Early risk factors for adult bipolar disorder in adolescents with mood disorders: a 15-year follow-up of a community sample

Päären, Aivar; Bohman, Hannes; Knorring, Lars von; Olsson, Gabriella; Knorring, Anne-Liis von; Jönsson, Ulf

doi:10.1186/s12888-014-0363-z

Cited by 22 publications

(19 citation statements)

References 117 publications

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“…OR=3.6 and OR=6.6)[55]. In this study, of the 64 adolescents with hypomania spectrum episodes during childhood, only 6 developed a hypomanic/manic episode as adults.…”

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confidence: 48%

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Early interventions for youths at high risk for bipolar disorder: a developmental approach

Benarous

Consoli

Milhiet

et al. 2015

Eur Child Adolesc Psychiatry

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In recent decades, ongoing research programmes on primary prevention and early identification of bipolar disorder (BD) have been developed. The aim of this article is to review the principal forms of evidence that support preventive interventions for BD in children and adolescents and the main challenges associated with these programmes. We performed a literature review of the main computerised databases (MEDLINE, PUBMED) and a manual search of the literature relevant to prospective and retrospective studies of prodromal symptoms, premorbid stages, risk factors, and early intervention programmes for BD. Genetic and environmental risk factors of BD were identified. Most of the algorithms used to measure the risk of developing BD and the early interventions programmes focused on the familial risk. The prodromal signs varied greatly and were age dependent. During adolescence, depressive episodes associated with genetic or environmental risk factors predicted the onset of hypomanic/manic episodes over subsequent years. In prepubertal children, the lack of specificity of clinical markers and difficulties in mood assessment were seen as impeding preventive interventions at these ages. Despite encouraging results, biomarkers have not thus far been sufficiently validated in youth samples to serve as screening tools for prevention. Additional longitudinal studies in youths at high risk of developing BD should include repeated measures of putative biomarkers. Staging models have been developed as an integrative approach to specify the individual level of risk based on clinical (e.g. prodromal symptoms and familial history of BD) and non-clinical (e.g. biomarkers and neuroimaging) data. However, there is still a lack of empirically validated studies that measure the benefits of using these models to design preventive intervention programmes.

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“…OR=3.6 and OR=6.6)[55]. In this study, of the 64 adolescents with hypomania spectrum episodes during childhood, only 6 developed a hypomanic/manic episode as adults.…”

mentioning

confidence: 48%

“…Longitudinal studies conducted in an unselected community-based sample can facilitate the generalisation of findings. In the Dunedin (New-Zealand) birth cohort (N=922 children), [55].…”

Section: Studies In a Community-based Samplementioning

confidence: 99%

Early interventions for youths at high risk for bipolar disorder: a developmental approach

Benarous

Consoli

Milhiet

et al. 2015

Eur Child Adolesc Psychiatry

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“…Future research is however needed to confirm this finding. Previous analyses of the same cohort have shown that a family history of bipolar disorder was a strong significant risk factor for bipolar disorder in adulthood [37]. The number of individuals in the data material with bipolar disorder in adulthood is however too small to disentangle relationships between parents’ bipolar disorder, parental separation, and the individual’s depression and bipolar disorder.…”

Section: Discussionmentioning

confidence: 98%

Parental separation in childhood as a risk factor for depression in adulthood: a community-based study of adolescents screened for depression and followed up after 15 years

et al. 2017

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BackgroundEarlier research has investigated the association between parental separation and long-term health outcomes among offspring, but few studies have assessed the potentially moderating role of mental health status in adolescence. The aim of this study was to analyze whether parental separation in childhood predicts depression in adulthood and whether the pattern differs between individuals with and without earlier depression.MethodsA community-based sample of individuals with adolescent depression in 1991–93 and matched non-depressed peers were followed up using a structured diagnostic interview after 15 years. The participation rate was 65% (depressed n = 227; non-depressed controls n = 155). Information on parental separation and conditions in childhood and adolescence was collected at baseline. The outcome was depression between the ages 19–31 years; information on depression was collected at the follow-up diagnostic interview. The statistical method used was binary logistic regression.ResultsOur analyses showed that depressed adolescents with separated parents had an excess risk of recurrence of depression in adulthood, compared with depressed adolescents with non-separated parents. In addition, among adolescents with depression, parental separation was associated with an increased risk of a switch to bipolar disorder in adulthood. Among the matched non-depressed peers, no associations between parental separation and adult depression or bipolar disorder were found.ConclusionsParental separation may have long-lasting health consequences for vulnerable individuals who suffer from mental illness already in adolescence.

