title: Functional impairment in adolescents and young adults with emerging mood disorders.
abstract: BACKGROUND
  Between 30 and 60% of adults with unipolar or bipolar disorders exhibit impairments across multiple domains. However, little is known about impaired functioning in youth with mood disorders.
  
  
  OBJECTIVE
  To examine the prevalence of objective, subjective and observer-rated disability in a large, representative sample of young people with a primary mood disorder.
  
  
  METHODS
  Individuals aged 16-25 years presenting to youth mental health services for the first time with a primary mood disorder participated in a systematic diagnostic and clinical assessment. Impairment was assessed using objective (unemployment or disability payments), observer- (Social and Occupational Functioning Assessment Scale; SOFAS) and self-rated measures (role functioning according to the Brief Disability Questionnaire).
  
  
  RESULTS
  Of 1241 participants (83% unipolar; 56% female), at least 30% were functionally impaired on the objective, self-rated and/or observer-rated measures, with 16% impaired according to all three criteria. Even when current distress levels were taken into account, daily use of cannabis and/or nicotine were significantly associated with impairment, with odds ratios (OR) ranging from about 1.5 to 3.0. Comorbid anxiety disorders were related to lower SOFAS scores (OR = 2-5).
  
  
  CONCLUSIONS
  Levels of disability were significant, even in those presenting for mental healthcare for the first time. Functional impairment did not differ between unipolar and bipolar cases, but some evidence suggested that females with bipolar disorder were particularly disabled. The prevalence of comorbid disorders (50%) and polysubstance use (28%) and their association with disability indicate that more meaningful indicators of mood episode outcomes should focus on functional rather than symptom-specific measures. The association between functioning and nicotine use requires further exploration.
authors.affiliation: Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Jan
authors.initials: J
authors.lastname: Scott
authors.affiliation: Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Scott
authors.affiliation: Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hermens
authors.affiliation: Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Naismith
authors.affiliation: Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Guastella
authors.affiliation: Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Django
authors.initials: D
authors.lastname: White
authors.affiliation: Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Bradley
authors.initials: B
authors.lastname: Whitwell
authors.affiliation: Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Jim
authors.initials: J
authors.lastname: Lagopoulos
authors.affiliation: Jan Scott, MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle and Centre for Affective Disorders, Institute of Psychiatry, London, UK; Elizabeth M. Scott, MBChB, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney and School of Medicine, University of Notre Dame, Sydney, Australia; Daniel F. Hermens, GradDipSci, PhD, Sharon L. Naismith, MClinPsych, DPsych, Adam J. Guastella, PhD, Django White, Bradley Whitwell, DipAppSci, Jim Lagopoulos, MBiomedE, PhD, FAINM, Ian B. Hickie, MD, FRANZCP, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia.
authors.forename: Ian B
authors.initials: IB
authors.lastname: Hickie
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D000339:Affect; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology* / Q000523:psychology*; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult