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Fang P, Zhou J, Liang Z, Yang Y, Luan S, Xiao X, Li X, Shang Q, Zhang H, Zeng X, Yuan Y. Unraveling the impact of irritability on esophageal diseases: Insights from multivariable Mendelian randomization analysis. J Affect Disord 2024; 366:189-195. [PMID: 39187201 DOI: 10.1016/j.jad.2024.08.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 08/18/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Previous studies have suggested a potential association between irritability and the risk of various diseases. However, establishing a causal relationship has remained a significant challenge. To address this issue, we employed Mendelian randomization (MR), a sophisticated approach that leverages genotype data to emulate the conditions of randomized controlled trials. This method enables us to investigate the potential causal link between irritability and the susceptibility to esophageal diseases. METHODS We conducted an extensive multivariable MR analysis using summary-level data from genome-wide association studies (GWAS) encompassing various esophageal diseases, including gastroesophageal reflux disease (GERD), esophageal cancer (EC), and Barrett's esophagus. Both univariable and multivariable MR analyses were performed to elucidate and confirm the causal association between genetically predicted irritability and the incidence of esophageal diseases. RESULTS Based on our primary causal effects model utilizing MR analyses with the inverse-variance weighted (IVW) method, genetically predicted irritability was identified as a risk factor for GERD (OR = 2.413; 95 % CI: 1.678-3.470; P = 2.03E-06) and Barrett's esophagus (OR = 2.306; 95 % CI: 1.042-5.101; P = 0.039). However, irritability was not found to be associated with the risk of EC, even after adjusting for BMI, smoking initiation, and alcohol consumption. CONCLUSION The multivariable MR analysis performed in this study demonstrated a causal relationship between irritability and esophageal diseases. It is imperative to acknowledge the need for further large-scale prospective studies to validate these findings.
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Affiliation(s)
- Pinhao Fang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Jianfeng Zhou
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiwen Liang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Yushang Yang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Siyuan Luan
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Xiao
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaokun Li
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Qixin Shang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Hanlu Zhang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxi Zeng
- Biomedical Big Data Center of West China Hospital, Med+X Center for Informatics, Sichuan University, Chengdu, China
| | - Yong Yuan
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China.
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2
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Perlis RH, Uslu A, Schulman J, Himelfarb A, Gunning FM, Solomonov N, Santillana M, Baum MA, Druckman JN, Ognyanova K, Lazer D. Prevalence and correlates of irritability among U.S. adults. Neuropsychopharmacology 2024:10.1038/s41386-024-01959-3. [PMID: 39181998 DOI: 10.1038/s41386-024-01959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/27/2024]
Abstract
This study aimed to characterize the prevalence of irritability among U.S. adults, and the extent to which it co-occurs with major depressive and anxious symptoms. A non-probability internet survey of individuals 18 and older in 50 U.S. states and the District of Columbia was conducted between November 2, 2023, and January 8, 2024. Regression models with survey weighting were used to examine associations between the Brief Irritability Test (BITe5) and sociodemographic and clinical features. The survey cohort included 42,739 individuals, mean age 46.0 (SD 17.0) years; 25,001 (58.5%) identified as women, 17,281 (40.4%) as men, and 457 (1.1%) as nonbinary. A total of 1218(2.8%) identified as Asian American, 5971 (14.0%) as Black, 5348 (12.5%) as Hispanic, 1775 (4.2%) as another race, and 28,427 (66.5%) as white. Mean irritability score was 13.6 (SD 5.6) on a scale from 5 to 30. In linear regression models, irritability was greater among respondents who were female, younger, had lower levels of education, and lower household income. Greater irritability was associated with likelihood of thoughts of suicide in logistic regression models adjusted for sociodemographic features (OR 1.23, 95% CI 1.22-1.24). Among 1979 individuals without thoughts of suicide on the initial survey assessed for such thoughts on a subsequent survey, greater irritability was also associated with greater likelihood of thoughts of suicide being present (adjusted OR 1.17, 95% CI 1.12-1.23). The prevalence of irritability and its association with thoughts of suicide suggests the need to better understand its implications among adults outside of acute mood episodes.
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Affiliation(s)
- Roy H Perlis
- Center for Quantitative Health, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Ata Uslu
- Network Science Institute, Northeastern University, Boston, MA, USA
- Institute for Quantitative Social Science, Harvard University, Boston, MA, USA
| | - Jonathan Schulman
- Department of Political Science, Northwestern University, Chicago, IL, USA
| | | | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Nili Solomonov
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Mauricio Santillana
- Network Science Institute, Northeastern University, Boston, MA, USA
- Institute for Quantitative Social Science, Harvard University, Boston, MA, USA
| | - Matthew A Baum
- John F. Kennedy School of Government and Department of Government, Harvard University, Cambridge, MA, USA
| | - James N Druckman
- Department of Political Science, University of Rochester, Rochester, NY, USA
| | - Katherine Ognyanova
- Department of Communication, School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - David Lazer
- Network Science Institute, Northeastern University, Boston, MA, USA
- Institute for Quantitative Social Science, Harvard University, Boston, MA, USA
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3
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Zhang T, Wan Y, Geng L. Unraveling the core and bridge menopausal symptoms of perimenopausal women: a network analysis. Menopause 2024:00042192-990000000-00370. [PMID: 39162480 DOI: 10.1097/gme.0000000000002431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
OBJECTIVE Perimenopause is the period from the early menopausal transition to 12 months after the final menstrual period. The clustering of menopausal symptoms poses a challenge for perimenopausal management. Core symptoms are targets for interventions that can alleviate other related symptoms. Bridge symptoms are connectors that link related symptom clusters and can improve the effectiveness of interventions. This study aims to construct a network structure of menopausal symptoms and to identify core and bridge symptoms as a reference for future management. METHODS Two hundred forty-two Chinese perimenopausal women were included in the survey. The structure and associations of the menopausal symptoms assessed by the Greene Climacteric Scale were analyzed using a network analysis. We generated the network structure graph using R software and checked its accuracy and stability. RESULTS In the menopausal transition, the most prevalent symptoms were feeling tired or lacking in energy, excitability, and irritability. Sexual dysfunction was common among early postmenopausal women. Irritability (S = 7.16, C = 0.0167, B = 8) was a core symptom of the network. The depressive symptom cluster was a core symptom cluster, most of which have high centrality indices. Excitability (B = 6) was a bridge symptom connecting the anxiety and depressive symptom clusters. CONCLUSIONS Our study has highlighted the crucial significance of irritability and excitability in perimenopausal management. Overcoming the challenges of perimenopausal management requires the public to ameliorate the prejudice and stigma associated with emotional symptoms.
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Affiliation(s)
| | - Yinglu Wan
- From the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Geng
- From the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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4
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Archer C, Jeong HJ, Reimann GE, Durham EL, Moore TM, Wang S, Ashar DA, Kaczkurkin AN. Concurrent and longitudinal neurostructural correlates of irritability in children. Neuropsychopharmacology 2024:10.1038/s41386-024-01966-4. [PMID: 39154134 DOI: 10.1038/s41386-024-01966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024]
Abstract
Irritability, or an increased proneness to frustration and anger, is common in youth; however, few studies have examined neurostructural correlates of irritability in children. The purpose of the current study was to examine concurrent and longitudinal associations between brain structure and irritability in a large sample of 9-10-year-old children. Participants included 10,647 children from the Adolescent Brain Cognitive Developmentsm Study (ABCD Study®). We related a latent irritability factor to gray matter volume, cortical thickness, and surface area in 68 cortical regions and to gray matter volume in 19 subcortical regions using structural equation modeling. Multiple comparisons were adjusted for using the false discovery rate (FDR). After controlling for age, sex, race/ethnicity, scanner model, parent's highest level of education, medication use, and total intracranial volume, irritability was associated with smaller volumes in primarily temporal and parietal regions at baseline. Longitudinal analyses showed that baseline gray matter volume did not predict irritability symptoms at the 3rd-year follow-up. No significant associations were found for cortical thickness or surface area. The current study demonstrates inverse associations between irritability and volume in regions implicated in emotional processing/social cognition, attention allocation, and movement/perception. We advance prior research by demonstrating that neurostructural differences associated with irritability are already apparent by age 9-10 years, extending this work to children and supporting theories positing socioemotional deficits as a key feature of irritability.
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Affiliation(s)
- Camille Archer
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Hee Jung Jeong
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | | | - Tyler M Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shuti Wang
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Devisi A Ashar
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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5
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Gröndal M, Ask K, Winblad S. An evaluation of the Ultimatum Game as a measure of irritability and anger. PLoS One 2024; 19:e0304038. [PMID: 39150923 PMCID: PMC11329143 DOI: 10.1371/journal.pone.0304038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/04/2024] [Indexed: 08/18/2024] Open
Abstract
The Ultimatum Game is an effective tool for understanding how social decision-making is influenced by emotions in both research and clinical settings. Previous findings have shown that the Ultimatum Game can evoke negative emotions, especially anger and aggression. In a sample of non-clinical adults (N = 143) we evaluated the sensitivity of an anger-infused version of the Ultimatum Game to individual differences in anger and irritability. Findings showed significant relationships between anger and aggressive behaviors in the Ultimatum game, but no association between irritability and aggressive behavior were observed. This indicates that the anger-infused Ultimatum Game is a promising method for studying individual differences in trait anger and anger expression. However, the relationship between decision-making in the anger-infused Ultimatum Game and irritability is less straight forward and needs further investigation. Therefore, when studying the behavioral responses of irritability, it would be beneficial to capture other behaviors beyond aggressive responses.
