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Understanding Treatment Outcomes in Pediatric Bipolar Disorder

Understanding Treatment Outcomes in Pediatric Bipolar Disorder 1024 575 Pam Georgiana
Teen girl with backpack

New study compares minimally adequate behavioral health treatments and clinical outcomes.

Pediatric bipolar disorder, which affects approximately 3.9% of youth globally, is the fourth leading cause of years of life lost due to disability and premature death for young people between the ages of 10 and 24. Effective treatment is critical to reduce these risks and improve the quality of life for patients.

Elyse Llamocca, PhD, senior research scientist in the Center for Suicide Prevention and Research in the Abigail Wexner Research Institute at Nationwide Children’s Hospital, recently led a team to investigate the relationship between minimally adequate treatment guidelines and clinical outcomes for youth aged 10 to 18 diagnosed with a new episode of bipolar disorder using multistate Medicaid data. The results were published in The Journal of Psychiatric Research.

“For my dissertation, I was particularly interested in expanding Dr. Fontanella’s work in understanding how disparities in treatment affected clinical outcomes in low-income youth suffering from bipolar disorder,” Dr. Llamocca explains. “I wanted to identify the interventions that led to the best outcomes.”

Cynthia A. Fontanella, PhD, mental health services researcher and principal investigator in the Center for Suicide Prevention and Research in the Abigail Wexner Research Institute at Nationwide Children’s, says, “This research is an important step in identifying which treatments actually make a difference for youth with bipolar disorder, especially those from underserved backgrounds. By examining real-world data, we can better understand how to close gaps in care and improve outcomes for vulnerable populations.”

The study focused on four measures of minimally adequate treatment over 180 days following the onset of a new bipolar disorder episode, based on guidelines published by the American Academy of Child and Adolescent Psychiatry (AACAP) and other organizations. These measures included:

  1. Pharmacotherapy: Use of mood stabilizers/atypical antipsychotics for at least 80% of the treatment period
  2. Psychotherapy: At least 8 visits during the treatment period
  3. Combined pharmacotherapy and psychotherapy
  4. No antidepressant monotherapy: Antidepressant therapy only in conjunction a mood stabilizer and/or atypical antipsychotic

The primary objective was to evaluate how adherence to these treatment measures affected four key clinical outcomes over the next year:

  1. Psychiatric hospitalizations related to bipolar disorder
  2. Emergency room visits related to bipolar disorder
  3. Deliberate self-harm
  4. Mortality

The data showed that the risk of hospitalization increased for youth receiving minimally adequate psychotherapy and both pharmacotherapy and psychotherapy. Similarly, the risk of emergency room visits was higher for those receiving minimally adequate pharmacotherapy and psychotherapy alone or in combination.

Notably, patients receiving no antidepressant monotherapy experienced a decreased risk of hospitalization. “This specific insight supports the current clinical recommendation against using antidepressants without mood stabilizers in this vulnerable population,” Dr. Llamocca explains.

While minimally adequate care was linked to increased healthcare utilization, Dr. Llamocca suggests this may reflect other influencing factors, such as severity of illness. “It is important to remember that children with more severe symptoms may be more likely to seek mental health services,” she says.

The study also revealed that self-harm and mortality were not significantly associated with the receipt of minimally adequate care. “There were very few instances of these outcomes in the sample, which made measurement challenging,” Dr. Llamocca notes.

Despite these limitations, Dr. Llamocca’s research highlights the importance of adhering to clinical guidelines, particularly the recommendation to avoid antidepressant monotherapy, which may exacerbate manic symptoms in youth with bipolar disorder.

Dr. Llamocca concludes, “We need to conduct further research to better understand the complexities of treatment adherence, the factors that affect treatment outcomes and their impact on real-world clinical outcomes.”

“This study provides valuable insights into improving care for youth with bipolar disorder”, Dr. Fontanella adds. “It highlights the need for practical, guideline-based treatment to optimize outcomes for our youngest patients.”

 

References:

  1. Van Meter A, Moreira ALR, Youngstrom E. Updated Meta-Analysis of Epidemiologic Studies of Pediatric Bipolar Disorder. J Clin Psychiatry. 2019;80(3):18r12180.
  2. Gore FM,  Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, Sawyer SM, Mathers CD. Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet. 2011;377:2093-2102.
  3. Llamocca EN, Fristad MA, Brock G, Steelesmith DL, Felix AS, Fontanella CA. Associations between minimally adequate treatment and clinical outcomes among Medicaid-enrolled youth with bipolar disorder. J Psychiatr Res. 2025;182:497-505.

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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