May is Mental Health Awareness Month, designed to raise awareness of stigma around and treatment for mental illness. For 2021, the National Alliance on Mental Illness’s theme for the month is “You Are Not Alone,” stressing the value of connection and the prioritization of mental health.¹

Raising awareness and promoting treatment is especially important for younger patients with mental illnesses such as bipolar disorder. Adolescent patients are at a uniquely vulnerable time in their lives. Medical professionals working with them should not only be aware of these patients’ unique experiences so they can better treat them, but also so they can better help the patients’ loved ones understand them and take steps to provide a stable environment. Here are just a few of the unique experiences and risks that adolescents with bipolar disorder face.

  1. Peer Problems

An adolescent with bipolar disorder faces risks because of their relationships with peers. A recent study in the International Journal of Environmental Research and Public Health examined the link between experiences with peers on the one hand, and suicide risk and other mental health difficulties on the other hand, for adolescents with bipolar disorder. Not surprisingly, they found that peer relationships play a large role.²

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Peers can affect patients both positively and negatively, but the researchers found that adolescents with bipolar disorder experienced more peer problems than adolescents without this disorder. They suggested that these peer problems and relationships had an indirect effect on suicide risk, with peer problems being a stronger mediator between bipolar experiences and suicide risk for boys than girls. Positive peer interaction and support were seen as protective factors that correlated with greater subjective well-being. Clinicians can suggest that parents promote more opportunities for positive peer interactions for their adolescent.

  1. Greater Extraversion

The researchers noted that adolescents experience higher levels of extraversion. This not only heightens the anxiety related to their peer problems but is often associated with greater manic symptoms in bipolar disorder patients. This extraversion can benefit adolescents if they can use it to develop positive peer relationships. However, not only does this increased energy put them at greater risk of manic episodes, but they may find themselves at a greater risk of substance and alcohol abuse, risk factors that have been correlated with a greater likelihood of suicidal ideation and suicide attempts.

  1. Familial Cohesion

A recent systemic review published in Medicina examined environmental risk factors, including familial risk factors, of adolescents who have bipolar disorder or are at high risk for it.³ In a study of family environments in bipolar adolescents with a high prevalence of suicidal ideation, family conflict, stressful events, adaptability, and cohesion played major roles. Family cohesion was defined as “the level of warmth and intimacy between family members.” Clinicians can encourage parents and family members of these adolescent patients to work on emotional openness and intimacy to provide a warmer environment.

  1. Attention-Deficit/Hyperactivity Disorder

Adolescents with bipolar disorder may be at risk of other psychiatric comorbidities, such as attention-deficit/hyperactivity disorder (ADHD). Psychiatric comorbidities can be significant environmental risks. On the other hand, a 2020 study in Brain Sciences suggested that separate, early diagnoses of bipolar disorder and ADHD can be protective factors that allow for better treatment.⁴ Parents and medical professionals need to be involved and empathetic. Open communication between the adolescent and all other parties may help with diagnoses, treatment, and stability in their lives. 


1. Mental Health Awareness Month. National Alliance on Mental Illness. Accessed May 6, 2021.

2. Fumero A, Marrero RJ, Pérez-Albéniz A, Fonseca-Pedrero E. Adolescents’ bipolar experiences and suicide risk: well-being and mental health difficulties as mediators. Int J Environ Res Public Health. 2021;18(6):3024. doi:10.3390/ijerph18063024

3. Menculini G, Balducci PM, Attademo L, Bernardini F, Moretti P, Tortorella A. Environmental risk factors for bipolar disorders and high-risk states in adolescence: a systematic review. Medicina (Kaunas). 2020;56(12):689. doi:10.3390/medicina56120689

4. Tatsiopoulou P, Porfyri GN, Bonti E, Diakogiannis I. Childhood ADHD and early-onset bipolar disorder comorbidity: a case report. Brain Sci. 2020;10(11):883. doi:10.3390/brainsci10110883

This article originally appeared on Psychiatry Advisor