Bipolar Disorders in a Community Sample of Older Adolescents: Prevalence, Phenomenology, Comorbidity, and Course

doi:10.1097/00004583-199504000-00012

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 34, Issue 4, April 1995, Pages 454-463

https://doi.org/10.1097/00004583-199504000-00012 Get rights and content

ABSTRACT

Objective

The purpose of this study was to examine the prevalence, clinical characteristics, and mental health treatment services utilization of adolescents with bipolar disorders and manic symptoms.

Method

Structured diagnostic interviews were administered to a representative community sample of 1,709 older adolescents (aged 14 through 18 years).

Results

The lifetime prevalence of bipolar disorders (primarily bipolar II disorder and cyclothymia) was approximately 1%. An additional 5.7% of the sample reported having experienced a distinct period of abnormally and persistently elevated, expansive, or irritable mood even though they never met criteria for bipolar disorder (“core positive” subjects). The rate of manic symptoms in these subjects was similar to that reported in clinical samples, and the course of bipolar disorder was relatively chronic. Compared with adolescents with a history of major depression (n = 316) and a “never mentally ill” group (n = 845), the bipolar and core positive subjects both exhibited significant functional impairment and high rates of comorbidity (particularly with anxiety and disruptive behavior disorders), suicide attempts, and mental health services utilization.

Conclusions

These data highlight the clinical and public health significance of even the milder and subthreshold cases of bipolar disorder in adolescence.

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Prevalence of affective disorders in Chinese school-attending children and adolescents aged 6–16 based on a national survey by MINI-Kid
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Major depressive disorder (MDD), dysthymia disorder (DD) and bipolar disorder (BD) are the most prevalent affective disorders. A nationwide epidemiological investigation of MDD, DD and BP in school-attending children and adolescents was carried out, taking the effect of age, gender and comorbidity into consideration.
A two-stage nationwide epidemiological study of point prevalence was conducted. Using a multistage cluster stratified random sampling strategy. The sample distribution was described, and the point prevalence of affective disorders was estimated. Chi-squared tests were used to compare disease prevalence based on sex and age. Comorbid ratios for MDD, DD and BP were calculated.
The total number of cases in Stage 1 was 72,107 (aged 6–16 years). The point prevalence of MDD, DD and BP were 2.004 % (95 % CI: 1.902 to 2.106), 0.352 % (95 % CI: 0.309 to 0.395) and 0.856 % (95 % CI: 0.788 to 0.923), respectively. The total prevalence of affective disorder was 3.212 % (95 % CI: 3.079 to 3.338). The total prevalence of affective disorders between sexes (female: 3.834 % versus male: 2.587 %, χ² = 90.155, p < 0.001) was consistent with the gender difference in MDD, DD and MD. The total prevalence of affective disorders in adolescents was higher than that in children (adolescents: 5.024 % versus children: 1.863 %, χ² = 566.841, p < 0.001).
Our study is the first nationwide survey on the prevalence of affective disorders among school-attending children and adolescents aged 6–16 in China. Our results also highlighted the importance of addressing comorbidities in future studies of affective disorders.
The Mood Disorder Assessment Schedule: Initial validation of a new measure for early identification of bipolar spectrum disorders in inpatient adolescents
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Due to the significant impairment associated with subthreshold bipolar symptomatology and the harmful effects of delayed diagnosis, there is a great need for diagnostic tools that can facilitate early identification of bipolar spectrum disorders. The Mood Disorder Assessment Schedule (MDAS) is a newly developed measure that focuses on autonomous changes in mood and energy, a key indicator of bipolar spectrum problems which is not included in current diagnostic tools for bipolar disorders. The current study tested the ability of the MDAS to identify individuals at risk for bipolar spectrum disorders. In a cross-sectional sample of 396 inpatient adolescents, the MDAS identified a group of individuals with several bipolar spectrum disorder (BSD) indicators, including greater manic and depressive symptoms, affective lability, suicidal behavior, adverse reactions to antidepressants, and a family history of bipolar disorder and suicidal behavior. When compared to a standard diagnostic interview for bipolar disorders (i.e., Kiddie Schedule for Affective Disorders and Schizophrenia [KSADS]), the MDAS yielded stronger clinical utility in its ability to identify individuals with BSD indicators. Therefore, the MDAS appears to be a promising diagnostic tool for identifying adolescents at risk for BSDs and may help facilitate earlier diagnosis and prevent harmful effects of improper treatment.
Suicidal behavior in juvenile bipolar disorder and major depressive disorder patients: Systematic review and meta-analysis
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Citation Excerpt :
Based on prospective studies, the pooled rates of BD and MDD also were similar, at 9.52%/year [6.17–12.9] and 9.60%/year [6.43–12.8] (Table 3). Based on 5 reports with data for both BD and MDD subjects (Lewinsohn et al., 1995; Wozniak et al., 2004; Dilsaver et al., 2006; Goldstein et al., 2012; Shon et al., 2014) random-effects meta-analysis yielded pooled OR = 1.59 [1.24–2.05] (z = 3.63, p < 0.0001), indicating that risk of suicide attempts was significantly, 59% greater with BD than with MDD (Fig. 2). Suicide attempt rate was significantly correlated with exposure (years), based on Spearman nonparametric correlation (rs = −0.657, p < 0.0001; Fig. 3).
To assess rates and lethality of suicidal behavior in studies of children and adolescents diagnosed with major depressive disorder (MDD) or bipolar disorder (BD).
This PROSPERO-registered protocol (CRD-42019159676) systematically reviewed reports on suicidal behavior among juveniles (age ≤ 18 years), and pooled data on risk (% of subjects) and rates (%/year), followed by random-effects meta-analysis and multivariable linear regression modeling.
Included were 41 reports (1995–2020) from 15 countries involving 104,801 juveniles (102,519 diagnosed with MDD, 2282 with BD), at risk for 0.80–12.5 years. Meta-analytically pooled suicide attempter-rates averaged 7.44%/year [95%CI: 5.63–9.25] with BD and 6.27%/year [5.13–7.41] with MDD. Meta-analysis of 5 studies with both diagnostic groups found significantly greater attempt risk with BD vs. MDD (OR = 1.59 [1.24–2.05], p < 0.0001). In 6 studies, suicide rate with juvenile mood disorders averaged 125 [56.9–236]/100,000/year, similar to adult rates, >30-times greater than in the general juvenile population, and higher among older adolescents. The ratio of attempts/suicides (A/S) was 52.6 among mood-disordered juveniles, indicating greater lethality than among juveniles in the general population (A/S ≥ 250), but somewhat less than in the estimated adult general population (A/S ca. 30).
Rates of suicide attempts in juveniles with a major mood disorder averaged 6580/100,000/year, were greater in BD versus MDD observed under the same conditions, and greater with shorter periods of observation. Lethality (fatalities per suicide attempt) was greater in juveniles diagnosed with major affective disorders than in the juvenile general population, but less than in adults.
Long term outcomes of pediatric Bipolar-I disorder: A prospective follow-up analysis attending to full syndomatic, subsyndromal and functional types of remission
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To examine patterns of remission of pediatric bipolar I (BP-I) disorder attending to syndromatic, symptomatic, and functional outcomes from childhood to adolescent and young adult years.
We analyzed data from a six-year prospective follow-up study of youths aged 6–17 years with BP-I disorder. Subjects were comprehensively assessed at baseline and subsequently at four, five, and six years thereafter. Assessments included structured diagnostic interviews and measures of psychosocial and educational functioning. Patterns of remission were calculated attending to whether syndromatic, symptomatic, and functional remission were achieved.
Kaplan-Meier failure functions revealed that the probability of functional recovery from pediatric BP-I disorder was very low. Of the 88 youths assessed, only 6% (N = 5) of the sample were euthymic with normal functioning during the year prior to their last follow-up assessment (average follow-up time = 5.8 ± 1.8 years).
These results provide compelling evidence of the high level of persistence of pediatric BP-I disorder. Symptomatic and functional remission were uncommon and most subjects continued to demonstrate high morbidity into late adolescence and early adulthood.
Correlates, Course, and Outcomes of Increased Energy in Youth with Bipolar Disorder
2020, Journal of Affective Disorders
Compare longitudinal trajectories of youth with Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV Bipolar Disorder (BD), grouped at baseline by presence/absence of increased energy during their worst lifetime mood episode (required for DSM-5).
Participants from the parent Course and Outcome of Bipolar Youth study (N = 446) were assessed utilizing The Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS), KSADS Mania Rating Scale (KMRS), and KSADS Depression Rating Scale (KDRS). Youth were grouped at baseline into those with increased energy (meeting DSM-5 Criteria A for mania) vs. without increased energy (meeting DSM-IV, but not DSM-5, Criteria A for mania), for those who had worst lifetime mood episode recorded (n = 430). Youth with available longitudinal data had the presence/absence of increased energy measured, as well as psychiatric symptomatology/clinical outcomes (evaluated via the Adolescent Longitudinal Interval Follow-Up Evaluation), at each follow-up for 12.5 years (n = 398).
At baseline, the increased energy group (based on endorsed increased energy during worst lifetime mood episode; 86% of participants) vs. the without increased energy group, were more likely to meet criteria for BD-I and BD Not Otherwise Specified, had higher KMRS/KDRS total scores, and displayed poorer family/global psychosocial functioning. However, frequency of increased energy between groups was comparable after 5 years, and no significant group differences were found on clinical/psychosocial functioning outcomes after 12.5 years.
Secondary data limited study design; groupings were based on one time point.
Results indicate no clinically relevant longitudinal group differences.

