Irritability has long been observed as a mood state that occurs in depression especially in young people. In young people irritable mood has an equivalent position to that of low mood. How common is irritability , alone or in combination with low mood, in young age depression? Do those with irritability differ from those without?
Argyris Stringaris, Barbara Maughan, William S. Copeland , E. Jane Costello and Adrian Angold reports results of a study answering these questions.The Great Smoky Mountains Study (GSMS) is a longitudinal study of the development of psychiatric disorders in rural and urban youth in North Carolina.Child and Adolescent Psychiatric Assessment (CAPA) was used to diagnose depression.Irritable mood was identified from CAPA questions ( irritable mood present in at least 2 activities, with at least 1 instance of snappiness, shouting, or quarrelsomeness, and at least sometimes uncontrollable by child).Data on 8,806 parent–child pairs of interviews carried out across the age range of 9 through 21 is used to produce the present report.
3 month prevalence of depression was 2.2%. Among cases, depressed mood was the most common cardinal mood state (58.7% of all subjects with a diagnosis of depression), followed by mixed depressed and irritable mood (35.6% of all subjects with a diagnosis of depression). Only a small minority of participants (5.7% of all subjects with depression) had irritable mood only. Irritable group was too small to analyze statistically and comparisons are done between lowmood depression group vs low mood plus irritability group.
Depressed boys were significantly more likely to present with irritability than depressed girls.Sleep problems were significantly more common in the depressed and irritable. Children with depression and irritability were more likely to experience comorbid disruptive disorders . The 2 groups ( pure low mood depression vs low mood plus irritability) did not differ in overall depression severity. Depressed children with irritability were more likely to continue to show “irritable depression” in the longer term.
Small numbers in pure irritability group.Analysis could be underpowered. Youngest in the cohort was 9 yrs old, it is possible that irritability is common in very young age and thus results may not be generalisable to all young people.
Conclusion: Eventhough DSM-IV and DSM-5 give episodic irritability an equal status to low mood as a cardinal criterion for the diagnosis of depression in youth,there is very little support for this. Irritability rarely occurs in the absence of low mood.
Summary of the article:
Irritable Mood as a Symptom of Depression in Youth: Prevalence, Developmental, and Clinical Correlates in the Great Smoky Mountains Study : JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY: VOLUME 52 NUMBER 8 AUGUST 2013