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Sex Differences in Pediatric Bipolar Disorder

Jeanne M. Duax, M.A.; Eric A. Youngstrom, Ph.D.; Joseph R. Calabrese, M.D.; and Robert L. Findling, M.D.

Objective: To explore sex differences in pediatric bipolar disorder in terms of subtype and severity of depressive and manic symptomatology.

Method: Participants were 760 youth (aged 5-17 years) and their legal guardians. Participants were part of a larger outpatient assessment protocol enriched for bipolar disorder. Youth were assessed for DSM-IV diagnoses using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version. Their presenting mood state was determined using the Young Mania Rating Scale and the Children's Depression Rating Scale-Revised. The study was conducted from January 1996 to February 2003.

Results: 387 youth (51%) met DSM-IV criteria for diagnoses of bipolar spectrum disorders. Results showed no sex differences in rates of bipolar spectrum disorders or any of the bipolar subtypes. Sex differences were found with regard to presenting mood states: boys presented with higher rates of manic mood, and girls presented with higher rates of depressed mood. Older children were also more likely than younger children to exhibit higher levels of depressed mood. There were no age differences in levels of manic mood.

Conclusion: This study highlights how bipolar disorder can manifest itself differently among girls and boys despite equivalent rates of diagnosis. It is important for clinicians to consider the full range of mood states in order to accurately diagnose and treat children. Future research is needed to assess the roles that genetics, puberty, cognitive styles, and environmental factors play in the expression of mania and depression in girls and boys over the course of their development.

(J Clin Psychiatry 2007;68:1565-1573)

Received Jan. 22, 2007; accepted April 25, 2007. From the Department of Psychology, Case Western Reserve University (Ms. Duax) and the Department of Psychiatry, University Hospitals Case Medical Center (Drs. Calabrese and Findling), Cleveland, Ohio; and the Department of Psychology, University of North Carolina-Chapel Hill (Dr. Youngstrom).

This research was supported by a Clinical Research Center Grant from the Stanley Medical Research Institute and by National Institute of Mental Health grant R01 MH-066647.

Dr. Calabrese has received research/grant support from, served as a consultant for, and/or served on a speakers bureau for Abbott, AstraZeneca, France Foundation, GlaxoSmithKline, Janssen, Johnson & Johnson, Solvay/Wyeth, Bristol-Myers Squibb, and Eli Lilly. Dr. Findling has received research/grant support from, served as a consultant for, and/or served on a speakers bureau for Abbott, AstraZeneca, Bristol-Myers Squibb, Celltech-Medeva, Forest, GlaxoSmithKline, Johnson & Johnson, Eli Lilly, New River, Novartis, Otsuka, Pfizer, Sanofi-Aventis, Shire, Solvay, and Wyeth. Ms. Duax and Dr. Youngstrom report no additional financial or other relationship relevant to the subject of this article.

Corresponding author and reprints: Jeanne M. Duax, Department of Psychology, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106-7123 (e-mail: