Characteristics and 12-month outcomes of clinically referred children and young people at risk of bipolar disorder

Abstract

Introduction Bipolar disorder is uncommon in children and young people (CYP), but those at risk are likely to be clinically referred. However, the characteristics and outcomes of CYP at risk of bipolar disorder referred to UK Child and Adolescent Mental Health Services (CAMHS) remain understudied. Methods Participants were 305 CYP aged 11–17 years, with emotional difficulties, referred to CAMHS. CYP and/or parent/carers self-completed the Development and Wellbeing Assessment (DAWBA, including the mania section) at baseline, and follow-up measures at 12 months. Results A computerised algorithm categorised 9 (3.0 %, 95 % CI [1.4 %, 5.5 %]) CYP as ‘possible’, 66 as ‘uncertain’, and 230 as ‘unlikely’ for bipolar disorder, using symptom and impact scores. CYP in the ‘possible’ bipolar disorder subgroup were young (mean age = 13 years) and of high socioeconomic status. These CYP were likely to have their CAMHS referral accepted (89 %) and treatment/intervention offered (67 %) and started (56 %) within 12 months of referral. They had high levels of self-harm thoughts and behaviours at baseline and follow-up. The diagnostic algorithm indicated that they had social phobia, generalised anxiety disorder, and/or depression. A third of them were diagnosed with these disorders or obsessive-compulsive disorder by clinicians within 12 months, but not bipolar disorder. Limitations Our categories of likelihood subgroups were conservative as some participants only had DAWBAs completed by one informant. Subgroups were not compared statistically. Conclusion CYP in the ‘possible’ bipolar disorder subgroup were more likely to receive CAMHS input. They have high self-harm risk. Comorbid emotional disorders among these CYP should be considered.