Do sub-syndromal manic symptoms influence outcome in treatment resistant depression in adolescents? A latent class analysis from the TORDIA study

Fadi T. Maalouf, Giovanna Porta, Benedetto Vitiello, Graham Emslie, Taryn Mayes, Gregory Clarke, Karen Wagner, Joan Rosenbaum Asarnow, Anthony Spirito, Martin Keller, Boris Birmaher, Neal Ryan, Wael Shamseddeen, Satish Iyengar, David Brent

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates. Methods: Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale-Revised (CDRS-R) through 72 weeks from intake. Results: 3 classes were identified: (1) little change in symptomatic status ("NO"), comprising 24.9% of participants, with a 72-week remission rate of 25.3%; (2) slow, steady improvement ("SLOW"), comprising 47.9% of participants, with a remission rate of 60.0%, and (3) rapid symptom response ("GO"), comprising 27.2% of participants, with a remission rate of 85.7%. Higher baseline CDRS-R (p < 0.001) and poorer functioning (p = 0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p < 0.001) and scores on the Mania Rating Scale (MRS) (p = 0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps ≤ 0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p = 0.02). Limitations: High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization. Conclusion: Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression.

Original languageEnglish (US)
Pages (from-to)86-95
Number of pages10
JournalJournal of Affective Disorders
Volume138
Issue number1-2
DOIs
StatePublished - Apr 2012
Externally publishedYes

Fingerprint

Treatment-Resistant Depressive Disorder
Bipolar Disorder
Depression
Family Conflict
Random Allocation
Therapeutics
Growth
Research

Keywords

  • Adolescent
  • Depression
  • Latent class analysis
  • TORDIA
  • Trajectories

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Do sub-syndromal manic symptoms influence outcome in treatment resistant depression in adolescents? A latent class analysis from the TORDIA study. / Maalouf, Fadi T.; Porta, Giovanna; Vitiello, Benedetto; Emslie, Graham; Mayes, Taryn; Clarke, Gregory; Wagner, Karen; Asarnow, Joan Rosenbaum; Spirito, Anthony; Keller, Martin; Birmaher, Boris; Ryan, Neal; Shamseddeen, Wael; Iyengar, Satish; Brent, David.

In: Journal of Affective Disorders, Vol. 138, No. 1-2, 04.2012, p. 86-95.

Research output: Contribution to journalArticle

Maalouf, FT, Porta, G, Vitiello, B, Emslie, G, Mayes, T, Clarke, G, Wagner, K, Asarnow, JR, Spirito, A, Keller, M, Birmaher, B, Ryan, N, Shamseddeen, W, Iyengar, S & Brent, D 2012, 'Do sub-syndromal manic symptoms influence outcome in treatment resistant depression in adolescents? A latent class analysis from the TORDIA study', Journal of Affective Disorders, vol. 138, no. 1-2, pp. 86-95. https://doi.org/10.1016/j.jad.2011.12.021
Maalouf, Fadi T. ; Porta, Giovanna ; Vitiello, Benedetto ; Emslie, Graham ; Mayes, Taryn ; Clarke, Gregory ; Wagner, Karen ; Asarnow, Joan Rosenbaum ; Spirito, Anthony ; Keller, Martin ; Birmaher, Boris ; Ryan, Neal ; Shamseddeen, Wael ; Iyengar, Satish ; Brent, David. / Do sub-syndromal manic symptoms influence outcome in treatment resistant depression in adolescents? A latent class analysis from the TORDIA study. In: Journal of Affective Disorders. 2012 ; Vol. 138, No. 1-2. pp. 86-95.
@article{29b5297f91d84c7aa25a47ee548e9950,
title = "Do sub-syndromal manic symptoms influence outcome in treatment resistant depression in adolescents? A latent class analysis from the TORDIA study",
abstract = "Background: To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates. Methods: Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale-Revised (CDRS-R) through 72 weeks from intake. Results: 3 classes were identified: (1) little change in symptomatic status ({"}NO{"}), comprising 24.9{\%} of participants, with a 72-week remission rate of 25.3{\%}; (2) slow, steady improvement ({"}SLOW{"}), comprising 47.9{\%} of participants, with a remission rate of 60.0{\%}, and (3) rapid symptom response ({"}GO{"}), comprising 27.2{\%} of participants, with a remission rate of 85.7{\%}. Higher baseline CDRS-R (p < 0.001) and poorer functioning (p = 0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p < 0.001) and scores on the Mania Rating Scale (MRS) (p = 0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps ≤ 0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p = 0.02). Limitations: High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization. Conclusion: Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression.",
keywords = "Adolescent, Depression, Latent class analysis, TORDIA, Trajectories",
author = "Maalouf, {Fadi T.} and Giovanna Porta and Benedetto Vitiello and Graham Emslie and Taryn Mayes and Gregory Clarke and Karen Wagner and Asarnow, {Joan Rosenbaum} and Anthony Spirito and Martin Keller and Boris Birmaher and Neal Ryan and Wael Shamseddeen and Satish Iyengar and David Brent",
year = "2012",
month = "4",
doi = "10.1016/j.jad.2011.12.021",
language = "English (US)",
volume = "138",
pages = "86--95",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",
number = "1-2",

