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Facial emotion recognition and mood symptom course in young adults with childhood-onset bipolar disorder

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Abstract

Facial emotion recognition deficits are common in bipolar disorder (BD) and associated with impairment. However, the relationship between facial emotion recognition and mood course is not well understood. This study examined facial emotion recognition and subsequent mood symptoms in young adults with childhood-onset BD versus typically developing controls (TDCs). The sample included 116 young adults (ages 18–30, 58% male, 78% White) with prospectively verified childhood-onset BD (n = 52) and TDCs (n = 64). At baseline, participants completed a facial emotion recognition task (Diagnostic Analysis of Non-Verbal Accuracy-2) and clinical measures. Then, participants with BD completed mood symptom assessments every 6 months (M = 8.7 ± 5.2 months) over two years. Analyses included independent-samples t tests and mixed-effects regression models. Participants with BD made significantly more recognition errors for child expressions than TDCs. There were no significant between-group differences for recognition errors for adult expressions, or errors for specific child or adult emotional expressions. