University of Louisville School of Medicine, Department of Pediatrics, Division of Child and Adolescent Psychiatry and Psychology, Louisville, KY, United States.
University of Louisville School of Medicine, Department of Pediatrics, Child and Adolescent Health Research Design & Support (CAHRDS) Unit, Louisville, KY, United States.
J Affect Disord. 2020 Mar 1;264:242-248. doi: 10.1016/j.jad.2019.12.018. Epub 2019 Dec 14.
Rates of pediatric bipolar disorders have increased and some are concerned about diagnostic accuracy. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in 2013. The purpose of this study was to assess diagnostic trends of bipolar disorders and DMDD and to identify predictors of receiving the DMDD diagnosis since implementation of DSM-5.
Kentucky Medicaid claims from 2012-2017 for children under 18 years (N = 814,919; 2012 n = 473,389; 2013 n = 470,918; 2014 n = 499,094; 2015 n = 517,199; 2016 n = 529,048; 2017 n = 535,814) were used. Logistic regression was used to identify predictors of a diagnosis of DMDD in 2015-2017 for a sub-sample (n = 5,071).
The use of DMDD rose after 2013 and mood disorder NOS decreased steadily through 2017. This decrease was seen when there was a diagnosis of bipolar and oppositional defiant disorder (ODD) combined with mood disorder NOS. A diagnosis of only mood disorder NOS in 2012 did not predict DMDD in 2015-2017, but the same diagnosis in 2013 was predictive (OR 2.14, p = 0.049). The reverse is true for a diagnosis of only ADHD in 2013, which did not predict DMDD in later years, but its presence in 2012 was predictive (OR 1.36, p = 0.010).
DMDD increased after 2013, and this was associated with a diagnosis of mood disorder NOS, ADHD, as well as with bipolar disorders comorbid with ODD. Given the complexity of comorbid diagnoses, DMDD may be more accurate in classifying some children. Administrative claims data have limitations, which are discussed; and the data represent only children living in Kentucky.
儿科双相障碍的发病率有所增加，一些人对诊断的准确性表示担忧。破坏性情绪失调障碍（DMDD）于 2013 年被纳入 DSM-5。本研究的目的是评估双相障碍和 DMDD 的诊断趋势，并确定自 DSM-5 实施以来接受 DMDD 诊断的预测因素。
利用 2012-2017 年肯塔基州医疗补助索赔数据，对 18 岁以下儿童（N=814919；2012 年 n=473389；2013 年 n=470918；2014 年 n=499094；2015 年 n=517199；2016 年 n=529048；2017 年 n=535814）进行分析。采用逻辑回归分析方法，对 2015-2017 年一个子样本（n=5071）的 DMDD 诊断预测因素进行分析。
2013 年后，DMDD 的使用增加，而心境障碍NOS 则稳步下降至 2017 年。当双相障碍和对立违抗性障碍（ODD）合并心境障碍NOS 时，会出现这种情况。2012 年仅诊断为心境障碍NOS 并不能预测 2015-2017 年的 DMDD，但同年的诊断是预测因素（OR 2.14，p=0.049）。反之，2013 年仅诊断为 ADHD 并不能预测随后几年的 DMDD，但 2012 年的诊断是预测因素（OR 1.36，p=0.010）。
2013 年后，DMDD 的使用增加，与心境障碍NOS、ADHD 以及双相障碍合并 ODD 的诊断有关。鉴于共病诊断的复杂性，DMDD 可能更能准确地对一些儿童进行分类。行政索赔数据存在局限性，本文对此进行了讨论；数据仅代表肯塔基州的儿童。