}

TY - JOUR

T1 - Do sub-syndromal manic symptoms influence outcome in treatment resistant depression in adolescents? A latent class analysis from the TORDIA study

AU - Maalouf, Fadi T.

AU - Porta, Giovanna

AU - Vitiello, Benedetto

AU - Emslie, Graham

AU - Mayes, Taryn

AU - Clarke, Gregory

AU - Wagner, Karen

AU - Asarnow, Joan Rosenbaum

AU - Spirito, Anthony

AU - Keller, Martin

AU - Birmaher, Boris

AU - Ryan, Neal

AU - Shamseddeen, Wael

AU - Iyengar, Satish

AU - Brent, David

PY - 2012/4

Y1 - 2012/4

N2 - Background: To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates. Methods: Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale-Revised (CDRS-R) through 72 weeks from intake. Results: 3 classes were identified: (1) little change in symptomatic status ("NO"), comprising 24.9% of participants, with a 72-week remission rate of 25.3%; (2) slow, steady improvement ("SLOW"), comprising 47.9% of participants, with a remission rate of 60.0%, and (3) rapid symptom response ("GO"), comprising 27.2% of participants, with a remission rate of 85.7%. Higher baseline CDRS-R (p < 0.001) and poorer functioning (p = 0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p < 0.001) and scores on the Mania Rating Scale (MRS) (p = 0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps ≤ 0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p = 0.02). Limitations: High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization. Conclusion: Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression.

AB - Background: To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates. Methods: Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale-Revised (CDRS-R) through 72 weeks from intake. Results: 3 classes were identified: (1) little change in symptomatic status ("NO"), comprising 24.9% of participants, with a 72-week remission rate of 25.3%; (2) slow, steady improvement ("SLOW"), comprising 47.9% of participants, with a remission rate of 60.0%, and (3) rapid symptom response ("GO"), comprising 27.2% of participants, with a remission rate of 85.7%. Higher baseline CDRS-R (p < 0.001) and poorer functioning (p = 0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p < 0.001) and scores on the Mania Rating Scale (MRS) (p = 0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps ≤ 0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p = 0.02). Limitations: High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization. Conclusion: Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression.

KW - Adolescent

KW - Depression

KW - Latent class analysis

KW - TORDIA

KW - Trajectories

UR - http://www.scopus.com/inward/record.url?scp=84858289082&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84858289082&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2011.12.021

DO - 10.1016/j.jad.2011.12.021

M3 - Article

C2 - 22284022

AN - SCOPUS:84858289082

VL - 138

SP - 86

EP - 95

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

IS - 1-2

ER -