Abstract
ContextEarly identification of Bipolar Disorder (BD) remains poor despite the high levels of disability associated with the disorder.ObjectiveWe developed and evaluated a new DSM orientated scale for the identification of young people at risk for BD based on the Child Behavior Checklist (CBCL) and compared its performance against the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) and the CBCL-Externalizing Scale, the two most widely used scales.MethodsThe new scale, CBCL-Mania Scale (CBCL-MS), comprises 19 CBCL items that directly correspond to operational criteria for mania. We tested the reliability, longitudinal stability and diagnostic accuracy of the CBCL-MS on data from the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective epidemiological cohort study of 2230 Dutch youths assessed with the CBCL at ages 11, 13 and 16. At age 19 lifetime psychiatric diagnoses were ascertained with the Composite International Diagnostic Interview. We compared the predictive ability of the CBCL-MS against the CBCL-Externalising Scale and the CBCL-PBD in the TRAILS sample.ResultsThe CBCL-MS had high internal consistency and satisfactory accuracy (area under the curve = 0.64) in this general population sample. Principal Component Analyses, followed by parallel analyses and confirmatory factor analyses, identified four factors corresponding to distractibility/disinhibition, psychosis, increased libido and disrupted sleep. This factor structure remained stable across all assessment ages. Logistic regression analyses showed that the CBCL-MS had significantly higher predictive ability than both the other scales.ConclusionsOur data demonstrate that the CBCL-MS is a promising screening instrument for BD. The factor structure of the CBCL-MS showed remarkable temporal stability between late childhood and early adulthood suggesting that it maps on to meaningful developmental dimensions of liability to BD.
Highlights
Bipolar Disorder (BD) is a complex mental disorder affecting between 0.1% and 4.4% of the general population [1]
Our data demonstrate that the Child Behavior Checklist (CBCL)-MS is a promising screening instrument for BD
A principal components analysis (PCA) of the Child Behavior Checklist—Mania Scale (CBCL-MS) data assessed at age 16 extracted four factors corresponding to: (1) distractibility/disinhibition (2) psychotic symptoms (3) increased libido (4) disrupted sleep (Figure 1)
Summary
Bipolar Disorder (BD) is a complex mental disorder affecting between 0.1% and 4.4% of the general population [1]. BD is the sixth leading cause of disability worldwide amongst adolescents and young adults [2]. This is partly due to the typically early onset of BD with the majority of patients presenting between 19–25 years of age [1,3]. BD is associated with high rates (between 60–80%) of psychotic symptoms during mood episodes [14,15]. High rates of psychotic symptoms have been reported in young patients and confirm their role as a key symptom dimension of BD in adolescence [16,17]. Additional diagnostic challenges arise from the symptomatic overlap between BD and Attention Deficit Hyperactivity Disorder (ADHD), which presents with poor attentional and emotional regulation [18]
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