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Affiliation(s)
- Maria Gröndal
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Karl Ask
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Winblad
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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6
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Dissanayake AS, Dupuis A, Arnold PD, Burton CL, Crosbie J, Schachar RJ, Levy T. Is irritability multidimensional: Psychometrics of The Irritability and Dysregulation of Emotion Scale (TIDES-13). Eur Child Adolesc Psychiatry 2024; 33:2767-2780. [PMID: 38228758 DOI: 10.1007/s00787-023-02350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024]
Abstract
Irritability is a common, impairing, and potentially multifaceted manifestation of psychopathology. We designed The Irritability and Dysregulation of Emotion Scale (TIDES-13) to determine whether various expressions of irritability in children and youth form multiple subdimensions with distinct correlates. We administered parent-report (n = 3875, mean age = 8.9) and youth self-report (n = 579, mean age = 15.1) versions of TIDES-13 in a population and community-based sample. We conducted exploratory/confirmatory factor analyses and regression analyses to examine the dimensionality of TIDES-13 and the associations of the scale with age, gender, anxiety, depression, ODD, ADHD traits, and the Affective Reactivity Index (ARI). A higher-order model with a global irritability dimension and four subdimensions, including proneness to anger (PA), internalized negative emotional reactivity (iNER), externalized negative emotional reactivity (eNER), and reactive aggression (RA), showed good to excellent fit in both parent-report and self-report. The global irritability dimension showed excellent internal reliability (⍵Total; parent-report = 0.97, ⍵Total; self-report = 0.95), explained a majority of the item variance (⍵Hierarchical; parent-report = 0.94, ⍵Hierarchical; self-report = 0.90), and was moderately correlated with the ARI (rparent = 0.68, rself = 0.77). Subdimensions PA, eNER, and RA were negatively associated with age in males, whereas iNER was positively associated with age in females. Traits of ODD and ADHD were associated primarily with the global irritability dimension, whereas iNER was strongly associated with anxiety and depression traits over and above the global irritability dimension. Our results support a unidimensional interpretation of irritability in a population sample. However, limited evidence of specific behavioral, age, and sex correlates with particular irritability subdimensions may warrant further investigation.
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Affiliation(s)
| | - Annie Dupuis
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul D Arnold
- Department of Child and Adolescent Psychiatry, The Mathison Centre for Mental Health Research & Education, Calgary, AB, Canada
| | - Christie L Burton
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Neurosciences and Mental Health/Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Tomer Levy
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Behavior Regulation Service, Geha Mental Health Center, Petach-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Niu Y, Buzzell GA, Cosmoiu A, Fox NA, Nelson CA, Zeanah CH, Humphreys KL. Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation. Res Child Adolesc Psychopathol 2024; 52:1183-1192. [PMID: 38642277 PMCID: PMC11288996 DOI: 10.1007/s10802-024-01193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
Irritability reflects a propensity for frustration and anger, and is a transdiagnostic symptom of both externalizing and internalizing psychopathology. While early adverse experiences are associated with higher levels of irritability, experiences of early psychosocial deprivation and whether family-based placements can mitigate the impact on subsequent irritability, remain underexplored. The current study examined irritability in 107 16-year-olds with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 49 community comparison children. At age 16 years, irritability was assessed using parent- and self-report forms of the Affective Reactivity Index. Compared to community adolescents, those with a history of institutional care exhibited significantly elevated irritability levels. Among those who experienced institutional care, those randomized to foster care had lower levels of irritability compared to participants randomized to the care-as-usual group, and this effect persists after controlling for baseline negative emotionality. These findings suggest a causal link between high-quality foster care and lower irritability following psychosocial deprivation. Additionally, longer duration in institutional care and non-family placement at age 16 years were associated with higher levels of irritability, highlighting the role of caregiving in explaining variation in irritability in adolescence. Policies that support long-term, high-quality family placements for children without regular caregivers should be prioritized.
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Affiliation(s)
- Yanbin Niu
- Department of Psychology & Human Development, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA
| | - George A Buzzell
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Ana Cosmoiu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Charles A Nelson
- Boston Children's Hospital of Harvard Medical School, Boston, MA, USA
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Charles H Zeanah
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kathryn L Humphreys
- Department of Psychology & Human Development, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA.
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8
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Bell E, Malhi GS. Understanding Irritability From Childhood to Adolescence. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00358-7. [PMID: 38997004 DOI: 10.1016/j.jaac.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/15/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
We read with great interest the article by Srinivasan et al.,1 and we are heartened to see a renewed focus on irritability as an important phenomenon that necessitates better understanding. In particular, the hypothesis that irritability in childhood may signal the development of psychiatric problems later in life is a persuasive concept that aligns with our thinking.
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Affiliation(s)
- Erica Bell
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Gin S Malhi
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia; University of Oxford, Oxford, United Kingdom; Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
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9
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Thompson KI, Schneider CJ, Lopez-Roque JA, Wakschlag LS, Karim HT, Perlman SB. A network approach to the investigation of childhood irritability: probing frustration using social stimuli. J Child Psychol Psychiatry 2024; 65:959-972. [PMID: 38124618 PMCID: PMC11161318 DOI: 10.1111/jcpp.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Self-regulation in early childhood develops within a social context. Variations in such development can be attributed to inter-individual behavioral differences, which can be captured both as facets of temperament and across a normal:abnormal dimensional spectrum. With increasing emphasis on irritability as a robust early-life transdiagnostic indicator of broad psychopathological risk, linkage to neural mechanisms is imperative. Currently, there is inconsistency in the identification of neural circuits that underlie irritability in children, especially in social contexts. This study aimed to address this gap by utilizing a functional magnetic resonance imaging (fMRI) paradigm to investigate pediatric anger/frustration using social stimuli. METHODS Seventy-three children (M = 6 years, SD = 0.565) were recruited from a larger longitudinal study on irritability development. Caregivers completed questionnaires assessing irritable temperament and clinical symptoms of irritability. Children participated in a frustration task during fMRI scanning that was designed to induce frustration through loss of a desired prize to an animated character. Data were analyzed using both general linear modeling (GLM) and independent components analysis (ICA) and examined from the temperament and clinical perspectives. RESULTS ICA results uncovered an overarching network structure above and beyond what was revealed by traditional GLM analyses. Results showed that greater temperamental irritability was associated with significantly diminished spatial extent of activation and low-frequency power in a network comprised of the posterior superior temporal sulcus (pSTS) and the precuneus (p < .05, FDR-corrected). However, greater severity along the spectrum of clinical expression of irritability was associated with significantly increased extent and intensity of spatial activation as well as low- and high-frequency neural signal power in the right caudate (p < .05, FDR-corrected). CONCLUSIONS Our findings point to specific neural circuitry underlying pediatric irritability in the context of frustration using social stimuli. Results suggest that a deliberate focus on the construction of network-based neurodevelopmental profiles and social interaction along the normal:abnormal irritability spectrum is warranted to further identify comprehensive transdiagnostic substrates of the irritability.
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Affiliation(s)
- Khalil I Thompson
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Clayton J Schneider
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Justin A Lopez-Roque
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburg School of Medicine, Pittsburgh, PA, USA
| | - Susan B Perlman
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
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10
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Lu B, Fang Y, Cai J, Chen Z. Psychometric Evaluation of the Affective Reactivity Index Among Children and Adolescents in China: A Multi-Method Assessment Approach. Assessment 2024; 31:1020-1037. [PMID: 37837333 DOI: 10.1177/10731911231199424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
The Affective Reactivity Index (ARI) is one of the most studied scales for assessing youth irritability, but little is known about its measurement performance in community populations. This study applied item response theory (IRT), network analysis, and classical test theory (CTT) to examine the psychometric properties of the ARI in a sample of n = 395 community-based children (Mage = 13.44, SD = 2.51) and n = 403 parents. In this sample, the ARI demonstrated good reliability, as well as convergent and concurrent validity. The one-factor structure was supported by both confirmatory factor analysis (CFA) and network analysis. IRT analysis revealed that the ARI effectively distinguished between various levels of irritability within the community population. Network analysis identified "Loses temper easily,""Gets angry frequently," and "Often loses temper" are central aspects of irritability. The findings support the ARI as a brief, reliable, and valid instrument to assess irritability in community children and adolescents.
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Affiliation(s)
- Boqing Lu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuan Fang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jimin Cai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhiyan Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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11
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Elvin OM, Modecki KL, Waters AM. An Expanded Conceptual Framework for Understanding Irritability in Childhood: The Role of Cognitive Control Processes. Clin Child Fam Psychol Rev 2024; 27:381-406. [PMID: 38856946 PMCID: PMC11222227 DOI: 10.1007/s10567-024-00489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024]
Abstract
Children prone to irritability experience significant functional impairments and internalising and externalising problems. Contemporary models have sought to elucidate the underlying mechanisms in irritability, such as aberrant threat and reward biases to improve interventions. However, the cognitive control processes that underlie threat (e.g., attention towards threats) and reward (e.g., attention towards reward-related cues) biases and the factors which influence the differential activation of positive and negative valence systems and thus leading to maladaptive activation of cognitive control processes (i.e., proactive and reactive control) are unclear. Thus, we aim to integrate extant theoretical and empirical research to elucidate the cognitive control processes underlying threat and reward processing that contribute to irritability in middle childhood and provide a guiding framework for future research and treatment. We propose an expanded conceptual framework of irritability that includes broad intraindividual and environmental vulnerability factors and propose proximal 'setting' factors that activate the negative valence and positive valence systems and proactive and reactive cognitive control processes which underpin the expression and progression of irritability. We consider the implications of this expanded conceptualisation of irritability and provide suggestions for future research.
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Affiliation(s)
- Olivia M Elvin
- School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia.
| | - Kathryn L Modecki
- Centre for Mental Health and School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia
- School of Psychological Science, University of Western Australia & Telethon Kids Institute, Perth, Australia
| | - Allison M Waters
- Centre for Mental Health and School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia.
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12
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Kaurin A, Wright AGC, Porta G, Hamilton E, Poling K, Bero K, Brent D, Goldstein TR. Weekly links among irritability and suicidal thoughts and behaviors in high-risk youth. J Child Psychol Psychiatry 2024. [PMID: 38651278 DOI: 10.1111/jcpp.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Previous studies demonstrate a link between irritability and suicidal thoughts and behaviors (STBs) in youth samples. However, they have mostly assessed irritability in community samples and as a largely dispositional (i.e. trait-like) construct. Thus, it remains unclear to what extent links between irritability and STBs reflect within-person processes of elevated risk in clinically meaningful time periods. METHODS The present study used clinical data from 689 adolescents aged 12-19 years attending a total of 6,128 visits at a specialty Intensive Outpatient Program for depressed and suicidal youth to examine patterns in weekly assessments of irritability and STBs throughout treatment, including associations among trends and fluctuations departing from these trends via multilevel structural equation modeling. Youth completed self-report measures of irritability, depression, and STBs weekly as part of standard IOP clinical care. RESULTS Overall, two-thirds of variance in weekly irritable mood was accounted for by between-person differences and the remaining portion by weekly fluctuations. After controlling for depression, during weeks when youth were more irritable they experienced increased STBs. Rates of change in irritability and STBs tended to track together at early stages of treatment, but these effects were generally accounted for by depression severity. CONCLUSIONS Our results suggest that although changes in STBs are best accounted for by depression, irritability can be understood as a specific, proximal risk factor for youth STBs that exacerbates youth STBs in clinically informative timeframes above and beyond depression.
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Affiliation(s)
- Aleksandra Kaurin
- Department of Psychology, University of Wuppertal, Wuppertal, Germany
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Giovanna Porta
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Edward Hamilton
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kimberly Poling
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kelsey Bero
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Brent
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tina R Goldstein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Lee H, Park Y, Kim D, Choi J, Park SC, Kim I, Kim E. Validity of the Korean Version of the Brief Irritability Test in Psychiatric Patients. Psychiatry Investig 2024; 21:396-402. [PMID: 38695047 PMCID: PMC11065526 DOI: 10.30773/pi.2023.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/08/2023] [Accepted: 01/26/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the validity and reliability of the Korean version of the Brief Irritability Test (BITe) and adapt it for Korean patients with psychiatric disorders. METHODS A total of 296 patients at the Department of Psychiatry of Hanyang University Guri Hospital completed the BITe, Korean Beck Depression Inventory-II, Korean Beck Anxiety Inventory, the Korean version of the State-Trait Anger Expression Inventory, and Barratt Impulsiveness Scale-11. Construct validity was confirmed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability testing included assessments of internal consistency (Cronbach's α) and item-total correlations. Convergent validity was examined through correlational analyses with variables such as anxiety, depression, anger, and impulsivity. RESULTS First, the scale had good internal consistency with a Cronbach's α of 0.88. Second, EFA indicated a single dimensionality of the BITe, and CFA demonstrated a reasonable fit for the single-factor model (comparative fit index=0.97, Tucker-Lewis Index=0.95, normed fit index=0.97, goodness-of-fit index=0.96, root mean square error of approximation=0.12, standardized root mean residual=0.03). Finally, the convergent validity analysis revealed a significant positive correlation with depression, anxiety, and anger, except for anger control, which is a sub-variable of anger. CONCLUSION The results showed that the Korean version of the BITe had good psychometric properties, and might serve as a valuable tool for assessing irritability in Korean patients with psychiatric disorders.
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Affiliation(s)
- Hyerin Lee
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Yongchon Park
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Deaho Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joonho Choi
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ilbin Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eunkyung Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
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Sistiaga S, Tseng WL, Zhang L, Rossignol M, Bellaert N. How are irritability and anhedonia symptoms linked? A network approach. J Clin Psychol 2024. [PMID: 38497904 DOI: 10.1002/jclp.23679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/08/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Anhedonia and irritability are two prevalent symptoms of major depressive disorder (MDD) that predict greater depression severity and poor outcomes, including suicidality. Although both symptoms have been proposed to result from paradoxical reward processing dysfunctions, the interactions between these symptoms remain unclear. Anhedonia is a multifaceted symptom reflecting impairments in multiple dimensions of reward processing (e.g., pleasure, desire, motivation, and effort) across distinct reward types (e.g., food, sensory experiences, social activities, hobbies) that may differentially interact with irritability. This study investigated the complex associations between anhedonia and irritability using network analysis. METHOD Participants (N = 448, Mage = 33.29, SD = 14.58) reported their symptoms of irritability on the Brief Irritability Test (Holtzman et al., 2015) and anhedonia (i.e., pleasure, desire, motivation, and effort dimensions across four reward types) on the Dimensional Anhedonia Rating Scale (Rizvi et al., 2015). A regularized Gaussian Graphical Model was built to estimate the network structure between items. RESULTS Irritability was negatively related to willingness to expand effort to obtain food/drinks (estimate = -0.18), social activities (-0.13), and hobbies (-0.12) rewards. Irritability was positively associated with a desire for food/drinks (0.12). LIMITATIONS Only a small proportion (5.8%) of our sample was clinical and the study design was cross-sectional. CONCLUSION A specific link between irritability and the effort dimension of the hedonic response across three reward types was identified. Investigating effort expenditure deficits with experimental paradigms may help us understand the mechanisms underlying the comorbidity between irritability and anhedonia in the context of MDD.
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Affiliation(s)
- Sonia Sistiaga
- Cognitive Psychology and Neuropsychology Department, University of Mons, Mons, Belgium
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Lanting Zhang
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Mandy Rossignol
- Cognitive Psychology and Neuropsychology Department, University of Mons, Mons, Belgium
| | - Nellia Bellaert
- Cognitive Psychology and Neuropsychology Department, University of Mons, Mons, Belgium
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15
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Evans SC, Karlovich AR, Khurana S, Edelman A, Buza B, Riddle W, López-Sosa D. Evidence Base Update on the Assessment of Irritability, Anger, and Aggression in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:277-308. [PMID: 38275270 PMCID: PMC11042996 DOI: 10.1080/15374416.2023.2292041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Irritability, anger, and aggression have garnered significant attention from youth mental health researchers and clinicians; however, fundamental challenges of conceptualization and measurement persist. This article reviews the evidence base for assessing these transdiagnostic constructs in children and adolescents. METHOD We conducted a preregistered systematic review of the evidence behind instruments used to measure irritability, anger, aggression, and related problems in youth. Searches were conducted in PsycINFO and PubMed, identifying 4,664 unique articles. Eligibility criteria focused on self- and proxy-report measures with peer-reviewed psychometric evidence from studies in English with youths ages 3-18. Additional measures were found through ancillary search strategies (e.g. book chapters, review articles, test publishers). Measures were screened and coded by multiple raters with acceptable reliability. RESULTS Overall, 68 instruments met criteria for inclusion, with scales covering irritability (n = 15), anger (n = 19), aggression (n = 45), and/or general overt externalizing problems (n = 27). Regarding overall psychometric support, 6 measures (8.8%) were classified as Excellent, 46 (67.6%) were Good, and 16 (23.5%) were Adequate. Descriptive information (e.g. informants, scales, availability, translations) and psychometric properties (e.g. reliability, validity, norms) are summarized. CONCLUSIONS Numerous instruments for youth irritability, anger, and aggression exist with varying degrees of empirical support for specific applications. Although some measures were especially strong, none had uniformly excellent properties across all dimensions, signaling the need for further research in particular areas. Findings promote conceptual clarity while also producing a well-characterized toolkit for researchers and clinicians addressing transdiagnostic problems affecting youth.
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Affiliation(s)
- Spencer C. Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Sakshi Khurana
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
- College of Education, DePaul University, Chicago, IL, USA
| | - Audrey Edelman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Bianca Buza
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - William Riddle
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Denise López-Sosa
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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16
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Shields A, Reardon K, Lawler T, Tackett J. Affective Contributions to Instrumental and Reactive Aggression in Middle Childhood: Variable- and Person-Centered Approaches. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:169-183. [PMID: 38039086 DOI: 10.1080/15374416.2023.2272951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Research on the role of affect in childhood aggression motives has largely focused on domain-level affective traits. Lower-order affective facets may show more distinct relationships with instrumental and reactive aggression - at both the variable and individual levels - and offer unique insights into whether and how several forms of affect are involved in aggression motives. METHOD Caregivers (98% mothers) of 342 children (Mage = 9.81 years, 182 girls, 31% White) reported on children's aggression and affect-relevant personality traits, personality pathology, and callous-unemotional traits. RESULTS Both reactive and instrumental aggressions were characterized by higher levels of trait irritability, fear, withdrawal, sadness, and callous-unemotional traits in zero-order analyses. Instrumental aggression was characterized by low trait positive emotions. Reactive aggression was uniquely associated with irritability, fear, withdrawal, and sadness, whereas instrumental aggression was uniquely associated with callous-unemotional traits and (low) positive emotions. Groups identified by latent profile analyses were differentiated only by aggression severity. CONCLUSIONS The findings support both the similarity and distinction of reactive and instrumental aggression vis-à-vis their affective phenomenology. Consistent with existing theories, reactive aggression was linked to multiple forms of negative emotionality, whereas instrumental aggression was linked to higher levels of callous-unemotional traits. In a novel finding, instrumental aggression was uniquely characterized by lower positive emotions. The findings highlight the utility of pre-registered approaches employing comprehensive personality-based affective frameworks to organize and understand similarities and differences between aggression functions.
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Carlson GA, Althoff RR, Singh MK. Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately 1. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:309-327. [PMID: 38588602 DOI: 10.1080/15374416.2024.2332999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Recognition of the importance of irritable mood and outbursts has been increasing over the past several decades. This "Future Directions" aims to develop a set of recommendations for future research emphasizing that irritable mood and outbursts "hang together," but have important distinctions and thus also need to "hang separately." Outbursts that are the outcome of irritable mood may be quite different from outbursts that are the trigger or driving force that make youth and his/her environment miserable. What, then, is the relation between irritable mood and outbursts? As the field currently stands, we not only cannot answer this question, but we may also lack the tools to effectively do so. Here, we will propose recommendations for understanding the phenomenology of irritable mood and outbursts so that more directed and clinically useful assessment tools can be designed. We discuss the transdiagnostic and treatment implications that relate to improvements in measurement. We describe the need to do more than repurpose our current assessment tools, specifically interviews and rating scales, which were designed for different purposes. The future directions of the study and treatment of irritable mood and outbursts will require, among others, using universally accepted nomenclature, supporting the development of tools to measure the characteristics of each irritable mood and outbursts, understanding the effects of question order, informant, development and longitudinal course, and studying the ways in which outbursts and irritable mood respond to treatment.
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Affiliation(s)
- Gabrielle A Carlson
- Psychiatry and Pediatrics, Renaissance School of Medicine at Stony Brook University
| | - Robert R Althoff
- Psychiatry, Pediatrics, & Psychological Science, University of Vermont
| | - Manpreet Kaur Singh
- Professor of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine
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18
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Skobic I, Pezza M, Howe G, Haynes PL. Examining insomnia disorder and stress generation among individuals who have experienced involuntary job loss. J Psychosom Res 2024; 177:111585. [PMID: 38215621 PMCID: PMC10922514 DOI: 10.1016/j.jpsychores.2023.111585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Depressed individuals generate more stressful life events than non-depressed individuals. Like depressive symptoms, the symptoms of insomnia disorder may lead to impaired decision-making, daytime sleepiness, fatigue, and emotion dysregulation, yet the prospective relationship with insomnia disorder and stress generation has not previously been investigated. We hypothesized that insomnia disorder within the first three months of involuntary job loss would lead to an increased number of stressful life events three-months later. METHODS This project employed a longitudinal design consisting of two timepoints occurring approximately 3 months apart. A sample 136 participants with complete data was sourced from the Assessing Daily Activity Patterns through Occupational Transitions study. Insomnia disorder was diagnosed using the Duke Structured Interview for Sleep Disorders, and the number of stressful life events was assessed using the Life Events and Difficulties Schedule. RESULTS A cross-lagged panel analysis utilizing Poisson and logistic regression techniques indicated that insomnia disorder at study baseline predicted an increased number of all stressful life events at follow-up (RR = 1.36, p = .01); conversely, stressful life events at baseline did not predict insomnia disorder (OR = 0.98, p = .87). CONCLUSION These results support a stress-generation hypothesis of insomnia disorder. Findings highlight insomnia disorder as a potential target for intervention in the prevention of additional stress exposure among recently unemployed individuals, who have been shown to be at increased risk for adverse health and health disparities.
