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Between 30 and 60% of adults with unipolar or bipolar disorders exhibit
impairments across multiple domains. However, little is known about
impaired functioning in youth with mood disorders.
To examine the prevalence of objective, subjective and observer-rated
disability in a large, representative sample of young people with a
primary mood disorder.
Individuals aged 16–25 years presenting to youth mental health services
for the first time with a primary mood disorder participated in a
systematic diagnostic and clinical assessment. Impairment was assessed
using objective (unemployment or disability payments), observer- (Social
and Occupational Functioning Assessment Scale; SOFAS) and self-rated
measures (role functioning according to the Brief Disability
Of 1241 participants (83% unipolar; 56% female), at least 30% were
functionally impaired on the objective, self-rated and/or observer-rated
measures, with 16% impaired according to all three criteria. Even when
current distress levels were taken into account, daily use of cannabis
and/or nicotine were significantly associated with impairment, with odds
ratios (OR) ranging from about 1.5 to 3.0. Comorbid anxiety disorders
were related to lower SOFAS scores (OR = 2–5).
Levels of disability were significant, even in those presenting for
mental healthcare for the first time. Functional impairment did not
differ between unipolar and bipolar cases, but some evidence suggested
that females with bipolar disorder were particularly disabled. The
prevalence of comorbid disorders (50%) and polysubstance use (28%) and
their association with disability indicate that more meaningful
indicators of mood episode outcomes should focus on functional rather
than symptom-specific measures. The association between functioning and
nicotine use requires further exploration.
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