Mania With and Without Depression in a Community Sample of US Adolescents
CONTEXT: There are limited data on the manifestations of mania in general community samples of adolescents. OBJECTIVE: To present the prevalence and clinical correlates of mania with and without depressive episodes in a representative sample of US adolescents. DESIGN: Cross-sectional survey of adolescents using a modified version of the Composite International Diagnostic Interview. PARTICIPANTS: Ten thousand one hundred twenty-three adolescents aged 13 to 18 years identified in household and school settings. MAIN OUTCOME MEASURES: Mania/hypomania with or without depression among those who met DSM-IV criteria for bipolar I or II disorder or major depressive disorder. RESULTS: Two and a half percent of youth met criteria for lifetime bipolar I or II disorder and 1.7%, for mania only. Twelve-month rates of mania with and without depression were 2.2% and 1.3%, respectively. There was a nearly 2-fold increase in rates of mania from ages 13-14 to 17-18 years. Mania with depression was associated with a greater number of all indictors of clinical severity including symptom number and severity, role disability, severe impairment, comorbidity, and treatment compared with depression alone, whereas correlates of mania were similar among those with mania with or without depression. CONCLUSIONS: The increasing prevalence of bipolar disorder with increasing age and the comparable rate of bipolar disorder with those of adult samples highlight adolescence as the peak period of onset of mania. The clinical significance of mania plus depression as demonstrated by a 1 in 5 suicide attempt rate and nearly 2 months per year of role impairment in adolescence has important implications for early intervention. The evidence for independence of mania from depression warrants additional scrutiny in the diagnostic nomenclature and etiologic dissection of bipolar disorder.