Pediatric Mood Disorders and Trauma: What are the Associations?

Background: There is limited data on the effects of Childhood Maltreatment (CM) on pediatric mood disorders in general and pediatric Bipolar Disorder (BD) in particular. We aimed to compare clinical and family characteristics of youth with CM and Mood Disorder Not Otherwise Specified (MD) to youth with CM and BD and to follow the youth with MD longitudinally to determine their course of illness. Methods: Twenty-two youths (ages 8-18 years) with mood symptoms (11 with BD and 11 with MD) and histories of CM prior to the age of 5 years were assessed using a structured clinical interview. A follow-up assessment was conducted with 8 of the 11 parents of youth with MD. Results: 11 subjects (5 females, mean age 13 ± 2.4 sd) met DSMIV-TR criteria for BD and 11 subjects (4 females, mean age 12.5 ± 3.1 sd) met DSM-IV-TR criteria for MD. BD subjects had a higher number of lifetime major depressive episodes (BD=18.9 versus MD=4, z(20)=-2.5, p=0.01) and lifetime manic episodes (BD=17.7 MD=0.3, z(19)=-5.1,p<0.001). Age at first reported trauma exposure was similar for both groups youth with BD (BD=3.1 ± 1.7 MD 3.4 ± 1.8 t(19.9)=-0.4, p=0.7), as were types of trauma, number of incidents, and PTSD symptoms. There were higher rates of schizophrenia, BD and major depressive disorder in the families of youth with BD compared to youth with MD. At follow up, 4/8 (50%) youth with MD at baseline either received a different diagnosis (n=2), or experienced a manic episode (n=2). Conclusions: The results suggest higher rates of schizophrenia, BD, and MDD in the families of youth with BD. These preliminary results suggest potential biological and genetic vulnerabilities, which may predispose children with histories of CM to develop specific mood disorders under certain circumstances.