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Mood lability and psychopathology in youth

Published online by Cambridge University Press:  11 December 2008

A. Stringaris  and
R. Goodman
A. Stringaris*
Affiliation:
King's College London, Institute of Psychiatry, Department of Child and Adolescent Psychiatry, London, UK
R. Goodman
Affiliation:
King's College London, Institute of Psychiatry, Department of Child and Adolescent Psychiatry, London, UK
*
*Address for correspondence: Dr A. Stringaris, King's College London, Institute of Psychiatry, Department of Child and Adolescent Psychiatry, Denmark Hill, LondonSE5 8AF, UK. (Email: a.stringaris@iop.kcl.ac.uk)
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Abstract

Background

Mood lability is a concept widely used. However, data on its prevalence and morbid associations are scarce. We sought to establish the occurrence and importance of mood lability in a large community sample of children and adolescents by testing a priori hypotheses.

Method

Cross-sectional data were taken from a national mental health survey including 5326 subjects aged 8–19 years in the UK. The outcomes were prevalence and characteristics of mood lability and its associations with psychopathology and overall impairment.

Results

Mood lability occurred in more than 5% of the population of children and adolescents, both by parent and self-report. Mood lability was strongly associated with a wide range of psychopathology and was linked to significant impairment even in the absence of psychiatric disorders. Mood lability was particularly strongly associated with co-morbidity between internalizing and externalizing disorders, even when adjusting for the association with individual disorders. The pattern of results did not change after excluding youth with bipolar disorder or with episodes of elated mood.

Conclusions

Clinically significant mood lability is relatively common in the community. Our findings indicate that mood lability is not a mere consequence of other psychopathology in that it is associated with significant impairment even in the absence of psychiatric diagnoses. Moreover, the pattern of association of mood lability with co-morbidity suggests that it could be a risk factor shared by both internalizing and externalizing disorders. Our data point to the need for greater awareness of mood lability and its implications for treatment.

Keywords

Adolescentsbipolar disorderchildrenco-morbidityemotional regulationirritabilitymood lability
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 8 , August 2009 , pp. 1237 - 1245
Copyright
Copyright © 2008 Cambridge University Press

