Bipolar risk and mental imagery susceptibility in a representative sample of Chinese adults residing in the community

Background: We need to better understand the cognitive factors associated with risk for bipolar disorders. Recent research suggests that increased susceptibility to mental imagery may be one such factor. However, since this research was primarily conducted in Western students, it is not known whether the relationship between imagery susceptibility and symptoms of bipolar disorders exists across cultures, nor within the general community. Further, because previous research was cross-sectional, it is also not clear whether this hypothesized relationship remains stable over time.
Aims: The current study evaluated whether Chinese adults identified as being at high risk of developing bipolar disorders showed greater mental imagery susceptibility compared with those at low risk for developing bipolar disorders. Further, we aimed to test whether such a relationship was stable over time by measuring imagery characteristics at baseline and at seven weeks’ follow-up.
Method: This prospective study recruited a representative community sample of Chinese adults (N=80 randomly selected from a pool of 5700 individuals) screened for absence of neurotic and psychotic disorders. The sample was split into high bipolar risk (n = 18) and low bipolar risk (n=62) groups at baseline based on a criterion cut-off score on a measure of hypomania, the Mood Disorder Questionnaire (MDQ). Participants completed measures of imagery susceptibility and its impact: the Spontaneous Use of Imagery Scale (SUIS) and the Impact of Future Events Scale (IFES). Participants completed the same questionnaires seven weeks later.
Results: Results at baseline show that the high bipolar risk group reported greater tendency to use imagery in daily life (SUIS) and greater emotional impact of prospective imagery (IFES) than the low bipolar risk group. At seven weeks’ follow-up these results remained stable in participants successfully traced for follow-up (70% of the participants at baseline: n=13, high bipolar risk group; n=44, low bipolar risk group), indicating stability in the relationship between bipolarity and mental imagery characteristics over time.
Conclusion: The current study provides preliminary evidence for increased susceptibility to mental imagery in individuals at high risk for bipolar disorders recruited from a community sample of Chinese adults. As such, this extends previous research in Western student samples suggesting that imagery (both levels of use and its impact) may be a cognitive factor with cross cultural relevance that is stable over time. The study provides some preliminary data that mental imagery susceptibility might be a cognitive risk factor that is worth exploring in future studies with larger sample size, prospectively, with a longer follow-up period, and in people with high familial risks for bipolar disorders.