarean section, having been transferred to hospital and the experience of informal coercion. Also, women with a migrant background seem to be at a higher risk to develop postpartum depression or having other mental health issues. Finally, women who had a non-instrumental vaginal birth reported higher satisfaction with childbirth experience and women who experienced informal coercion reported lower satisfaction.ConclusionsOne in four women experience informal coercion during childbirth, and this experience is associated with being at risk for postpartum depression and lower satisfaction with childbirth. Health care professionals should make every effort to prevent informal coercion and ensure sensitive aftercare for all new mothers in order to prevent traumatic effects.

scholarly journals Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey of women in Switzerland

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephan Oelhafen ◽  
Manuel Trachsel ◽  
Settimio Monteverde ◽  
Luigi Raio ◽  
Eva Cignacco Müller
Keyword(s):  
Risk Factors ◽  
Postpartum Depression ◽  
Cesarean Section ◽  
Health Care Professionals ◽  
Dropout Rate ◽  
Vaginal Birth ◽  
High Rate ◽  
Emergency Cesarean ◽  
Increased Risk ◽  
Informal Coercion

Abstract Background In many countries, the increase in facility births is accompanied by a high rate of obstetric interventions. Lower birthrates or elevated risk factors such as women’s higher age at childbirth and an increased need for control and security cannot entirely explain this rise in obstetric interventions. Another possible factor is that women are coerced to agree to interventions, but the prevalence of coercive interventions in Switzerland is unknown. Methods In a nationwide cross-sectional online survey, we assessed the prevalence of informal coercion during childbirth, women’s satisfaction with childbirth, and the prevalence of women at risk of postpartum depression. Women aged 18 years or older who had given birth in Switzerland within the previous 12 months were recruited online through Facebook ads or through various offline channels. We used multivariable logistic regression to estimate the risk ratios associated with multiple individual and contextual factors. Results In total, 6054 women completed the questionnaire (a dropout rate of 16.2%). An estimated 26.7% of women experienced some form of informal coercion during childbirth. As compared to vaginal delivery, cesarean section (CS) and instrumental vaginal birth were associated with an increased risk of informal coercion (planned CS risk ratio [RR]: 1.52, 95% confidence interval [1.18,1.96]; unplanned CS RR: 1.92 [1.61,2.28]; emergency CS RR: 2.10 [1.71,2.58]; instrumental vaginal birth RR: 2.17 [1.85,2.55]). Additionally, migrant women (RR: 1.45 [1.26,1.66]) and women for whom a self-determined vaginal birth was more important (RR: 1.15 [1.06,1.24]) more often reported informal coercion. Emergency cesarean section (RR: 1.32 [1.08,1.62]), being transferred to hospital (RR: 1.33 [1.11,1.60]), and experiencing informal coercion (RR: 1.35 [1.19,1.54]) were all associated with a higher risk of postpartum depression. Finally, women who had a non-instrumental vaginal birth reported higher satisfaction with childbirth while women who experienced informal coercion reported lower satisfaction. Conclusions One in four women experience informal coercion during childbirth, and this experience is associated with a higher risk of postpartum depression and lower satisfaction with childbirth. To prevent traumatic after-effects, health care professionals should make every effort to prevent informal coercion and to ensure sensitive aftercare for all new mothers.

Childhood trauma and being at-risk for psychosis are associated with higher peripheral endocannabinoids

2019 ◽  
Vol 50 (11) ◽  
pp. 1862-1871 ◽  
Author(s):  
E. Appiah-Kusi ◽  
R. Wilson ◽  
M. Colizzi ◽  
E. Foglia ◽  
E. Klamerus ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Childhood Trauma ◽  
Childhood Maltreatment ◽  
Peripheral Blood ◽  
Endocannabinoid System ◽  
History Of Childhood ◽  
Increased Risk ◽  
History Of