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Affiliation(s)
- Iva Skobic
- Mel and Enid Zuckerman College of Public Health, University of Arizona, United States of America
| | - Mattea Pezza
- School of Social Work, Arizona State University, United States of America
| | - George Howe
- Department of Psychological and Brain Sciences, George Washington University, United States of America
| | - Patricia L Haynes
- Mel and Enid Zuckerman College of Public Health, University of Arizona, United States of America.
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19
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Klein DN. Assessment of Depression in Adults and Youth. Assessment 2024; 31:110-125. [PMID: 37081793 DOI: 10.1177/10731911231167446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
This article selectively reviews the key issues and measures for the assessment of depressive disorders and symptoms in youth and adults. The first portion of the article addresses the nature and conceptualization of depression and some key issues that must be considered in its assessment. Next, the diagnostic interview and clinician- and self-administered rating scales that are most widely used to diagnose, screen for, and assess the severity of depression in adults and youth are selectively reviewed. In addition, the assessment of three transdiagnostic clinical features (anhedonia, irritability, and suicidality) that are frequently associated with both depression and other forms of psychopathology is discussed. The article concludes with some broad recommendations for assessing depression in research and clinical practice and suggestions for future research.
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Maltby J, Norton WHJ, McElroy E, Cromby J, Halliwell M, Hall SS. Refining Anger: Summarizing the Self-Report Measurement of Anger. J Pers Assess 2023; 105:752-762. [PMID: 36480742 DOI: 10.1080/00223891.2022.2152345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
Abstract
The current paper presents a five-factor measurement model of anger summarizing scores on public-domain self-report measures of anger. Exploratory and confirmatory factor analyses of self-report measures of anger (UK, n = 500; USA, n = 625) suggest five replicable latent anger factors: anger-arousal, anger-rumination, frustration-discomfort, anger-regulation, and socially constituted anger. Findings suggested a 5-factor interpretation provided the best fit of the data. We also report evidence of measurement invariance for this 5-factor model of anger across gender, age, and ethnicity. The findings suggest a useful and parsimonious account of anger, summarizing over 50 years of research around the self-report measurement of anger.
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Affiliation(s)
- John Maltby
- School of Psychology and Vision Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Will H J Norton
- School of Psychology and Vision Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Eoin McElroy
- School of Psychology, University of Ulster, Coleraine, United Kingdom
| | - John Cromby
- School of Psychology and Vision Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Martin Halliwell
- School of Psychology and Vision Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Sophie S Hall
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Antón-Galindo E, Cabana-Domínguez J, Torrico B, Corominas R, Cormand B, Fernàndez-Castillo N. The pleiotropic contribution of genes in dopaminergic and serotonergic pathways to addiction and related behavioral traits. Front Psychiatry 2023; 14:1293663. [PMID: 37937232 PMCID: PMC10627163 DOI: 10.3389/fpsyt.2023.1293663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Co-occurrence of substance use disorders (SUD) and other behavioral conditions, such as stress-related, aggressive or risk-taking behaviors, in the same individual has been frequently described. As dopamine (DA) and serotonin (5-HT) have been previously identified as key neurotransmitters for some of these phenotypes, we explored the genetic contribution of these pathways to SUD and these comorbid phenotypes in order to better understand the genetic relationship between them. Methods We tested the association of 275 dopaminergic genes and 176 serotonergic genes with these phenotypes by performing gene-based, gene-set and transcriptome-wide association studies in 11 genome-wide association studies (GWAS) datasets on SUD and related behaviors. Results At the gene-wide level, 68 DA and 27 5-HT genes were found to be associated with at least one GWAS on SUD or related behavior. Among them, six genes had a pleiotropic effect, being associated with at least three phenotypes: ADH1C, ARNTL, CHRNA3, HPRT1, HTR1B and DRD2. Additionally, we found nominal associations between the DA gene sets and SUD, opioid use disorder, antisocial behavior, irritability and neuroticism, and between the 5-HT-core gene set and neuroticism. Predicted gene expression correlates in brain were also found for 19 DA or 5-HT genes. Discussion Our study shows a pleiotropic contribution of dopaminergic and serotonergic genes to addiction and related behaviors such as anxiety, irritability, neuroticism and risk-taking behavior, highlighting a role for DA genes, which could explain, in part, the co-occurrence of these phenotypes.
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Affiliation(s)
- Ester Antón-Galindo
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Judit Cabana-Domínguez
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Bàrbara Torrico
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Roser Corominas
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Noèlia Fernàndez-Castillo
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
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Whiting C, Bellaert N, Deveney C, Tseng WL. Associations between sleep quality and irritability: Testing the mediating role of emotion regulation. PERSONALITY AND INDIVIDUAL DIFFERENCES 2023; 213:112322. [PMID: 38549685 PMCID: PMC10978035 DOI: 10.1016/j.paid.2023.112322] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
OBJECTIVES Irritability and sleep problems are common symptoms that span a range of internalizing and externalizing mental health disorders. While poor sleep has been associated with symptoms related to irritability (e.g., anxiety and depression), few studies have directly tested the association between sleep quality and irritability and whether the association is direct or mediated by a separate mechanism. METHOD The present study used self-report measures to test whether sleep is associated with irritability in 458 adults aged 19-74 years (58 % female; 79 % White), and whether this association is mediated by emotion regulation. Confirmatory factor analyses were carried out to support the use of scores from these measures. RESULTS Controlling for anxiety and depression symptoms, results showed a direct association between poorer sleep quality and increased irritability (β = 0.25, p < .001) that was not mediated by emotion regulation. CONCLUSIONS Our findings underscore the important link between sleep and irritability, both of which are common features of mental health difficulties, prompting further inquiry into the directionality of the findings and potential mediators. This work has notable clinical implications for sleep as a possible intervention target for individuals with high irritability.
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Affiliation(s)
- Claire Whiting
- Department of Psychology, Princeton University, Princeton, NJ, USA
| | - Nellia Bellaert
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Cognitive Psychology & Neuropsychology, University of Mons, Mons, Belgium
| | | | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Saatchi B, Olshansky EF, Fortier MA. Irritability: A concept analysis. Int J Ment Health Nurs 2023; 32:1193-1210. [PMID: 36929104 DOI: 10.1111/inm.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Irritability is a term used to describe feelings of anger, annoyance and impatience, and is commonly experienced by individuals in daily life. However, there are diverse conceptualizations of irritability in public and clinical research, which often result in confusing irritability with anger and other overlapping concepts. This, in turn, leads to a lack of conceptual clarity. Accordingly, the purpose of this concept analysis was to explore the irritability concept, including its definitions, defining characteristics, antecedents, consequences and empirical referents. The findings showed that irritability is predominantly conceptualized as a psychophysiological concept in the literature. We demonstrated that irritability can be differentiated from overlapping concepts like anger by qualities, such as 'unpredictability and lowered emotion control', 'lowered threshold for negative emotional stimuli', 'being manifested in response to frustrative situations or physiological needs' and 'experience of disproportionate and unjustified emotional irritation'. Importantly, severe irritability prospectively predicts psychiatric disorders and greater impairments in health, financial, educational and social functioning in individuals. Taken together, our analysis showed that one should take into account the context, duration, intensity and importantly outcomes, when assessing irritability in an individual. Considering these findings and the presence of irritability in nursing practice, it is crucial for nurses to recognize and successfully identify this concept in the nursing care they provide within the diverse settings and patient populations.
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Affiliation(s)
- Babak Saatchi
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Ellen F Olshansky
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Michelle A Fortier
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
- Center on Stress & Health, University of California Irvine, Orange, California, USA
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Fekih-Romdhane F, Azzi V, Hallit R, Malaeb D, Dabbous M, Sakr F, Obeid S, Hallit S. Validation of the Arabic version of the brief irritability test (Ar-BITe) in non-clinical adolescents. BMC Psychiatry 2023; 23:701. [PMID: 37752461 PMCID: PMC10521430 DOI: 10.1186/s12888-023-05211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Despite the substantial clinical relevance of irritability in the development and maintenance of several mental disorders and its negative effects on functioning, no valid and reliable measures are available yet to identify the presence and consequences of irritability as a distinct construct among the Arabic-speaking populations. To bridge this gap, and help advance this field in the under-researched Arab region, we aimed to validate an Arabic-language version of the Brief Irritability Test (BITe). METHODS Eligible participants were native Arabic-speaking non-clinical adolescents from Lebanon; 527 participants aged 15.73 ± 1.81 years (56% females) completed the survey. RESULTS Utilizing the Confirmatory Factor Analysis approach, we found that the five items of the Arabic BITe loaded into a single factor structure. The scale showed excellent reliability, as both Cronbach's alpha and McDonald's omega coefficient values were of 0.88. Multi-group analyses showed invariance across sex groups in our sample at the configural, metric, and scalar levels. Female adolescents exhibited higher BITe scores than their male counterparts (14.01 vs. 13.25), but this difference did not reach the statistical significance. Good concurrent validity was supported based on positive correlations between irritability scores and measures of aggression, anger and hostility (r Pearson's coefficients ranging from 0.35 to 0.42), as well as positive correlations with insomnia symptoms scores. CONCLUSION The present findings allow us to conclude that the Arabic version of the BITe is a unidimensional, reliable, valid, brief, and economic self-report measure of the irritability construct for both male and female Arabic-speakers. Providing an Arabic validated version of the BITe will hopefully foster the research efforts of the Arab scientific community in this area, and promote the implementation of timely, evidence-informed and culturally-sensitive mental health interventions that appropriately address irritability-related problems and consequences among Arab young populations.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Vanessa Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours, University Hospital Center, Byblos, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Groves L, Jones C, Welham A, Hamilton A, Liew A, Richards C. Non-pharmacological and pharmacological interventions for the reduction or prevention of topographies of behaviours that challenge in people with intellectual disabilities: a systematic review and meta-analysis of randomised controlled trials. Lancet Psychiatry 2023; 10:682-692. [PMID: 37595996 DOI: 10.1016/s2215-0366(23)00197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND People with intellectual disability show a high prevalence of behaviours that challenge. Clinical guidelines recommend that such behaviour should first be treated with non-pharmacological interventions, but research suggests off-label pharmaceuticals are commonly used. We aimed to evaluate the efficacy of non-pharmacological and pharmacological interventions for topographies of behaviours that challenge drawn from randomised controlled trials (RCTs). METHODS In this systematic review and meta-analysis, we searched PsycINFO, MEDLINE, Embase, CINAHL, and CENTRAL databases for RCT studies assessing an intervention (pharmacological or non-pharmacological) for behaviours that challenge (self-injury behaviour, aggression, destruction of property, irritability, and a composite overall measure) in participants with intellectual disability. The primary aim was to assess the efficacy of non-pharmacological and pharmacological interventions on behaviours that challenge. Secondary aims were to evaluate how effects varied over time and whether intervention, methodological, and participant characteristics moderate efficacy. We extracted standard mean difference (SMD) effect sizes (Cohen's d) from eligible studies and meta-analysed the data using a series of random effects models and subgroup analyses. This study was registered with PROSPERO 2021, CRD4202124997. FINDINGS Of 11 912 reports identified, 82 studies were included. 42 (51%) studies assessed non-pharmacological interventions and 40 (49%) assessed pharmacological interventions. Across all studies, 4637 people with intellectual disability aged 1-84 years (mean age 17·2 years) were included. 2873 (68·2%) were male, 1339 (28·9%) were female, and for 425 (9·2%) individuals, data on gender were not available. Data on ethnicity were unavailable. Small intervention effects were found for overall behaviours that challenge at post-intervention (SMD -0·422, 95% CI -0·565 to -0·279), overall behaviours that challenge at follow-up (-0·324, -0·551 to -0·097), self-injury behaviour at post-intervention (-0·238, -0·453 to -0·023), aggression at post-intervention (-0·438, -0·566 to -0·309), and irritability at post-intervention (-0·255, -0·484 to -0·026). No significant differences between non-pharmacological and pharmacological interventions were found for any topography of behaviours that challenge (all p>0·05). INTERPRETATION A broad range of interventions for behaviours that challenge are efficacious with small effect sizes for people with intellectual disability. These findings highlight the importance of precision in the measurement of behaviours that challenge, and when operationalising intervention components and dosages. FUNDING Cerebra.