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: This research was supported in part by NIMH awards MH40501 and MH50522.

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SPECIAL ARTICLEBipolar Disorders in a Community Sample of Older Adolescents: Prevalence, Phenomenology, Comorbidity, and Course

ABSTRACT

Objective

Method

Results

Conclusions

J. Am Acad Child Adolesc Psychiatr

J Affect Disord

Psychiatr Clin North Am

J Affect Disord

J. Am Acad Child Adolesc Psychiatry

J. Am Acad Child Psychiatry

J Am Acad Child Adolesc Psychiatry

Affective disorders in referred children and younger siblings of manic-depressives: mode of onset and prospective course

Arch Gen Psychiatry

Criteria for the “soft” bipolar spectrum: treatment implications

Psychopharmacol Bull

Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III)

Parental influence on early adolescent substance use: specific and nonspecific effects

J. Early Adolesc

Manic depressive psychosis in childhood

J. Child Psychol Psychiatry

The atypical clinical picture of adolescent mania

Am J Psychiatry

Annotation: child and adolescent mania–diagnostic considerations

J. Child Psychol Psychiatry

A coefficient of agreement for nominal scales

Educ Psychol Meas

Neurobehavioral aspects of affective disorders

Annu Rev Psychol

A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: a conceptual framework and five validation studies

J Abnorm Psychol

Age differences in the reliability of the psychiatric interview of the child

Child Dev

Amish study: affective disorder among the Amish, 1976–1980

Am J Psychiatry

SPECIAL ARTICLE
Bipolar Disorders in a Community Sample of Older Adolescents: Prevalence, Phenomenology, Comorbidity, and Course