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References

Angold, A (2002). Diagnostic interviews with parents and children. In Child and Adolescent Psychiatry (ed.Rutter, M. T.), pp. 32–51. Blackwell Publishing: Oxford.Google Scholar
Angold, A, Costello, EJ, Erkanli, A (1999). Comorbidity. Journal of Child Psychology and Psychiatry 40, 57–87.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
Axelson, D, Birmaher, B, Strober, M, Gill, MK, Valeri, S, Chiappetta, L, Ryan, N, Leonard, H, Hunt, J, Iyengar, S, Bridge, J, Keller, M (2006). Phenomenology of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry 63, 1139–1148.Google Scholar
Bourdon, KH, Goodman, R, Rae, DS, Simpson, G, Koretz, DS (2005). The Strengths and Difficulties Questionnaire: U.S. normative data and psychometric properties. Journal of the American Academy of Child and Adolescent Psychiatry 44, 557–564.Google Scholar
Brotman, MA, Kassem, L, Reising, MM, Guyer, AE, Dickstein, DP, Rich, BA, Towbin, KE, Pine, DS, Mcmahon, FJ, Leibenluft, E (2007). Parental diagnoses in youth with narrow phenotype bipolar disorder or severe mood dysregulation. American Journal of Psychiatry 164, 1238–1241.Google Scholar
Brotman, MA, Schmajuk, M, Rich, BA, Dickstein, DP, Guyer, AE, Costello, EJ, Egger, HL, Angold, A, Pine, DS, Leibenluft, E (2006). Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biological Psychiatry 60, 991–997.Google Scholar
Carlson, GA (1984). Classification issues of bipolar disorders in childhood. Psychiatric Developments 2, 273–285.Google Scholar
Carlson, GA (1998). Mania and ADHD: comorbidity or confusion. Journal of Affective Disorders 51, 177–187.Google Scholar
Carlson, GA, Kashani, JH (1988). Manic symptoms in a non-referred adolescent population. Journal of Affective Disorders 15, 219–226.Google Scholar
Carlson, GA, Meyer, SE (2006). Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: complexities and developmental issues. Development and Psychopathology 18, 939–969.Google Scholar
Caron, C, Rutter, M (1991). Comorbidity in child psychopathology: concepts, issues and research strategies. Journal of Child Psychology and Psychiatry 32, 1063–1080.Google Scholar
Caspi, A (2000). The child is father of the man: personality continuities from childhood to adulthood. Journal of Personality and Social Psychology 78, 158–172.Google Scholar
Caspi, A, Henry, B, Mcgee, RO, Moffitt, TE, Silva, PA (1995). Temperamental origins of child and adolescent behavior problems: from age three to age fifteen. Child Development 66, 55–68.Google Scholar
Costello, EJ, Angold, A, Burns, BJ, Stangl, DK, Tweed, DL, Erkanli, A, Worthman, CM (1996). The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry 53, 1129–1136.Google Scholar
Eisenberg, N, Sadovsky, A, Spinrad, TL, Fabes, RA, Losoya, SH, Valiente, C, Reiser, M, Cumberland, A, Shepard, SA (2005). The relations of problem behavior status to children's negative emotionality, effortful control, and impulsivity: concurrent relations and prediction of change. Development and Psychopathology 41, 193–211.Google Scholar
Ford, T, Goodman, R, Meltzer, H (2003). The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders. Journal of the American Academy of Child and Adolescent Psychiatry 42, 1203–1211.Google Scholar
Geller, B, Tillman, R, Bolhofner, K, Zimerman, B, Strauss, NA, Kaufmann, P (2006). Controlled, blindly rated, direct-interview family study of a prepubertal and early-adolescent bipolar I disorder phenotype: morbid risk, age at onset, and comorbidity. Archives of General Psychiatry 63, 1130–1138.Google Scholar
Geller, B, Tillman, R, Craney, JL, Bolhofner, K (2004). Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry 61, 459–467.Google Scholar
Geller, B, Zimerman, B, Williams, M, Delbello, MP, Bolhofner, K, Craney, JL, Frazier, J, Beringer, L, Nickelsburg, MJ (2002). DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls. Journal of Child and Adolescent Psychopharmacology 12, 11–25.Google Scholar
Goodman, R (1994). A modified version of the Rutter parent questionnaire including extra items on children's strengths: a research note. Journal of Child Psychology and Psychiatry 35, 1483–1494.Google Scholar
Goodman, R (1997). The Strengths and Difficulties Questionnaire: a research note. Journal of Child Psychology and Psychiatry 38, 581–586.Google Scholar
Goodman, R (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry 40, 1337–1345.Google Scholar
Goodman, R, Ford, T, Richards, H, Gatword, R, Meltzer, H (2000). The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry 41, 645–655.Google Scholar
Goodman, R, Scott, S (1999). Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: is small beautiful? Journal of Abnormal Child Psychology 27, 17–24.Google Scholar
Green, H, McGinnity, A, Meltzer, H, Ford, T, Goodman, R (2005). Mental Health of Children and Young People in Great Britain, 2004. The Stationery Office: London.Google Scholar
Hankin, BL, Mermelstein, R, Roesch, L (2007). Sex differences in adolescent depression: stress exposure and reactivity models. Child Development 78, 279–295.Google Scholar
Harrington, R, Myatt, T (2003). Is preadolescent mania the same condition as adult mania? A British perspective. Biological Psychiatry 53, 961–969.Google Scholar
Khan, AA, Jacobson, KC, Gardner, CO, Prescott, CA, Kendler, KS (2005). Personality and comorbidity of common psychiatric disorders. British Journal of Psychiatry 186, 190–196.Google Scholar
Kim-Cohen, J, Caspi, A, Moffitt, TE, Harrington, H, Milne, BJ, Poulton, R (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort Archives of General Psychiatry 60, 709–717.Google Scholar
Klein, DN, Riso, LP (1994). Psychiatric disorders: problems of boundaries and comorbidity. In Basic Issues in Psychopathology (ed.Costello, C. G.), pp. 19–66. Guilford Press: New York.Google Scholar
McClellan, J, Kowatch, R, Findling, RL (2007). Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 46, 107–125.Google Scholar
Mick, E, Spencer, T, Wozniak, J, Biederman, J (2005). Heterogeneity of irritability in attention-deficit/hyperactivity disorder subjects with and without mood disorders. Biological Psychiatry 58, 575–682.Google Scholar
Neale, MC, Kendler, KS (1995). Models of comorbidity for multifactorial disorders. American Journal of Human Genetics 57, 935–953.Google Scholar
NIMH roundtable (2001). National Institute of Mental Health research roundtable on prepubertal bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 40, 871–878.Google Scholar
Pavuluri, MN, Birmaher, B, Naylor, MW (2005). Pediatric bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry 44, 846–871.Google Scholar
StataCorp (2007). STATA Statistical Software: Release 10. Stata Corporation: College Station, TX.Google Scholar
Stringaris, A, Goodman, R (in press). Three dimensions of oppositionality in youth. Journal of Child Psychology and Psychiatry.Google Scholar
Thuppal, M, Carlson, GA, Sprafkin, J, Gadow, KD (2002). Correspondence between adolescent report, parent report, and teacher report of manic symptoms. Journal of Child and Adolescent Psychopharmacology 12, 27–35.Google Scholar
Tillman, R, Geller, B, Craney, JL, Bolhofner, K, Williams, M, Zimerman, B (2004). Relationship of parent and child informants to prevalence of mania symptoms in children with a prepubertal and early adolescent bipolar disorder phenotype. American Journal of Psychiatry 161, 1278–1284.Google Scholar