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Affiliation(s)
- Laura Groves
- School of Psychology, University of Birmingham, Birmingham, UK; Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK; Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.
| | - Chris Jones
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Alice Welham
- School of Psychology, University of Birmingham, Birmingham, UK; Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Anna Hamilton
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Ashley Liew
- School of Psychology, University of Birmingham, Birmingham, UK; Paediatric Neurosciences, Evelina London Children's Hospital, London, UK; Institute for Mental Health, University of Birmingham, Birmingham, UK; CEDAR, University of Warwick, Warwick, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, UK; Cerebra Network, University of Birmingham, Birmingham, UK
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Gröndal M, Ask K, Winblad S. The distinction between irritability and anger and their associations with impulsivity and subjective wellbeing. Sci Rep 2023; 13:10398. [PMID: 37369760 DOI: 10.1038/s41598-023-37557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/23/2023] [Indexed: 06/29/2023] Open
Abstract
Irritability, anger, and impulsivity have important associations with psychological well-being. However, studying the internal relationships between such emotional constructs is challenging, largely because of the lack of precise operational definitions and extensively validated measurement tools. The aim of this study was to examine relationships between the above emotional constructs and how they relate to satisfaction with life and perceived negative impact on different life domains. Participants (N = 471) completed a self-report questionnaire online. Correlational analyses showed that higher levels of irritability and trait anger were associated with lower life satisfaction. Impulsivity displayed complex relationships with life satisfaction, with some aspects (sensation seeking) showing a positive relationship and others (urgency, lack of perseverance) showing a negative relationship. A two-factor Confirmatory Factor Analysis treating irritability and anger as separate constructs showed a better fit compared with a one-factor model, indicating that irritability and anger should be treated as separate constructs. An exploratory moderation analysis showed that higher irritability predicted increased anger only for participants scoring average to high on urgency (a facet of impulsivity). Our findings increase the understanding of the relationship between these dispositional constructs and supports the conceptualization of irritability and anger as related but distinct constructs.
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Affiliation(s)
- Maria Gröndal
- Department of Psychology, University of Gothenburg, Box 100, 405 30, Gothenburg, Sweden.
| | - Karl Ask
- Department of Psychology, University of Gothenburg, Box 100, 405 30, Gothenburg, Sweden
| | - Stefan Winblad
- Department of Psychology, University of Gothenburg, Box 100, 405 30, Gothenburg, Sweden
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Losiewicz OM, Metts AV, Zinbarg RE, Hammen C, Craske MG. Examining the indirect contributions of irritability and chronic interpersonal stress on symptoms of anxiety and depression in adolescents. J Affect Disord 2023; 329:350-358. [PMID: 36863468 DOI: 10.1016/j.jad.2023.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Chronic interpersonal stress has been identified as predictive of anxiety and depression. However, more research is needed to understand predictors of chronic interpersonal stress and mediators of its relationship with anxiety and depression. Irritability, a transdiagnostic symptom closely related to chronic interpersonal stress, may provide more insight into this relationship. While some research has demonstrated that irritability is related to chronic interpersonal stress, directionality is unknown. A bidirectional relationship between irritability and chronic interpersonal stress was hypothesized, such that irritability mediates the relationship between chronic interpersonal stress and internalizing symptoms and chronic interpersonal stress mediates the relationship between irritability and internalizing symptoms. METHODS This study used three cross-lagged panel models to investigate the indirect effects of irritability and chronic interpersonal stress on anxiety and depression symptoms using data from 627 adolescents (68.9 % female, 57.7 % white) over a six-year period. RESULTS In partial support for our hypotheses, we found that the relationships between chronic interpersonal stress and both fears and anhedonia were mediated by irritability, and that the relationship between irritability and anhedonia was mediated by chronic interpersonal stress. LIMITATIONS Study limitations include some temporal overlap in symptom measurements, an irritability measure that has not been previously validated to measure the construct, and lack of a lifespan perspective. CONCLUSIONS More targeted approaches in intervention for both chronic interpersonal stress and irritability may improve prevention and intervention efforts to address anxiety and depression.
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Affiliation(s)
- Olivia M Losiewicz
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Allison V Metts
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Richard E Zinbarg
- Northwestern University, Department of Psychology, 2029 Sheridan Road, Swift Hall 102, Evanston, IL 60208, USA; The Family Institute, Northwestern University, Evanston, IL, USA
| | - Constance Hammen
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Michelle G Craske
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA.
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Faurholt-Jepsen M, Busk J, Tønning ML, Bardram JE, Frost M, Vinberg M, Kessing LV. Irritability in bipolar disorder and unipolar disorder measured daily using smartphone-based data: An exploratory post hoc study. Acta Psychiatr Scand 2023; 147:593-602. [PMID: 37094823 DOI: 10.1111/acps.13558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To investigate (i) the proportions of time with irritability and (ii) the association between irritability and affective symptoms and functioning, stress, and quality of life in patients with bipolar disorder (BD) and unipolar depressive disorder (UD). METHODS A total of 316 patients with BD and 58 patients with UD provided self-reported once-a-day data on irritability and other affective symptoms using smartphones for a total of 64,129 days with observations. Questionnaires on perceived stress and quality of life and clinical evaluations of functioning were collected multiple times during the study. RESULTS During a depressive state, patients with UD spent a significantly higher proportion of time with presence of irritability (83.10%) as compared with patients with BD (70.27%) (p = 0.045). Irritability was associated with lower mood, activity level and sleep duration and with increased stress and anxiety level, in both patient groups (p-values<0.008). Increased irritability was associated with impaired functioning and increased perceived stress (p-values<0.024). In addition, in patients with UD, increased irritability was associated with decreased quality of life (p = 0.002). The results were not altered when adjusting for psychopharmacological treatments. CONCLUSIONS Irritability is an important part of the symptomatology in affective disorders. Clinicians could have focus on symptoms of irritability in both patients with BD and UD during their course of illness. Future studies investigating treatment effects on irritability would be interesting.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg hospital, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Busk
- Department of Energy Conversion and Storage, Technical University of Denmark, Lyngby, Denmark
| | - Morten Lindberg Tønning
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg hospital, Frederiksberg, Denmark
| | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | | | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Northern Zealand, Hilleroed, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg hospital, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Grassi ML, Valente D, Berardi A, Tofani M, Galeoto G. Validation and Analysis of the Psychometric Properties of Two Irritability-Measuring Tools: The Affective Reactivity Index (ARI) and the Born-Steiner Irritability Scale (BSIS) in the Italian Adult and Adolescent Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4607. [PMID: 36901616 PMCID: PMC10001850 DOI: 10.3390/ijerph20054607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Irritability is a transdiagnostic symptom that affects quality of life during the lifespan of individuals. The objective of the present research was to validate two assessment tools, namely the Affective Reactivity Index (ARI) and the Born-Steiner Irritability Scale (BSIS). We investigated internal consistency as measured with Cronbach's alpha, test-retest with intraclass correlation coefficient (ICC) and convergent validity confronting ARI and BSIS scores with the strength and difficulties questionnaire (SDQ). Our results revealed ARI good internal consistency with a Cronbach's α of 0.79 for adolescent and 0.78 for adults. The BSIS also demonstrated good internal consistency for both samples with Cronbach's α = 0.87. Test-retest analysis showed excellent values for both tools. Convergent validity showed positive and significant correlation with SDW, albeit weak for some sub-scales. In conclusion, we found ARI and BSIS to be good tools for measuring irritability in adolescents and adults, and now, Italian healthcare professionals can use it with more confidence.
