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Randomized Controlled Trial
. 2020 Dec 1:277:394-401.
doi: 10.1016/j.jad.2020.08.018. Epub 2020 Aug 13.

Longitudinal trajectories of mood symptoms and global functioning in youth at high risk for bipolar disorder

Marc J Weintraub  1 , Christopher D Schneck  2 , Patricia D Walshaw  3 , Kiki D Chang  4 , Aimee E Sullivan  2 , Manpreet K Singh  5 , David J Miklowitz  3
Affiliations
Randomized Controlled Trial

Longitudinal trajectories of mood symptoms and global functioning in youth at high risk for bipolar disorder

Marc J Weintraub et al. J Affect Disord. .

Abstract

Background: Little is known about the longitudinal course of mood symptoms and functioning in youth who are at high risk for bipolar disorder (BD). Identifying distinct course trajectories and predictors of those trajectories may help refine treatment approaches.

Methods: This study examined the longitudinal course of mood symptoms and functioning ratings in 126 youth at high risk for BD based on family history and early mood symptoms. Participants were enrolled in a randomized trial of family-focused therapy and followed longitudinally (mean 2.0 years, SD = 53.6 weeks).

Results: Using latent class growth analyses (LCGA), we observed three mood trajectories. All youth started the study with active mood symptoms. Following the index mood episode, participants were classified as having a "significantly improving course" (n = 41, 32.5% of sample), a "moderately symptomatic course" (n = 21, 16.7%), or a "predominantly symptomatic course" (n = 64, 50.8%) at follow-up. More severe depression, anxiety, and suicidality at the study's baseline were associated with a poorer course of illness. LCGA also revealed three trajectories of global functioning that closely corresponded to symptom trajectories; however, fewer youth exhibited functional recovery than exhibited symptomatic recovery.

Limitations: Mood trajectories were assessed within the context of a treatment trial. Ratings of mood and functioning were based on retrospective recall.

Conclusions: This study suggests considerable heterogeneity in the course trajectories of youth at high risk for BD, with a significant proportion (32.5%) showing long-term remission of symptoms. Treatments that enhance psychosocial functioning may be just as important as those that ameliorate symptoms in youth at risk for BD.

Keywords: Depression; Familial risk; Illness course; Mania; Pediatric; Prognosis.

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Conflict of interest statement

Conflicts of Interest:

The authors have no conflicts of interest to declare. Dr. Weintraub receives research support from Aim for Mental Health and the Shear Family Foundation. Dr. Schneck receives research support from the NIMH and the Ryan White HIV/AIDS Treatment Extension Act. Dr. Walshaw has no disclosures. Dr. Chang is a consultant for Sunovion, Allergan, and Impel Neuropharma; he is also on the speakers’ bureau for Sunvion. Dr. Singh receives research support from Stanford’s Maternal Child Health Research Institute, National Institute of Mental Health, National Institute of Aging, Johnson and Johnson, Allergan, and the Brain and Behavior Research Foundation. She is on the advisory board for Sunovion, is a consultant for Google X and Limbix, and receives royalties from the American Psychiatric Association Publishing. Dr. Miklowitz has received research funding from the NIMH, Brain and Behavior Research Foundation, Attias Family Foundation, Danny Alberts Foundation, Carl and Roberta Deutsch Foundation, Kayne Family Foundation, Max Gray Foundation, American Foundation for Suicide Prevention, and AIM for Mental Health. He receives book royalties from Guilford Press and John Wiley & Sons.

Figures

Figure 1.
Figure 1.
Latent classes of euthymic mood over three years
Figure 2.
Figure 2.
Latent classes of global functioning over three years
See this image and copyright information in PMC

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