Hypomania spectrum disorder in adolescence: a 15-year follow-up of non-mood morbidity in adulthood

Abstract

BackgroundWe investigated whether adolescents with hypomania spectrum episodes have an excess risk of mental and physical morbidity in adulthood, as compared with adolescents exclusively reporting major depressive disorder (MDD) and controls without a history of adolescent mood disorders.MethodsA community sample of adolescents (N = 2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes (40 full-syndromal, 18 with brief episode, and 32 subsyndromal), while another 197 fulfilled the criteria for MDD without a history of a hypomania spectrum episode. A follow up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. The participation rate at the follow-up interview was 71% (64/90) for the hypomania spectrum group, and 65.9% (130/197) for the MDD group. Multiple imputation was used to handle missing data.ResultsThe outcomes of the hypomania spectrum group and the MDD group were similar regarding subsequent non-mood Axis I disorders in adulthood (present in 53 vs. 57%). A personality disorder was reported by 29% of the hypomania spectrum group and by 20% of the MDD group, but a statistically significant difference was reached only for obsessive-compulsive personality disorder (24 vs. 14%). In both groups, the risk of Axis I disorders and personality disorders in adulthood correlated with continuation of mood disorder. Prescription drugs and health service use in adulthood was similar in the two groups. Compared with adolescents without mood disorders, both groups had a higher subsequent risk of psychiatric morbidity, used more mental health care, and received more psychotropic drugs.ConclusionsAlthough adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes, both groups are at increased risk for subsequent mental health problems. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course.

Childhood interleukin-6, C-reactive protein and atopic disorders as risk factors for hypomanic symptoms in young adulthood: a longitudinal birth cohort study

“…Prevalence estimates of hypomania in non-clinical samples using this format of HCL-32 also appear to be comparable with bipolar disorder prevalence in other sources (Meyer et al 2007). Clinical verification of hypomania and information on bipolar disorder diagnoses would strengthen our conclusions, but it is likely that a number of individuals with hypomania symptoms will progress to a diagnosis and these symptoms are associated with a range of adverse psychiatric outcomes (Zimmermann et al 2009; Päären et al 2014). The items in the HCL-32 do not relate to symptoms of psychosis or depression, and after additional adjustment for depression the association remained, so the relationship cannot be driven by this previously identified association (Khandaker et al 2014 a ).…”

“…Combined, this body of work suggests that aberrant immune response in childhood might influence the risk of a range of major mental disorders. It is recognized that hypomanic symptoms in early adulthood are associated generally with an increased risk of Axis I disorders, and specifically with developing bipolar disorder (Zimmermann et al 2009; Päären et al 2014). The result is particularly interesting as it suggests an association of subtle changes in cytokine levels in early life with hypomanic symptoms assessed in adulthood, where previous research has found immune activation returns to normal between affective episodes in bipolar disorder (Kunz et al 2011; Stertz et al 2013).…”

“…Indeed it may be that this association is less likely than a longitudinal association with psychotic experiences as, whilst it has been found that chronic immune activation occurs in schizophrenia, previous research has suggested that bipolar disorder is an episode-related inflammatory syndrome, with normal cytokine function between affective episodes (Kunz et al 2011; Stertz et al 2013). Hypomanic symptoms in early adulthood are a risk factor for developing bipolar disorder (Zimmermann et al 2009), but are also associated with increased future risk of non-affective Axis I disorders, personality disorders, mental health service use and psychotropic drug prescribing (Päären et al 2014). …”

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

“…Detailed methods of this community-based study have been published elsewhere [ 10 ],[ 14 ],[ 45 ]. Briefly, 2,300 of 2,446 (93%) 16- to 17-year-olds in a mid-sized Swedish community participated in a screening procedure aimed at identifying individuals with depressive symptoms using the Beck Depression Inventory-Child (BDI-C) [ 46 ],[ 47 ] and the Centre for Epidemiological Studies – Depression Scale for Children (CES-DC) [ 48 ]-[ 50 ].…”

“…No major differences were identified between those who participated and those who were lost to follow up. Details regarding the follow-up attrition have been published previously [ 45 ].…”