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Affiliation(s)
- Maria Letizia Grassi
- Department Human Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, 00185 Rome, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Neuromed IRCCS, 86007 Pozzilli, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Tofani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Neuromed IRCCS, 86007 Pozzilli, Italy
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30
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Mohamed AK, Croarkin PE, Jha MK, Vande Voort JL. Early reduction in irritability is associated with improved outcomes among youth with depression: Findings from the AMOD study. J Affect Disord 2023; 324:77-81. [PMID: 36549343 DOI: 10.1016/j.jad.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 11/18/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Evaluate whether early improvement in irritability predicts improvement in depression severity in a naturalistic sample of adolescents undergoing pharmacologic treatment for major depressive disorder. METHODS Adolescents (N = 161) aged 13-18 years with a moderate to severe depressive episode were enrolled. Outcome measures included the Children's Depression Rating Scale-Revised (CDRS-R), Quick Inventory of Depressive Symptomatology (QIDS-A17), and Clinical Global Impression scale (CGI). Paired t-tests were used to estimate the change in irritability items from baseline to week-4, and Cohen's d effect sizes were computed. Separate linear regression analyses with CDRS-R, QIDS-A17, and CGI at week-8 as the dependent variables and baseline levels of irritability and baseline-to-week-4 changes in irritability as independent variables of interest were conducted. These analyses were repeated after controlling for overall depression severity (minus the irritability item) at baseline and baseline to week-4 change. RESULTS Greater baseline to week-4 reduction in irritability was associated with lower levels of CDRS-R, QIDS-A17, and CGI at week-8. These findings were significant for QIDS-A17 and CGI even after controlling for baseline-to-week-4 changes in other depressive symptoms. LIMITATIONS The single item evaluation of irritability reduced assessment reliability in the absence of validated measures of irritability. CONCLUSIONS Early reduction in irritability is strongly associated with better outcomes in depressed youths, regardless of baseline depression severity. Further research is needed to quantify the burden of irritability, explore it as a tool for measurement-based care, and to develop targeted treatments for irritability.
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Affiliation(s)
- Alaa K Mohamed
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Paul E Croarkin
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Manish K Jha
- Department of Psychiatry, UT Southwestern, United States of America
| | - Jennifer L Vande Voort
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States of America.
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Carlson GA, Singh MK, Amaya-Jackson L, Benton TD, Althoff RR, Bellonci C, Bostic JQ, Chua JD, Findling RL, Galanter CA, Gerson RS, Sorter MT, Stringaris A, Waxmonsky JG, McClellan JM. Narrative Review: Impairing Emotional Outbursts: What They Are and What We Should Do About Them. J Am Acad Child Adolesc Psychiatry 2023; 62:135-150. [PMID: 35358662 DOI: 10.1016/j.jaac.2022.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking. METHOD The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis. RESULTS Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses. CONCLUSION Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed.
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Affiliation(s)
- Gabrielle A Carlson
- Renaissance School of Medicine at Stony Brook University, Putnam Hall, South Campus, Stony Brook, New York.
| | | | | | - Tami D Benton
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Jeff Q Bostic
- MedStar Georgetown University Hospital, Washington, DC
| | - Jaclyn Datar Chua
- Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Pennsylvania, Philadelphia
| | | | - Cathryn A Galanter
- SUNY Downstate, Brooklyn, New York; Kings County Hospital Center, Brooklyn, New York
| | | | - Michael T Sorter
- Cincinnati Children's Hospital and the University of Cincinnati, Ohio
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Saatchi B, Agbayani CJG, Clancy SL, Fortier MA. Measuring irritability in young adults: An integrative review of measures and their psychometric properties. J Psychiatr Ment Health Nurs 2023; 30:35-53. [PMID: 35716348 PMCID: PMC10084147 DOI: 10.1111/jpm.12851] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 01/13/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Irritability is a transdiagnostic psychiatric symptom among different mental health diagnoses, such as depression, anxiety, personality and substance abuse disorders. Despite the prevalence of irritability across various psychiatric disorders, there is a lack of assessment measures developed and validated to specifically assess irritability. Existing evidence suggests that young adults with depression combined with irritability experience higher disease burden compared with depressed peers with low levels of irritability. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This integrative review demonstrates that the Brief Irritability Test (BITe) is a more precise and reliable tool for measuring irritability in young adults, particularly in that it differentiates irritability from related but distinct symptoms such as anger, aggression and hostility. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Utilizing valid and reliable tools to measure irritability could help identify the presence of irritability as a distinct construct, which could lead to the development of tailored/personalized mental health interventions that will adequately address the impact of irritability on functioning. The findings have implications for symptom science, one focus of nursing research that evaluates symptom experiences and their impact on quality of life and functioning. Irritability is consistent with this framework as it has disabling effects on educational, financial and social functioning, as well as vulnerability to psychiatric disorders and health-related quality of life. ABSTRACT: Introduction Irritability is associated with a higher burden of psychiatric symptoms and impairments in young adults' educational, financial and social functioning. Still, it has been measured mainly by subscales within larger tools. Few specific measures have been developed to capture this construct validly and reliably, hindering the differentiation of irritability from similar constructs like anger and aggression. Aim This integrative review was undertaken to identify the irritability measures used in young adults between 2000 and 2021. Method The 5-stage method was proposed by Whittemore and Knafl (Journal of Advanced Nursing, 52, 546, 2005). Results Of 1258 results, 15 articles that included young adults as their participants and measured irritability with a specific tool were identified to be reviewed. Discussion Among the existing tools, the Brief Irritability Test (BITe) is a more precise and specific tool in young adults for measuring irritability and differentiating irritability from similar constructs. Implications for practice The findings have potential implications for better assessment and understanding of irritability in nursing research and practice, leading to the development of nursing interventions tailored to the affected young adult populations and improving the quality of life in these groups.
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Affiliation(s)
- Babak Saatchi
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | | | - Stephen L Clancy
- Research Librarian for Health Sciences and Nursing Science, Science Library, University of California, Irvine, USA
| | - Michelle A Fortier
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
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33
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Bell E, Pooley A, Tam P, Boyce P, Bryant R, Porter R, Malhi GS. A novel exploration of irritability in adolescent males: A preliminary study. Australas Psychiatry 2022:10398562221141362. [PMID: 36421033 DOI: 10.1177/10398562221141362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Irritability is a key symptom of mood disorders and is common in adolescence; nevertheless, it is poorly understood and assessed. Research examining irritability and its relationship to mood and anxiety disorders risk factors in adolescent males is lacking. Therefore, the current study aimed to address this gap. METHOD An online survey designed to interrogate the relationship between irritability and other risk factor variables was administered to 627 adolescent males (ages 12-17). Findings were analysed statistically using MANOVAs. RESULTS When divided into high and low irritability groups, higher irritability scores were significantly correlated with higher scores on all risk factor variables. Further, higher irritability scores were associated with higher scores on all variables that indicate an increased risk for development of psychological disorders, such as depression and anxiety. CONCLUSION This study is the first to focus on subjective irritability. In adolescent males, it identifies a potentially novel model of irritability's involvement in maladaptive processes relating to emotional dysregulation, behavioural difficulties and anxiety.
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Affiliation(s)
- Erica Bell
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, 4334The University of Sydney, Sydney, NSW, Australia.,CADE Clinic and Mood-T, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Amanda Pooley
- Research Institute for Children and Adolescents, Wahroonga, NSW, Australia
| | - Philip Tam
- Child and adolescent psychiatrist and researcher in private practice.,Co-founder of Network for Internet Investigation and Research in Australia (NIIRA)
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, 4334University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, 7800University of New South Wales, Sydney, NSW, Australia
| | - Richard Porter
- Department of Psychological Medicine, 2495University of Otago, New Zealand
| | - Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, 4334The University of Sydney, Sydney, NSW, Australia.,CADE Clinic and Mood-T, Royal North Shore Hospital, Sydney, NSW, Australia.,Visiting Professor, Department of Psychiatry, 6396University of Oxford, UK
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Men's Depression, Externalizing, and DSM-5-TR: Primary Signs and Symptoms or Co-occurring Symptoms? Harv Rev Psychiatry 2022; 30:317-322. [PMID: 36103684 DOI: 10.1097/hrp.0000000000000346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Remmert N, Schmidt KMB, Mussel P, Hagel ML, Eid M. The Berlin Misophonia Questionnaire Revised (BMQ-R): Development and validation of a symptom-oriented diagnostical instrument for the measurement of misophonia. PLoS One 2022; 17:e0269428. [PMID: 35727794 PMCID: PMC9212156 DOI: 10.1371/journal.pone.0269428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 05/22/2022] [Indexed: 11/17/2022] Open
Abstract
Misophonia is a clinical syndrome which is characterized by intense emotional and physical reactions to idiosyncratic sounds. However, its psychometric measurement is still in the early stages. This study describes the optimization of a self-report instrument, the Berlin Misophonia Questionnaire (BMQ), and addresses its strengths in comparison to existing psychometric measures. This new measure integrates contemporary empirical findings and is based on the latest criteria of misophonia. A cross-sectional online study was conducted using data of 952 affected as well as non-affected individuals. The final BMQ-R consists of 77 items in 21 scales, which were selected using a probabilistic item selection algorithm (Ant Colony Optimization). The results of confirmatory factor analyses, the assessment of reliability, and an extensive construct validation procedure supported the reliability and validity of the developed scales. One outstanding strength of the BMQ-R is its comprehensive measurement of misophonic emotional and physical responses. The instrument further allows for distinguishing between behavioral, cognitive, and emotional dysregulation; the measurement of clinical insight and significance; as well as discerning reactive and anticipating avoidance strategies. Our work offers several improvements to the measurement of misophonia by providing a reliable and valid multidimensional diagnostical instrument. In line with the scientific consensus on defining misophonia, the BMQ-R allows to formally recognize individuals with misophonia and so to compare findings of future studies. Undoubtedly, this measure fills a research gap, which we hope will facilitate the investigation of causes and treatment of misophonia.
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Affiliation(s)
- Nico Remmert
- Department of Psychology, Freie Universität Berlin, Berlin, Germany
- * E-mail:
| | | | - Patrick Mussel
- Department of Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Michael Eid
- Department of Psychology, Freie Universität Berlin, Berlin, Germany
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Zik J, Deveney CM, Ellingson JM, Haller SP, Kircanski K, Cardinale EM, Brotman MA, Stoddard J. Understanding Irritability in Relation to Anger, Aggression, and Informant in a Pediatric Clinical Population. J Am Acad Child Adolesc Psychiatry 2022; 61:711-720. [PMID: 34438022 PMCID: PMC8863995 DOI: 10.1016/j.jaac.2021.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/13/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Despite its clinical relevance to pediatric mental health, the relationship of irritability with anger and aggression remains unclear. We aimed to quantify the relationships between well-validated, commonly used measurements of these constructs and informant effects in a clinically relevant population. METHOD A total of 195 children with primary diagnoses of attention-deficit/hyperactivity disorder, disruptive mood dysregulation disorder, or no major disorder and their parents rate irritability, anger, and aggression on measures of each construct. Construct and informant relationships were mapped via multi-trait, multi-method factor analysis. RESULTS Parent- and child-reported irritability and child-reported anger are highly associated (r = 0.89) but have some significant differences. Irritability overlaps with outward expression of anger but diverges from anger in anger suppression and control. Aggression has weaker associations with both irritability (r = 0.56) and anger (r = 0.49). Across measures, informant source explains a substantial portion of response variance. CONCLUSION Irritability, albeit distinct from aggression, is highly associated with anger, with notable overlap in child-reported outward expression of anger, providing empirical support for formulations of clinical irritability as a proneness to express anger outwardly. Diagnostic and clinical intervention work on this facet of anger can likely translate to irritability. Further research on external validation of divergence of these constructs in anger suppression and control may guide future scale revisions. The proportion of response variance attributable to informant may be an under-recognized confound in clinical research and construct measurement.