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“…Although the German study of Tijssen et al excluded baseline lifetime cases of BD, it did not nd any new cases of BD over the ensuing 8 years, despite the presence of hypomanic symptoms in some subjects and the study focusing on emerging affective symptoms. The 15-year follow up in the Swedish study (Päären et al 2013(Päären et al , 2014 found only a small percentage of adolescents with "hypomania spectrum disorder" developed BD-I (3%) or BD-II (6%) by their early 30 s.…”

Section: Adolescent Hypomania Often Not Resulting In Adult Bipolar DImentioning

confidence: 98%

“…The majority of bipolar spectrum cases across the 19 studies were of adolescents and by self-report. The validity of these diagnoses is thrown into some question by two of the newer studies ( Päären et al 2013( Päären et al , 2014Tijssen et al 2010) that incorporated follow-up interviews some years later. Although the German study of Tijssen et al excluded baseline lifetime cases of BD, it did not nd any new cases of BD over the ensuing 8 years, despite the presence of hypomanic symptoms in some subjects and the study focusing on emerging affective symptoms.…”

Section: Adolescent Hypomania Often Not Resulting In Adult Bipolar DImentioning

confidence: 99%

‘Pediatric Bipolar Disorder’ Rates are Still Lower than Claimed – A Re-examination of Eight Epidemiological Surveys used by an Updated Meta-analysis

Parry

Allison

Bastiampillai

2020

Preprint

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Background: ‘Pediatric bipolar disorder’ (PBD) is a controversial diagnosis with varying rates of clinical diagnosis. A highly cited meta-analysis (Van Meter et al. 2011) of a dozen epidemiological surveys suggested a global community prevalence of 1.8%. This was further updated to 3.9% with eight additional surveys (Van Meter et al. 2019a). A narrative analysis (Parry et al. 2018) of the original 12 surveys concluded rates of PBD were substantially lower than 1.8% and led to a nine-article debate on the validity, overdiagnosis and iatrogenic aspects of the PBD diagnosis (e.g. Carlson and Dubicka 2019). This article extends the narrative analysis to include the eight newer community surveys.Methods: In terms of the Cochrane Handbook for Systematic Reviews of Interventions, the heterogenous community surveys were arguably unsuitable for statistical meta-analysis and warranted a narrative analysis.Results: Across all twenty surveys there was significant variation in methodologies and reported prevalence rates. Of the eight newer surveys, five (two Brazilian, one English, one Turkish, one United States) provided information of pre-adolescent rates of bipolar spectrum disorder. These pre-adolescent rates were zero or close to zero. Rates of adolescent hypomania/mania were higher, but follow-up data suggested most hypomania did not progress to adult bipolar disorder.Limitations: Methods in the original surveys vary and criteria used for various bipolar diagnoses were not always fully described. This limitation applies to a narrative analysis but also to a statistical meta-analysis.Conclusion: Bipolar disorder is very rare in childhood and rare in adolescence. PBD as a diagnostic construct fails to correlate with adult bipolar disorder and the term should be abandoned. Hypomanic syndromes in adolescence may not progress to adult bipolar disorder. Early diagnosis of bipolar disorder is important, but over-diagnosis risks adverse iatrogenic consequences.

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Early risk factors for adult bipolar disorder in adolescents with mood disorders: a 15-year follow-up of a community sample

Cited by 22 publications

References 117 publications

Early interventions for youths at high risk for bipolar disorder: a developmental approach

Early interventions for youths at high risk for bipolar disorder: a developmental approach

Parental separation in childhood as a risk factor for depression in adulthood: a community-based study of adolescents screened for depression and followed up after 15 years

‘Pediatric Bipolar Disorder’ Rates are Still Lower than Claimed – A Re-examination of Eight Epidemiological Surveys used by an Updated Meta-analysis

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