AbstractBackgroundEvidence has been accumulating regarding alterations in components of the endocannabinoid system in patients with psychosis. Of all the putative risk factors associated with psychosis, being at clinical high-risk for psychosis (CHR) has the strongest association with the onset of psychosis, and exposure to childhood trauma has been linked to an increased risk of development of psychotic disorder. We aimed to investigate whether being at-risk for psychosis and exposure to childhood trauma were associated with altered endocannabinoid levels.MethodWe compared 33 CHR participants with 58 healthy controls (HC) and collected information about previous exposure to childhood trauma as well as plasma samples to analyse endocannabinoid levels.ResultsIndividuals with both CHR and experience of childhood trauma had higher N-palmitoylethanolamine (p < 0.001) and anandamide (p < 0.001) levels in peripheral blood compared to HC and those with no childhood trauma. There was also a significant correlation between N-palmitoylethanolamine levels and symptoms as well as childhood trauma.ConclusionsOur results suggest an association between CHR and/or childhood maltreatment and elevated endocannabinoid levels in peripheral blood, with a greater alteration in those with both CHR status and history of childhood maltreatment compared to those with either of those risks alone. Furthermore, endocannabinoid levels increased linearly with the number of risk factors and elevated endocannabinoid levels correlated with the severity of CHR symptoms and extent of childhood maltreatment. Further studies in larger cohorts, employing longitudinal designs are needed to confirm these findings and delineate the precise role of endocannabinoid alterations in the pathophysiology of psychosis.

scholarly journals Multi-omics analysis reveals the influence of genetic and environmental risk factors on developing gut microbiota in infants at risk of celiac disease

Microbiome ◽  
2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Maureen M. Leonard ◽  
◽  
Hiren Karathia ◽  
Meritxell Pujolassos ◽  
Jacopo Troisi ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Risk Factor ◽  
Celiac Disease ◽  
Cesarean Section ◽  
Gut Microbiota ◽  
Environmental Risk ◽  
Environmental Risk Factors ◽  
Environmental Risk Factor ◽  
Cesarean Section Delivery

Abstract Background Celiac disease (CD) is an autoimmune digestive disorder that occurs in genetically susceptible individuals in response to ingesting gluten, a protein found in wheat, rye, and barley. Research shows that genetic predisposition and exposure to gluten are necessary but not sufficient to trigger the development of CD. This suggests that exposure to other environmental stimuli early in life, e.g., cesarean section delivery and exposure to antibiotics or formula feeding, may also play a key role in CD pathogenesis through yet unknown mechanisms. Here, we use multi-omics analysis to investigate how genetic and early environmental risk factors alter the development of the gut microbiota in infants at risk of CD. Results Toward this end, we selected 31 infants from a large-scale prospective birth cohort study of infants with a first-degree relative with CD. We then performed rigorous multivariate association, cross-sectional, and longitudinal analyses using metagenomic and metabolomic data collected at birth, 3 months and 6 months of age to explore the impact of genetic predisposition and environmental risk factors on the gut microbiota composition, function, and metabolome prior to the introduction of trigger (gluten). These analyses revealed several microbial species, functional pathways, and metabolites that are associated with each genetic and environmental risk factor or that are differentially abundant between environmentally exposed and non-exposed infants or between time points. Among our significant findings, we found that cesarean section delivery is associated with a decreased abundance of Bacteroides vulgatus and Bacteroides dorei and of folate biosynthesis pathway and with an increased abundance of hydroxyphenylacetic acid, alterations that are implicated in immune system dysfunction and inflammatory conditions. Additionally, longitudinal analysis revealed that, in infants not exposed to any environmental risk factor, the abundances of Bacteroides uniformis and of metabolite 3-3-hydroxyphenylproprionic acid increase over time, while those for lipoic acid and methane metabolism pathways decrease, patterns that are linked to beneficial immunomodulatory and anti-inflammatory effects. Conclusions Overall, our study provides unprecedented insights into major taxonomic and functional shifts in the developing gut microbiota of infants at risk of CD linking genetic and environmental risk factors to detrimental immunomodulatory and inflammatory effects.

Correlates of Postpartum Depression in First Time Mothers Without Previous Psychiatric Contact

2016 ◽  
Vol 40 ◽  
pp. 4-12 ◽  
Author(s):  
S.M. Sylvén ◽  
T.P. Thomopoulos ◽  
N. Kollia ◽  
M. Jonsson ◽  
A. Skalkidou
Keyword(s):  
Risk Factors ◽  
Depressive Symptoms ◽  
Postpartum Depression ◽  
Path Analysis ◽  
Subjective Experience ◽  
Delivery Mode ◽  
Increased Risk ◽  
First Time Mothers ◽  
History Of ◽  
First Time