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Affiliation(s)
- Jodi Zik
- Pediatric Mental Health Institute, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora.
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Editorial: The Boundaries of Irritability and Implications for Measurement. J Am Acad Child Adolesc Psychiatry 2022; 61:610-611. [PMID: 35151791 PMCID: PMC9830456 DOI: 10.1016/j.jaac.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 01/12/2023]
Abstract
Irritability is a defining feature or symptom in at least 15 DSM-5 disorders,1 and this does not even account for many more disorders that commonly co-occur with irritability. However, just as the transdiagnostic nature of irritability supports its unequivocal importance in child mental health, it also contributes to criticisms that it is "ubiquitous."2 How to conceptualize the role of irritability in psychopathology rests on our ability to define it and its boundaries. Unfortunately, there is a lack of consensus on the definition of irritability. In fact, how to disentangle irritability's mood and behavioral components has been described as one of the biggest challenges related to irritability research.3 This editorial is a commentary on Zik et al.'s4 study, which takes an emprical approach to determine the overlap between questionnaire measures of irritability, anger, and aggression, thereby informing our conceptualization of irritabiltiy and focusing attention on critical measurement issues such as the impact of informant.
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Kishida K, Tsuda M, Takahashi F, Ishikawa SI. Irritability and mental health profiles among children and adolescents: A result of latent profile analysis. J Affect Disord 2022; 300:76-83. [PMID: 34952126 DOI: 10.1016/j.jad.2021.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Irritability is a transdiagnostic symptom that accompanies both internalizing and externalizing problems. However, there has been a scarcity of research concerning the relationships between irritability and mental health profiles among children and adolescents. AIM This study aimed to identify latent profiles in children and adolescents using anxiety, depression, oppositionality, and irritability. In addition, the profiles were further examined in their relationships with mental health symptoms. METHOD The study analyzed data from 1867 children and adolescents aged 6-15 years from the COVID-19 Online-Survey for Children and Adolescents in Japan (J-COSCA). Parent-reported questionnaires were used in this study. RESULTS A latent profile analysis detected five latent profiles. High oppositionality characterized the first profile ("oppositional": n = 405, 22%). High levels of depression and other less pronounced symptoms characterized the second profile ("depressed": n = 276, 15%). The third profile ("average": n = 602, 33%) presented average symptoms of anxiety, depression and oppositionality and low irritability. The fourth profile ("well-adjusted": n = 235, 13%) presented low values for all the applicable symptoms. The last profile ("comorbid": n = 308, 17%) exhibited high values for all the symptoms and the highest level of irritability of the five profiles. LIMITATION We analyzed the data from a community sample alone after capturing it using parent-reported questionnaires. CONCLUSION This study revealed that the five profiles (oppositional, depressed, average, well-adjusted, and comorbid) were identified, and children and adolescents in the comorbid profiles had high irritability as well as high anxiety, depression, and oppositionality.
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Affiliation(s)
- Kohei Kishida
- Organization for Research Initiatives and Development, Doshisha University, Japan; Faculty of Psychology, Doshisha University, Japan.
| | - Masami Tsuda
- Graduate School of Psychology, Doshisha University, Japan
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39
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Trait irritability in adults is unrelated to face emotion identification. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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40
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French Adaptation of the Brief Irritability Test: Factor Structure, Psychometric Properties, and Relationship with Depressive Symptoms. Psychol Belg 2022; 62:47-61. [PMID: 35106182 PMCID: PMC8796690 DOI: 10.5334/pb.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 01/13/2022] [Indexed: 11/20/2022] Open
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Evans SC, Corteselli KA, Edelman A, Scott H, Weisz JR. Is Irritability a Top Problem in Youth Mental Health Care? A Multi-informant, Multi-method Investigation. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01301-8. [PMID: 35064392 DOI: 10.1007/s10578-021-01301-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
Irritability is often described as a common problem affecting youth referred for mental health services; however, little is known about the prevalence and nature of irritability as a focus of treatment. We examined assessment data from a diverse sample of youths (N = 206; ages 7-15; 52% male, 48% female; 33% White, 27% Black, 25% Latinx) referred for outpatient treatment of emotional and behavioral concerns. Caregivers and youths completed nomothetic (standardized checklist) and idiographic (free response) measures at intake. Irritability was identified as a top problem (TP) in 58% of cases, commonly reported by caregivers (38%), youths (42%), or both (23%)-rates that were significantly greater than those of other TP domains (depression, anxiety, ADHD, conduct, and defiance). Further analyses identified clinical correlates of irritability TPs, with results supporting the incremental utility of multiple informants and methods. Findings suggest that irritability is among the most common problems for which families seek youth treatment.
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Affiliation(s)
- Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | | | - Audrey Edelman
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Hannah Scott
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Harima Y, Miyawaki D, Goto A, Hirai K, Sakamoto S, Hama H, Kadono S, Nishiura S, Inoue K. Associations Between Chronic Irritability and Sensory Processing Difficulties in Children and Adolescents. Front Psychiatry 2022; 13:860278. [PMID: 35573381 PMCID: PMC9095987 DOI: 10.3389/fpsyt.2022.860278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Irritability is one of the most common reasons for which children and adolescents are referred for psychiatric evaluation and care. However, clinical irritability is difficult to define; thus, its prevalence varies widely. Chronic irritability may be associated with sensory processing difficulties (SPD), but little is known about the relationship between these two factors in clinical populations. In this study, we examined the prevalence of chronic irritability and its association with SPD in 166 children aged 5-16 years who were referred to the psychiatric outpatient clinic of the Osaka City University Hospital. Chronic irritability and parent-reported scores for the Short Sensory Profile, Infant Behavior Checklist-Revised, Child Behavior Checklist, and Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (Present and Lifetime version) questionnaires were used for assessment. A total of 22 children (13.2%) presented with chronic irritability (i.e., the irritability group) and were more likely to have oppositional defiant disorder, externalizing problems, and attention issues than those without chronic irritability (i.e., the control group). SPD were reported in eight (36%) patients in the irritability group and in 21 (15%) in the control group (p = 0.029). Moreover, compared to the control group, the irritability group showed a significant difference in almost all items of the Short Sensory Profile. Chronic irritability was associated with more severe overall SPD, even after adjusting for possible confounding factors (internalizing and externalizing problems, age, sex, and low income). We provide evidence to support our hypothesis that chronic irritability is associated with SPD in children and adolescents. Therefore, SPD should be assessed to provide appropriate interventions in children and adolescents with chronic irritability.
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Affiliation(s)
- Yuji Harima
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Dai Miyawaki
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ayako Goto
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kaoru Hirai
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.,Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shoko Sakamoto
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Hama
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shin Kadono
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Sayaka Nishiura
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koki Inoue
- Department of Neuropsychiatry, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Forte A, Orri M, Turecki G, Galera C, Pompili M, Boivin M, Tremblay RE, Côté SM, Geoffroy MC. Identifying environmental pathways between irritability during childhood and suicidal ideation and attempt in adolescence: findings from a 20-year population-based study. J Child Psychol Psychiatry 2021; 62:1402-1411. [PMID: 33721915 DOI: 10.1111/jcpp.13411] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Irritable children are at increased risk of suicidal ideation and suicide attempt, but the underlying environmental mechanisms accounting for these associations are largely unknown. We aimed to investigate the mediating role of peer victimization and harsh parenting in the association between childhood irritability and adolescent suicidal ideation and attempt. METHOD N = 1,483 participants from the Québec Longitudinal Study of Child Development followed up from 5 months until 20 years of age (2018) with annual or biannual assessments. Irritability was operationalized using assessments of teacher-reported temper tantrums and reactive aggression. Suicidal ideation and suicide attempt at ages 13, 15, 17, and 20 years were self-reported. Peer victimization (self-reported at age 13) and harsh parenting (mothers reported at age 13) were considered as potential mediators. RESULTS We identified four trajectories of teacher-reported irritability symptoms from 6 to 12 years: low (74.8%), rising (12.9%), declining (7.3%), and persistent (4.9%). In adjusted models, children in the persistent and rising trajectories had, respectively, 2.81-fold (CI, 1.27-6.22) and 2.14-fold (CI, 1.20-3.81) increased odds of suicide attempt in adolescence, but not suicidal ideation. We found that a significant proportion of the association between irritability trajectories and suicide attempt was mediated by peer victimization (33% and 35% for rising and persistent, respectively), but there was no mediation via harsh parenting. CONCLUSIONS Our findings suggest that peer victimization may be a key mechanism explaining the increased suicide attempt risk of children presenting with persistently high or increasing irritability. Interventions to reduce peer victimization may be helpful to reduce suicide risk among irritable children.
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Affiliation(s)
- Alberto Forte
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy.,Department of Psychiatry and Substance Abuse, ASL Roma 5, Rome, Italy
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Cedric Galera
- Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Michel Boivin
- School of Psychology, Laval University, Quebec, QC, Canada
| | - Richard E Tremblay
- Departments of Pediatrics and Psychology, University of Montreal, Montreal, QC, Canada.,School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Sylvana M Côté
- Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Department of Education and Counselling Psychology, McGill University, Montreal, QC, Canada
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Towards Explaining Knowledge Hiding through Relationship Conflict, Frustration, and Irritability: The Case of Public Sector Teaching Hospitals. SUSTAINABILITY 2021. [DOI: 10.3390/su132212598] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Organizations grow and excel with knowledge sharing; on the other hand, knowledge hiding is a negative behavior that impedes innovation, growth, problem solving, and timely correct decision making in organizations. It becomes more critical in the case of teaching hospitals, where, besides patient care, medical students are taught and trained. We assume that negative emotions lead employees to hide explicit knowledge, and in the same vein, this study has attempted to explain the hiding of explicit knowledge in the presence of relational conflicts, frustration, and irritability. We collected data from 290 employees of a public sector healthcare organization on adopted scales to test conjectured relationships among selected variables. Statistical treatments were applied to determine the quality of the data and inferential statistics were used to test hypotheses. The findings reveal that relationship conflicts positively affect knowledge hiding, and frustration partially mediates the relationship between relationship conflicts and knowledge hiding. Irritability moderates the relationship between relationship conflicts and frustration. The findings have both theoretical and empirical implications. Theoretically, the study tests a novel combination of variables, and adds details regarding the intensity of their relationships to the existing body of literature. Practically, the study guides hospital administrators in managing knowledge hiding, and informs on how to maintain it at the lowest possible level.
