Prevalence and correlates of bipolar I disorder among adults with primary youth‐onset anxiety disorders

Abstract

Objectives-It is of potentially great public health importance to determine whether youth-onset anxiety disorders are associated with increased prevalence of subsequent bipolar I disorder (BD) among adults, and to identify risk factors for BD in this population. Methods-The 2001-2002National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with social phobia, panic disorder, or generalized anxiety disorder that onset in youth (<19 years) and was not preceded by a major depressive, manic, or mixed episode (N=1,571; 572 males, 999 females). The prevalence of BD among subjects with, versus without, these youth-onset anxiety disorders was examined. Variables that could be associated with increased risk of BD among subjects with youth-onset anxiety disorders were examined, including conduct disorder, youth-onset substance use disorders (SUD), and family history of depression and/or alcoholism. Analyses were computed separately for males and females.Results-The prevalence of BD was significantly greater among adults with, versus without, primary youth-onset anxiety disorders for both males (15.9% vs 2.7%; χ2=318.4, df=1, p<0.001) and females (13.8% vs 2.9%; χ2=346.2, df=1, p<0.001). Youth-onset anxiety disorders remained significantly associated with BD after controlling for interceding major depression, and this was true for each of the specific anxiety disorders examined. Among males with youth-onset primary anxiety disorders, conduct disorder and loaded family history of depression were associated with significantly increased risk of BD. Among females, conduct disorder and loaded family history of alcoholism were associated with significantly increased risk of BD.Conclusions-The prevalence of BD was elevated among subjects with youth-onset primary anxiety disorders, particularly if comorbid conduct disorder was present. Future studies are needed to confirm these findings prospectively, and to develop preventive strategies for populations at risk.

Course of comorbid anxiety disorders among adults with bipolar disorder in the U.S. population

“…On average, the onset of anxiety disorders preceded the onset of BP in individuals with both disorders and supports the idea that anxiety disorders could be a risk factor for subsequent development of BP (Goldstein & Levitt, 2007). Interestingly, recent studies found that offspring of parents with BP had higher rates of anxiety disorders than offspring of control parents suggesting that anxiety may be a precursor of BP among BP offspring (Birmaher et al, 2009; Goldstein et al).…”

Lifetime Psychiatric Disorders in School-aged Offspring of Parents With Bipolar Disorder

“…There were no differences in the rates of other anxiety disorders, but the base rate of these disorders was low. Other studies of high risk for BP and studies of adults and youth with BP have also reported high rates of anxiety disorders 7,9,67-73. Also, high rates of anxiety disorders have been consistently observed in adults with early-onset BP when compared with adults with late-onset BP,1,70,71 and anxiety disorders appear to be associated with increased risk of developing BP during adulthood 44,74,75.…”

Clinical, Demographic, and Familial Correlates of Bipolar Spectrum Disorders Among Offspring of Parents With Bipolar Disorder

“…Duffy and colleagues found that 30% of offspring of parents with BP who initially manifested sleep or anxiety disorders went on to develop BP 52. Retrospective studies indicate that childhood anxiety disorders and ODD/CD are more common among adults with BP compared to controls53, and youth-onset anxiety disorders have been associated with elevated rates of BP in adulthood 54. Previous studies have found starkly contradictory findings regarding ADHD.…”