Irritability, Not Sad Low Mood Contributes to Conduct Disorder Rule Breaking Symptoms in Children and Adolescents with Major Depressive Disorder With or Without Persistent Depressive Disorder - Abstract
The specific relationships between conduct disorder symptoms, anxiety and the two main mood components of depressive disorders – sad, low mood and irritability – have not been systematically examined in young people with major depressive disorder with and without persistent depressive disorder. The relationships are important to clarify because these symptom dimensions are common, affect associated morbidity and treatment responsiveness of children and adolescents with these depressive disorders. 313 medication naïve young people (aged 6-16 years), with active major depressive disorder (MDD) alone, persistent depressive disorder (DD), alone and comorbid active MDD and DD were identified through semi-structured clinical interview and parent and/or child standardized questionnaires. ‘Anxiety’, ‘sad/unhappy’ and ‘irritable’ mood were identified by parent standardized questionnaire. Standard multiple regression was used to investigate how well ‘Anxiety’, ‘sad/unhappy’ and ‘irritable’ mood predict conduct disorder rule breaking symptoms. Only ‘Anxiety’ (3% of the variance – decreased) and ‘irritable’ mood (18% of the variance- increased) made independent significant contributions to conduct disorder rule breaking symptoms. A main limitation of these results is that oppositional defiant disorder and conduct disorder symptoms were not analyzed separately. Nevertheless, the association of irritability with conduct disorder rule breaking symptoms may reflect a unique contribution of irritable mood to conduct disorder features in young people whether depressive disorders are present or not or only when they are present. Decreasing irritability and managing increased anxiety via more targeted and comprehensive management approaches may ameliorate conduct disorder in young people with these depressive disorders.