AbstractBackgroundPostpartum depression (PPD) is a common disorder after childbirth. The strongest known predictors are a history of depression and/or a history of PPD. However, for a significant proportion of women, PPD constitutes their first depressive episode. This study aimed to gain further insight into the risk factors for PPD in first time mothers without previous psychiatric contact.MethodsWomen delivering in Uppsala University Hospital, Sweden, from May 2006 to June 2007, were asked to participate and filled out questionnaires five days and six weeks postpartum, containing inter alia the Edinburgh Postnatal Depression Scale (EPDS). Univariate logistic regression models, as well as a path analysis, were performed to unveil the complex interplay between the study variables.ResultsOf the 653 participating primiparas, 10.3% and 6.4% reported depressive symptoms (EPDS ≥ 12 points) five days and six weeks postpartum, respectively. In the path analysis, a positive association between anxiety proneness and depressive symptoms at five days and six weeks postpartum was identified. For depressive symptoms six weeks after delivery, additional risk factors were detected, namely depressive symptoms five days postpartum and subjective experience of problems with the baby. Caesarean section and assisted vaginal delivery were associated with fewer depressive symptoms at 6 six weeks postpartum.ConclusionsIdentification of anxiety proneness, delivery mode and problems with the baby as risk factors for self-reported depressive symptoms postpartum in this group of primiparas can be important in helping health care professionals identify women at increased risk of affective disorders in the perinatal period, and provide a base for early intervention.

Surgical-Site Infections Following Cesarean Section in an Estonian University Hospital: Postdischarge Surveillance and analysis of Risk Factors

2005 ◽  
Vol 26 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Piret Mitt ◽  
Katrin Lang ◽  
Aira Peri ◽  
Matti Maimets
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Fetal Monitoring ◽  
University Hospital ◽  
Cross Sectional Survey ◽  
Increased Risk ◽  
Multi Method Approach ◽  
Method Approach

AbstractObjectives:To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.Design:Cross-sectional survey.Setting:Academic tertiary-care obstetric and gynecology center with 54 beds.Patients:All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.Methods:Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System.Results:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95)], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P=.02).Conclusions:The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454).

scholarly journals Preterm birth and risk for language delays before school entry: A sibling-control study

2020 ◽  
pp. 1-6
Author(s):  
Imac Maria Zambrana ◽  
Margarete E. Vollrath ◽  
Bo Jacobsson ◽  
Verena Sengpiel ◽  
Eivind Ystrom
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Preterm Birth ◽  
Familial Risk ◽  
Language Delay ◽  
Language Delays ◽  
Increased Risk ◽  
Mother And Child ◽  
Sibling Control ◽  
Before School

Abstract We investigated whether children born preterm are at risk for language delay using a sibling-control design in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. Participants included 26,769 siblings born between gestational weeks 23 and 42. Language delay was assessed when the children were 1.5, 3, and 5 years old. To adjust for familial risk factors, comparisons were conducted between preterm and full-term siblings. Pregnancy-specific risk factors were controlled for by means of observed variables. Findings showed that preterm children born before week 37 had increased risk for language delays at 1.5 years. At 3 and 5 years, only children born before week 34 had increased risk for language delay. Children born weeks 29–33 and before week 29 had increased risk for language delay at 1.5 years (RR = 4.51, 95% CI [3.45, 5.88]; RR = 10.32, 95% CI [6.7, 15.80]), 3 years (RR = 1.50, 95% CI [1.02, 2.21]; RR = 2.78, 95% CI [1.09, 7.07]), and 5 years (RR = 1.63, 95% CI [1.06, 2.51]; RR = 2.98, 95% CI [0.87, 10.26]), respectively. In conclusion, children born preterm are at risk for language delays, with familial confounders only explaining a moderate share of the association. This suggests a cause-effect relationship between early preterm birth and risk for language delay in preschool children.

scholarly journals Multi-omics analysis reveals the influence of genetic and environmental risk factors on developing gut microbiota in infants at risk of celiac disease

2020 ◽  
Author(s):  
Maureen M Leonard ◽  
Hiren Karathia ◽  
Meritxell Pujolassos ◽  
Jacopo Troisi ◽  
Francesco Valitutti ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Risk Factor ◽  
Celiac Disease ◽  
Cesarean Section ◽  
Gut Microbiota ◽  
Environmental Risk ◽  
Environmental Risk Factors ◽  
Environmental Risk Factor ◽  
Cesarean Section Delivery

