Longitudinal course of depressive symptom severity among youths with bipolar disorders: Moderating influences of sustained attention and history of child maltreatment

Abstract

Background: Pediatric bipolar disorders are often characterized by disruptions in cognitive functioning, and exposure to child maltreatment (e.g., physical and sexual abuse) is associated with a significantly poorer course of illness. Although clinical and developmental research has shown maltreatment to be robustly associated with poorer cognitive functioning, it is unclear whether maltreatment and cognitive function jointly influence the clinical course of bipolar symptoms.

Methods: This secondary analysis examined moderating effects of lifetime childhood physical and sexual abuse, and cognitive disruptions (sustained attention, affective information processing), on longitudinal ratings of depression symptom severity in youths from the Course and Outcome of Bipolar Youth (COBY) study, examined from intake (M = 12.24 years) through age 22 (N = 198; 43.9% female; Mean age of bipolar onset = 8.85 years).

Results: A significant moderating effect was detected for sustained attention and maltreatment history. In the context of lower sustained attention, maltreatment exposure was associated with higher depression symptom severity during childhood, but not late adolescence. There was no association between maltreatment and symptom severity in the context of higher sustained attention, and no association between attention and depression symptom severity for non-maltreated youths.

Limitations: Depression symptom ratings at each assessment were subject to retrospective recall bias despite the longitudinal design. Cognitive assessments were administered at different ages across youths.

Conclusions: Depressive symptoms in pediatric bipolar may be jointly moderated by impairments in attention and exposure to maltreatment. Assessment of these risks, particularly in childhood, may be beneficial for considering risk of recurrence or chronicity of depressive symptoms.

Keywords: Bipolar disorder; Childhood adversity; Cognitive function; Depression; Physical abuse; Sexual abuse.

Figure 1.. Timeline of Study Assessments for the Original COBY Study.

CANTAB = Cambridge Neuropsychological Testing Automated Battery. *Participants continuing to complete follow-up assessments through 2016 completed CANTABs at alternating follow-up visits to allow for at least 12 months between cognitive assessments. All study activities for participants in the current sample occurred between the years 2000 and 2016. Study intakes took place between 2000 and 2006, and clinical follow-up assessments with semi-structured interviews took place an average of every 7.2 months between 2000 and 2016. The second funding cycle for the COBY study began in 2007 and the CANTAB was introduced at that time. Participants completed a minimum of one and maximum of six CANTABs from 2007 to 2016.

Figure 2.. Severity of Depressive Symptoms over Follow-Up Moderated by Child Maltreatment History and Sustained Attention.

RVP=Rapid Visual Processing Test for sustained attention subtest of the CANTAB=Cambridge Neuropsychological Test Automated Battery. Severity of depressive symptoms over follow-up moderated by childhood maltreatment history (left vs. right panels) and sustained attention (indexed by total hits on the RVP task). Depression rating scale scores on the y-axis are standardized to illustrate differences (in standard deviations) in symptom severity from the mean score of 0. Slopes for low and high RVP scores in the left panel (Never maltreated) are non-significant. The slope for high RVP scores in the right panel (History of maltreatment) is non-significant. Only the slope for low RVP scores in the right panel represents a significant association between attention and depressive symptoms (p=.005).