BIPOLAR DISORDERS IN A COMMUNITY SAMPLE OF OLDER ADOLESCENTS - PREVALENCE, PHENOMENOLOGY, COMORBIDITY, AND COURSE

Objective: The purpose of this study was to examine the prevalence, cl inical characteristics, and mental health treatment services utilizati on of adolescents with bipolar disorders and manic symptoms. Method: S tructured diagnostic interviews were administered to a representative community sample of 1,709 older adolescents (aged 14 through 18 years) . Results: The lifetime prevalence of bipolar disorders (primarily bip olar II disorder and cyclothymia) was approximately 1%. An additional 5.7% of the sample reported having experienced a distinct period of ab normally and persistently elevated, expansive, or irritable mood even though they never met criteria for bipolar disorder (''core positive'' subjects). The rate of manic symptoms in these subjects was similar t o that reported in clinical samples, and the course of bipolar disorde r was relatively chronic. Compared with adolescents with a history of major depression (n = 316) and a ''never mentally ill'' group (n = 845 ), the bipolar and core positive subjects both exhibited significant f unctional impairment and high rates of comorbidity (particularly with anxiety and disruptive behavior disorders), suicide attempts, and ment al health services utilization. Conclusions: These data highlight the clinical and public health significance of even the milder and subthre shold cases of bipolar disorder in adolescence.