Abstract Background: Celiac disease (CD) is an autoimmune digestive disorder that occurs in genetically susceptible individuals in response to ingesting gluten, a protein found in wheat, rye, and barley. Research shows that genetic predisposition and exposure to gluten are necessary but not sufficient to trigger the development of CD. This suggests that exposure to other environmental stimuli early in life, e.g., cesarean section delivery, exposure to antibiotics or formula feeding, may also play a key role in CD pathogenesis through yet unknown mechanisms. Here, we use multi-omics analysis to investigate how genetic and early environmental risk factors alter the development of the gut microbiota in infants at risk of CD. Results: Toward this end, we selected 31 infants from a large-scale prospective birth cohort study of infants with a first-degree relative with CD. We then performed rigorous multivariate association, cross-sectional and longitudinal analyses using metagenomic and metabolomic data collected at birth, three months and six months of age to explore the impact of genetic predisposition and environmental risk factors on the gut microbiota composition, function and metabolome prior to the introduction of trigger (gluten). These analyses revealed several microbial species, functional pathways and metabolites that are associated with each genetic and environmental risk factor or that are differentially abundant between environmentally exposed and non-exposed infants or between time points. Among our significant findings, we found that cesarean section delivery is associated with a decreased abundance of Bacteroides vulgatus and Bacteroides dorei and of folate biosynthesis pathway, and with an increased abundance of hydroxyphenylacetic acid, alterations that are implicated in immune system dysfunction and inflammatory conditions. Additionally, longitudinal analysis revealed that, in infants not exposed to any environmental risk factor, the abundances of Bacteroides uniformis and of metabolite 3-3-hydroxyphenylproprionic acid increase over time while those for lipoic acid and methane metabolism pathways decrease, patterns that are linked to beneficial immunomodulatory and anti-inflammatory effects. Conclusions: Overall, our study provides unprecedented insights into major taxonomic and functional shifts in the developing gut microbiota of infants at risk of CD linking genetic and environmental risk factors to detrimental immunomodulatory and inflammatory effects.

scholarly journals Cesarean Section: Risk Factors Threatening the Health of the Mother, the Fetus and Newborn: A Grounded Theory Study

2021 ◽  
Author(s):  
Mehrnush Mostafayi ◽  
Behzad Imani
Keyword(s):  
Risk Factors ◽  
Grounded Theory ◽  
Cesarean Section ◽  
Operating Room ◽  
Medical Team ◽  
Structured Interviews ◽  
Risk Pregnancy ◽  
Data Saturation ◽  
Health Related ◽  
Constant Comparative Analysis

Abstract Background: The excessive increase of cesarean section and the mother's attitude towards performing a cesarean section, despite the health-related complications for mother, fetus, and newborn, are a current global concern. Identifying risk factors can be effective in reducing the maternal and infant mortality. Therefore, the aim of this study was to explore risk factors threatening the health of the mother, fetus, and newborn in cesarean section.Methods: The present study is a grounded theory which was performed from December 2019 to July 2020 in Fatemieh Hospital, Hamadan / Iran. Purposive and theoretical sampling was used to recruit Gynecologist, anesthesiologists, pediatricians, operating room and anesthesia experts, and midwives working in the operating room. In-depth, semi-structured interviews were conducted with 25 participants. Constant comparative analysis together with data collection. The analysis included open, axial, and selective coding to achieve data saturation. EQUATOR guidelines for qualitative research (COREQ) were applied.Results: After analyzing the data, 8 sub-categories and 3 main categories were extracted. The three main themes extracted from the interviews were as follows: (1) Background factors with sub-categories “high-risk pregnancy, unusual fetus, and background risk factor ", (2) Environmental factors with sub-categories "poor operating room facilities, lack of proper electro-surgery safety measures, excessive workload" and (3) Human factors with sub-categories "lack of medical team skills and by individual error of the medical team ".Conclusion: The results of this study provide an in-depth look at the risk factors threatening the health of the Mother, the Fetus and Newborn in cesarean section. According to the results of this study, obstetrics and gynecology operating rooms can prevent the occurrence of risks by using appropriate management methods and provide safe care to patients.

scholarly journals Comparison of a Cancer Family History Collection and Risk Assessment Tool – ItRunsInMyFamily – with Risk Assessment by Health-Care Professionals

2021 ◽  
pp. 1-9
Author(s):  
Jordon B. Ritchie ◽  
Brandon M. Welch ◽  
Caitlin G. Allen ◽  
Lewis J. Frey ◽  
Heath Morrison ◽  
...  
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Genetic Counseling ◽  
Hereditary Cancer ◽  
Health Care Professionals ◽  
Assessment Tool ◽  
Family Health ◽  
Primary Care Providers ◽  
Care Providers ◽  
Increased Risk

