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Depression more troublesome than mania for youth with bipolar disorder


 

FROM THE JOURNAL OF AFFECTIVE DISORDERS

Among youths with bipolar spectrum disorder, depressive symptoms more adversely affected their psychological functioning and quality of life than did manic symptoms, results from a small study showed.

"We hypothesized that the impact of bipolar depression in youth would be significant, but the lopsided nature of the results was more striking than expected," researchers led by Anna R. Van Meter reported online in the Journal of Affective Disorders. "Across numerous measures, depression was a significant predictor of negative outcomes, mania was not.

"This is not to say that mania is not impairing, our sample included only youth with bipolar disorder, so we cannot comment on the degree to which mania and/or depression caused problems for youth with bipolar disorder, relative to youth without mood disturbance. Still, at the very least, these findings suggest that the collective focus on mania, often it seems at the exclusion of depression, may be misguided."

For the study, Ms. Van Meter and her associates recruited 54 youths aged 7-13 years old who met DSM-IV-TR criteria for bipolar spectrum disorders from a clinic in a large Midwestern city (J. Affect. Dis. 2013 June 12 [doi:10.1016/j.jad.2013.05.039]).

They used regression analyses to evaluate clinician and parent reports of manic and depressive symptoms from numerous survey instruments in an effort to determine how each set of symptoms affected child functioning. Measures included the Washington University Schedule for Affective Disorders, the Children’s Global Assessment Scale, the Young Mania Rating Scale, and the Child Bipolar Depression Rating Scale.

The mean age of the 54 study participants was 9 years, 42% were female, and more than half (60%) were of white European descent. Diagnoses included bipolar disorder not otherwise specified (57%), bipolar I disorder (41%), and bipolar II disorder (2%).

Parent-rated child depression symptoms were associated with problem behaviors (P less than .05) and lower quality of life (P less than .001), while clinician-rated child depression was associated with greater psychiatric illness (P less than .05), lower child self-concept (P less than .001), lower quality of life (P less than .05), hopelessness (P less than .05), and suicidal ideation (P less than .05), reported Ms. Van Meter of the department of psychology at the University of North Carolina, Chapel Hill, and her associates.

At the same time, parent-rated mania was associated with better self-esteem (P less than 0.05) and physical well-being (P less than .05), while clinician-rated mania was associated with greater psychiatric illness (P less than .05) and physical well-being (P less than .05).

"Which specific aspects of bipolar depression cause decreased quality of life and through what mechanisms mania provides protection against functional impairment remain important areas for study," the researchers concluded. "In general, the identification of how different symptom constellations in pediatric bipolar disorder relate to functional impairment should be an important mission for our research agenda. Thus, this study introduces new questions to guide researchers in developing a more in-depth understanding of this complex disorder and raises awareness of the debilitating effects of bipolar depression in youth."

They acknowledged certain limitations of the study. One is that specific outcomes predicted by parent- and clinician-rated symptoms vary.

The study was supported by the National Institute of Mental Health. The researchers stated that they had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

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