背景：躁鬱症為一家族聚集性高的疾病，在特定文化的影響下，許多家庭危險因子會增加躁鬱症的風險，然而躁鬱症家庭危險因子的致病路徑卻鮮少被研究。
目標：探討家庭危險因子在漢民族文化中對躁鬱症診斷及早發特質的影響。
方法：透過家族研究設計，我們一共邀請329位躁鬱症病人與202位健康控制組受試者參與研究。透過使用組合性國際診斷晤談工具 (CIDI)，蒐集臨床特徵、雙親的精神病理特質、親子關係以及家庭內衝突。我們除了使用羅吉斯迴歸(logistic regression)去分析躁鬱症與早發特質的家庭危險因子，也建立致病派模組(Causaul-pie models)去估算每一危險因子在特定組型中所貢獻的比例，以探討不同組型的致病路徑。
結果：研究發現雙親的憂鬱、神經質與焦慮特質、父親的物質使用問題以及疏離的親子關係會增加子女躁鬱症的風險；母親的憂鬱特質會預測躁鬱症的早發特質；而父親或母親的精神病理特質越多，子女罹患躁鬱症的風險越高。此外，在致病派模組中，三種主要路徑會增加躁鬱症風險：父親的物質使用問題、母親憂鬱特質與疏離的親子關係與家庭內衝突的交互作用。
結論：從不同觀點均可發現家庭危險因子對躁鬱症診斷及早發特質有負面影響；致病派模組之結果，有助於臨床工作者瞭解危險因子的致病路徑以及發展有效的治療計畫。

Background: Bipolar disorders (BPD) tend to aggregate within family and several family risk factors were suggested to increase the risk for BPD with culture specific effects. Whether family risk factors involved in the same or different causal pathways for bipolar illness was less studied.
Aims: We examined effects of a variety of family risk factors on BPD diagnosis and early onset in Han Chinese population.
Methods: Our samples included 329 clinically diagnosed BPD patients and 202 healthy controls. Data on clinical features, parental psychopathologies, family relationship and conflict within families were collected through structured interview. In addition to applying logistic regression models, we built causal-pie models for pathways with different risk factor profiles to develop BPD. Causal-pie weights were calculated to estimate the proportions of BPD patients attributed to specific causal-pies.
Results: The risk of BPD was significantly increased with parental depression, neurosis, anxiety, and paternal substance use problems, and poor relationship with parents. Having depressed mother further predicted early onset of BPD. A greater risk was observed with higher numbers of paternal or maternal psychopathologies disregarding specific categories of them. Significant causal-pies were built through three major pathways to develop BPD: paternal substance use problem (73.0%), maternal depression (17.6%), and through poor relationship with parents and conflict within family (6.3%).
Conclusions: Different aspects of family risk factors had negative impacts on BPD diagnosis and early onset. Results from causal-pie models provide clinical implications to target on specific factors for employing efficient intervention programs.

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