Adult outcomes of youth irritability: a 20-year prospective community-based study.
OBJECTIVE
Irritability is a widely occurring DSM-IV symptom in youths. However, little is known about the relationship between irritability in early life and its outcomes in mid-adulthood. This study examines the extent to which youth irritability is related to adult psychiatric outcomes by testing the hypothesis that it predicts depressive and generalized anxiety disorders.


METHODS
The authors conducted a longitudinal community-based study of 631 participants whose parents were interviewed when participants were in early adolescence (mean age=13.8 years [SD=2.6]) and who were themselves interviewed 20 years later (mean age=33.2 years [SD=2.9]). Parent-reported irritability in adolescence was used to predict self-reported psychopathology, assessed by standardized diagnostic interview at 20-year follow-up.


RESULTS
Cross-sectionally, irritability in adolescence was widely associated with other psychiatric disorders. After adjustment for baseline emotional and behavioral disorders, irritability in adolescence predicted major depressive disorder (odds ratio=1.33, 95% confidence interval [CI]=1.00-1.78]), generalized anxiety disorder (odds ratio=1.72, 95% CI=1.04-2.87), and dysthymia (odds ratio=1.81, 95% CI=1.06-3.12) at 20-year follow-up. Youth irritability did not predict bipolar disorder or axis II disorders at follow-up.


CONCLUSIONS
Youth irritability as reported by parents is a specific predictor of self-reported depressive and anxiety disorders 20 years later. The role of irritability in developmental psychiatry, and in the pathophysiology of mood and anxiety disorders specifically, should receive further study.
Stringaris
Argyris
A
Section on Bipolar Spectrum Disorders, Emotion and Development Branch, Mood and Anxiety Program, NIMH Bldg. 15K, MSC-2670, Bethesda, MD 20892-2670,USA. stringarisa@mail.nih.gov
Cohen
Patricia
P
Pine
Daniel S
DS
Leibenluft
Ellen
E
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007508:Irritable Mood; D008137:Longitudinal Studies; D008297:Male; D009518:New York / Q000453:epidemiology; D010290:Parents / Q000523:psychology; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome