Predictors of longitudinal psychosocial functioning in bipolar youth transitioning to adults

Heather Hower¹, Erica J Lee², Richard N Jones³, Boris Birmaher⁴, Michael Strober⁵, Benjamin I Goldstein⁶, John Merranko⁴, Martin B Keller⁷, Tina R Goldstein⁴, Lauren M Weinstock², Daniel P Dickstein⁷, Jeffrey I Hunt⁷, Rasim S Diler⁴, Neal D Ryan⁴, Mary Kay Gill⁴, David Axelson⁸, Shirley Yen⁹

Affiliations

¹ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
² Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Butler Hospital, 700 Butler Drive, Providence, RI 02906, USA.
³ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA.
⁴ Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
⁵ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, 760 Westwood Plaza, Mail Code 175919, Los Angeles, CA 90095, USA.
⁶ Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON M4N-3M5, Canada.
⁷ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA.
⁸ Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, 1670 Upham Dr., Columbus, OH 43210, USA.
⁹ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.

PMID: 30605876
PMCID: PMC6363880
DOI: 10.1016/j.jad.2018.12.108

Predictors of longitudinal psychosocial functioning in bipolar youth transitioning to adults

Heather Hower et al. J Affect Disord. 2019.

. 2019 Mar 1:246:578-585.

doi: 10.1016/j.jad.2018.12.108. Epub 2018 Dec 26.

Authors

Affiliations

¹ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
² Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Butler Hospital, 700 Butler Drive, Providence, RI 02906, USA.
³ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA.
⁴ Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
⁵ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, 760 Westwood Plaza, Mail Code 175919, Los Angeles, CA 90095, USA.
⁶ Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON M4N-3M5, Canada.
⁷ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA.
⁸ Department of Psychiatry, Nationwide Children's Hospital and The Ohio State College of Medicine, 1670 Upham Dr., Columbus, OH 43210, USA.
⁹ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.

PMID: 30605876
PMCID: PMC6363880
DOI: 10.1016/j.jad.2018.12.108

Abstract

Objectives: In a sample of participants diagnosed with Bipolar Disorder (BD) in youth, we aim: (1) to examine longitudinal psychosocial functioning; (2) to determine whether psychosocial impairment remains in those who remitted from mood disorders during later periods of follow-up; (3) to examine predictors of psychosocial impairment despite symptomatic remission.

Method: A Course and Outcome of Bipolar Youth subsample of 367 (≥ 4 years follow-up data) were grouped into mood trajectories: Class 1 Predominantly Euthymic; Class 2 Moderately Euthymic; Class 3 Ill with Improving Course; Class 4 Predominantly Ill. Psychosocial functioning was assessed via Children's Global Assessment Scale (C-GAS) for those under age 22; Global Assessment of Functioning (GAF) scale after 22. Current school, employment, and disability status were examined. Established predictors of symptomatic impairment were analyzed.

Results: The Predominantly Euthymic Class had better psychosocial functioning, and were more likely to be in school/employed. The Persistently Ill Class had worse psychosocial functioning, and were more likely to receive disability. However, 44% of Predominantly Euthymic and 93% of Ill with Improving Course participants continued to experience current psychosocial impairment. Early BD onset, low Socioeconomic Status (SES), and current comorbidity, predicted poor psychosocial functioning. Low SES, and current comorbidity, predicted no school enrollment/unemployment.

Limitations: The study does not have a healthy control group to compare functioning findings.

Conclusions: In general, youth with persistent mood symptoms had worse psychosocial functioning, moreover, those with remitted symptoms still exhibited current psychosocial functioning deficits. High risk individuals with predictors of impairment should be targeted for functioning interventions.

Keywords: Bipolar disorder; Longitudinal studies; Predictors; Psychosocial functioning.

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References

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Predictors of longitudinal psychosocial functioning in bipolar youth transitioning to adults

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Predictors of longitudinal psychosocial functioning in bipolar youth transitioning to adults

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