<b><i>Introduction:</i></b> Primary care providers (PCPs) and oncologists lack time and training to appropriately identify patients at increased risk for hereditary cancer using family health history (FHx) and clinical practice guideline (CPG) criteria. We built a tool, “ItRunsInMyFamily” (ItRuns) that automates FHx collection and risk assessment using CPGs. The purpose of this study was to evaluate ItRuns by measuring the level of concordance in referral patterns for genetic counseling/testing (GC/GT) between the CPGs as applied by the tool and genetic counselors (GCs), in comparison to oncologists and PCPs. The extent to which non-GCs are discordant with CPGs is a gap that health information technology, such as ItRuns, can help close to facilitate the identification of individuals at risk for hereditary cancer. <b><i>Methods:</i></b> We curated 18 FHx cases and surveyed GCs and non-GCs (oncologists and PCPs) to assess concordance with ItRuns CPG criteria for referring patients for GC/GT. Percent agreement was used to describe concordance, and logistic regression to compare providers and the tool’s concordance with CPG criteria. <b><i>Results:</i></b> GCs had the best overall concordance with the CPGs used in ItRuns at 82.2%, followed by oncologists with 66.0% and PCPs with 60.6%. GCs were significantly more likely to concur with CPGs (OR = 4.04, 95% CI = 3.35–4.89) than non-GCs. All providers had higher concordance with CPGs for FHx cases that met the criteria for genetic counseling/testing than for cases that did not. <b><i>Discussion/Conclusion:</i></b> The risk assessment provided by ItRuns was highly concordant with that of GC’s, particularly for at-risk individuals. The use of such technology-based tools improves efficiency and can lead to greater numbers of at-risk individuals accessing genetic counseling, testing, and mutation-based interventions to improve health.

scholarly journals Improving early recognition and intervention in people at increased risk for the development of bipolar disorder - Study protocol of a prospective-longitudinal, naturalistic cohort study (Early-BipoLife)

2019 ◽  
Author(s):  
Andrea Pfennig ◽  
Karolina Leopold ◽  
Julia Martini ◽  
Anne Boehme ◽  
Martin Lambert ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Cohort Study ◽  
Psychosocial Functioning ◽  
Preventive Intervention ◽  
Early Recognition ◽  
Natural Course ◽  
Teaching Hospitals ◽  
Increased Risk ◽  
Prospective Longitudinal

Abstract Background Bipolar disorders (BD) belong to the most severe mental disorders, characterized by an early onset, predominantly recurrent/chronic course and poor psychosocial functioning. Many patients with BD experience substantial symptomatology months or even years before full BD manifestation. Adequate diagnosis and treatment is often delayed, which is associated with a worse outcome. This study aims to prospectively evaluate and improve early recognition and intervention strategies for persons at-risk for BD. Methods and Results Early-BipoLife is a prospective-longitudinal cohort study of 1419 participants (aged 15-35 years) with at least five waves of assessment over a period of at least 2 years (baseline, 6, 12, 18 and 24 months). A research consortium of ten university and teaching hospitals across Germany conducts this study. The following risk groups (RGs) were recruited: RG I: help-seeking youth & young adults consulting early recognition centres/facilities presenting ≥1 of the proposed risk factors for BD, RG II: in-/outpatients with unipolar depressive syndrome, and RG III: in-/ outpatients with attention-deficit/hyperactivity disorder (ADHD). The reference cohort was selected from the German representative IMAGEN cohort. Over the study period, the natural course of risk and resilience factors, early symptoms of BD and changes of symptom severity (including conversion to manifest BD) are observed. Psychometric properties of recently developed, structured instruments on potential risk factors for conversion to BD and subsyndromal symptomatology (Bipolar Prodrome Symptom Scale, Bipolar at-risk criteria, EPI bipolar ) and biomarkers that potentially improve prediction are investigated. Moreover, actual treatment recommendations are monitored in the participating specialized services and compared to recently postulated clinical categorization and treatment guidance in the field of early BD. Conclusion Findings from this study will contribute to an improved knowledge about the natural course of BD, from the onset of first noticeable symptoms (precursors) to fully developed BD, and about mechanisms of conversion from subthreshold to manifest BD. Moreover, these generated data will provide information for the development of evidence-based guidelines for early-targeted detection and preventive intervention for people at risk for BD.

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