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45
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Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic. J Affect Disord 2021; 294:753-760. [PMID: 34375200 PMCID: PMC8433813 DOI: 10.1016/j.jad.2021.07.072] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The 2019 coronavirus disease (COVID-19) pandemic has impacted the mental health and well-being of medical personnel, including nursing students. Network analysis provides a deeper characterization of symptom-symptom interactions in mental disorders. The aim of this study was to elucidate characteristics of anxiety and depressive symptom networks of Chinese nursing students during the COVID-19 pandemic. METHOD A total of 932 nursing students were included. Anxiety and depressive symptom were measured using the seven-item Generalized Anxiety Disorder Scale (GAD-7) and two-item Patient Health Questionnaire (PHQ-2), respectively. Central symptoms and bridge symptoms were identified via centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. RESULTS Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood had the highest centrality values. Three bridge symptoms (Depressed mood, Nervousness, and Anhedonia) were also identified. Neither gender nor region of residence was associated with network global strength, distribution of edge weights or individual edge weights. LIMITATIONS Data were collected in a cross-sectional study design, therefore, causal relations and dynamic changes between anxiety and depressive symptoms over time could not be inferred. Generalizability of findings may be limited to Chinese nursing students during a particular phase of the current pandemic. CONCLUSIONS Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood constituted central symptoms maintaining the anxiety-depression network structure of Chinese nursing students during the pandemic. Timely, systemic multi-level interventions targeting central symptoms and bridge symptoms may be effective in alleviating co-occurring experiences of anxiety and depression in this population.
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Bell E, Malhi GS, Mannie Z, Boyce P, Bryant R, Inder M, Porter RJ. Novel insights into irritability: the relationship between subjective experience, age and mood. BJPsych Open 2021; 7:e198. [PMID: 34709149 PMCID: PMC8570102 DOI: 10.1192/bjo.2021.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The relationship between irritability as a subjective experience and the behavioural indicators typically used to measure the construct are not known. Its links to mood, and contextual relationships, vary with age and are yet to be thoroughly examined. AIMS First, to interrogate the relationship between the subjective experience of irritability and mood, and that with its behavioural indicators. Second, to determine how these relationships vary with age and over time. METHOD This study examined data from a previous clinical trial of adolescents and young adults (N = 82) with bipolar disorder, who received a psychological intervention over 18 months. Participants completed a battery of questionnaires, which included assessments of irritability. Analyses of covariance were conducted to examine the interaction between mood symptoms, subjective measures of irritability, behavioural measures of irritability and age over time. RESULTS Subjective irritability scores differed significantly over time when controlling for manic, but not depressive, symptom scores. Further, subjective irritability significantly differed when controlling for behavioural measures of irritability (temper outbursts and argumentativeness). There were significant interactions between scores of depressive symptoms, temper outbursts and subjective irritability with age, wherein younger participants showed no correlation between depressive symptoms and temper outbursts. In addition, younger participants showed lower correlations between subjective irritability and both depressive and temper outburst scores, than older participants. CONCLUSIONS Subjective irritability is linked to mood morbidity and behavioural outbursts, and these relationships are contingent on age. Our novel findings suggest that subjective irritability should be assessed in greater detail in patients with mood disorders.
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Affiliation(s)
- Erica Bell
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Zola Mannie
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia; and NSW Health, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Philip Boyce
- Speciality of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Australia
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, New Zealand
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Gröndal M, Ask K, Luke TJ, Winblad S. Self-reported impact of the COVID-19 pandemic, affective responding, and subjective well-being: A Swedish survey. PLoS One 2021; 16:e0258778. [PMID: 34653222 PMCID: PMC8519461 DOI: 10.1371/journal.pone.0258778] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/05/2021] [Indexed: 12/23/2022] Open
Abstract
A rapid stream of research confirms that the COVID-19 pandemic is a global threat to mental health and psychological well-being. It is therefore important to identify both hazardous and protective individual factors during the pandemic. The current research explored the relationships between self-reported affective responding, perceived personal consequences of the COVID-19 pandemic, and subjective well-being. An online survey (N = 471) conducted in Sweden between June and September, 2020, showed that higher levels of irritability, impulsivity, and the tendency to experience and express anger were generally associated with more severe personal consequences of the pandemic, particularly in areas related to family life, work/study, and finances. While more severe impacts of the pandemic in these areas of life were directly associated with lower subjective well-being, emotion regulation through cognitive reappraisal appeared to moderate the extent to which consequences of the pandemic in other areas of life (i.e., social, free-time and physical activities) translated into decreased well-being. This suggests that cognitive reappraisal may serve to protect against some of the debilitating effects of the COVID-19 pandemic on mental health. Overall, the results indicate that the perceived consequences of the pandemic are multifaceted and that future research should examine these consequences using a multidimensional approach.
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Affiliation(s)
- Maria Gröndal
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Karl Ask
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Timothy J. Luke
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Winblad
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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Dysphoria and Irritability-Diagnostic Pitfalls in the Assessment of Interictal Dysphoric Disorder in Epilepsy. J Clin Med 2021; 10:jcm10194624. [PMID: 34640642 PMCID: PMC8509667 DOI: 10.3390/jcm10194624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
This article aims to review the concept of epilepsy-specific psychiatric disturbance, Interictal Dysphoric Disorder (IDD), focusing on issues related to its core symptoms and methodological pitfalls. In the psychiatric literature, an epilepsy-specific pleomorphic mood disorder has been long recognized and described as IDD, a condition characterized by eight symptoms, which are grouped into four labile depressive symptoms, two labile affective symptoms, and two specific symptoms. The existence of IDD is still a matter of debate because of several methodological issues. The main features of IDD, such as dysphoria and irritability, lack precise and clear definition. This review article explores the different definitions and approaches towards both terms described in the psychiatric literature and the rationale for modifying the diagnostic process of IDD.
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49
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Liu Q, Cole DA. The association of phasic irritability (aggressive outbursts) and tonic irritability (irritable mood) to depression occurrences, symptoms, and subtypes. J Affect Disord 2021; 293:9-18. [PMID: 34157615 DOI: 10.1016/j.jad.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research among adults has rarely differentiated between tonic irritability (i.e., irritable mood) and phasic irritability (i.e., aggressive outbursts) with respect to multiple dimensions of depression. The current study explored both tonic and phasic irritability in relation to depression severity, depression chronicity, age of depression onset, individual depressive symptom, and depression subtypes. METHODS The study included participants (N = 5692) from the National Comorbidity Survey - Replication (NCS-R) part two. The NCS-R used lay-administered, fully standardized diagnostic interviews. The current study implemented linear models, generalized linear models, Cox proportional hazard model, and latent class regression. RESULTS Both types of irritability were significantly associated with greater risk for MDD diagnosis, as well as risk for having at least one depressive symptom, early MDE onset, and MDE chronicity. Both phasic and tonic irritability were associated with greater odds of specific depressive symptoms and were differentially related to distinct depressive symptom constellations. Phasic irritability related only to severe depression. Lastly, both phasic and tonic irritability was associated with suicidal ideation, but only phasic irritability was associated with a suicide plan and attempt, above and beyond depression subtypes. CONCLUSIONS Both phasic and tonic irritability differentially related to almost all aspects of depression in adults. Specifically, tonic irritability showed overall stronger associations with various depressive features, whereas phasic irritability marked higher depressive severity.
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Affiliation(s)
- Qimin Liu
- Vanderbilt University, Nashville, Tennessee.
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Liu Q, Nestor BA, Cole DA. Differential associations of phasic and tonic irritability to suicidality among U.S. adults. J Affect Disord 2021; 292:391-397. [PMID: 34139413 DOI: 10.1016/j.jad.2021.05.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
Research on the relations between irritability and suicidality among adults has rarely compared or differentiated between tonic versus phasic irritability. The current cross-sectional study investigated the role of both tonic and phasic irritability in relation to lifetime suicidal ideation, plans, and attempts. The study included adult participants who completed the suicidality module from the National Comorbidity Survey - Replication (NCS-R) (N = 7683 for suicidal ideation and N = 1223 for suicidal plan and attempt). The NCS-R used lay-administered, standardized diagnostic interviews. Phasic and tonic irritability were assessed with individual screener items from the World Health Organization Composite International Diagnostic Interviews (CIDI). The current study used logistic regression, weighted Cox proportional hazard model, and multinomial logit regression, adjusting for sex, race/ethnicity, age, education, and marital status. Both types of irritability were included simultaneously in the models. Results indicated that both types of irritability were significantly associated with increased odds of suicidal ideation (phasic: Odds Ratio 2.72 [2.35,3.14]); tonic: OR 2.34 [2.04,2.68]), age of first-time suicidal ideation (phasic: Adjusted Hazard Ratio 2.87 [2.27, 3.63]; tonic: AHR 2.12 [1.76,2.54]), and suicide attempt (phasic: OR 1.53 [1.13,2.07]); tonic: OR 1.44 [1.11,1.89]). Only tonic but not phasic irritability was associated with suicide plans (OR 1.39 [1.08,1.79]). When suicide attempts were divided into those that were impulsive versus planned and compared them to no suicide attempt, both types of irritability were associated planned attempts, (phasic: OR 1.53 [1.13,2.07]); tonic: OR 1.44 [1.11,1.89]) but only phasic irritability was related to impulsive attempts (OR 1.70 [1.10,2.64]). Phasic and tonic irritability show differential relations to and can serve as differential markers for suicide-related outcomes in adults.
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Affiliation(s)
- Qimin Liu
- Department of Psychology and Human Development, Vanderbilt University, USA.
| | - Bridget A Nestor
- Department of Psychology and Human Development, Vanderbilt University, USA
| | - David A Cole
- Department of Psychology and Human Development, Vanderbilt University, USA
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