2 - (IOP 32) Latent Profiles of Mood: Toward an Empirical Definition of Mixed Mood in Youth

Mixed mood is a dominant presentation of pediatric mood disorders. However, present categorical taxonomies of psychopathology position mania as the primary youth bipolar presentation and poorly capture mixed mood in youth. For example, the DSM-5 “with mixed features” specifier has thresholds derived from adults and does not specify common mixed presentations. Present taxonomies of mental disorders, therefore, must be reassessed and realigned with empirical research on mood disorder dimensions and presentations in youth. Accordingly, the present study aimed to define dimensions of mood with exploratory factor analysis (EFA) using two common clinical interviews for mania and depression and to identify clusters of youth with similar mood presentations using a Latent Profile Analysis (LPA).

All participants (N=710) were families with children, ages 5-18 (M= 10.93, SD= 3.41), seeking outpatient mental health services between July 2003 to July 2007 at Applewood Centers or Case Western Reserve/University Hospitals of Cleveland. Participants were majority male (58.7%) and black (70.7%). The Young Mania Rating Scale (YMRS) and the Child Depression Rating Scale: Revised Edition (CDRS-R) rated each youth's severity of current manic and depressive symptoms, respectively. Clinician-rated scores on the YMRS and CDRS-R represent combined information from parent, child, and clinical observation during intake. Demographics, DSM-IV LEAD diagnoses, and parent-report assessments of psychopathology and impairment assessed criterion validity of LPA-generated profiles.

A three-factor solution with manic, depressive, and psychomotor retardation factors, named according to their constituent items, best represented the data. The LPA differentiated seven profiles, labeled after careful consideration of their features and associated criterion validators: three mood profiles—Moderate Low Mood (N=88), Major Depressive Episode (N=92), and Mixed Mood Episode (N=179)—two non-mood symptomatic profiles—ADHD and DBDs (N=120) and Psychomotor Retardation Without Mood Symptoms (N=41)—and two profiles with low psychopathology—Euthymic (N=123) and Adjustment and Other Mild Problems (N=67).

Analyses corroborated findings from empirical studies stating that mixed mood is a notable, even dominant, mood presentation in kids with distinct characteristics. Furthermore, the mood categories found in the present study are incongruent with the main diagnostic categories in the DSM-5, corroborating previous findings of misalignment between empirical findings and categorical taxonomies. For example, the DSM-5 holds mania as the primary indicator of bipolar disorder in youth; however, in the present study, mania was rare, and pediatric mania mostly presented mixed. Findings also demonstrated that mixed mood youth can be clearly identified using a dimensional approach despite categorical systems deprioritizing mixed presentation.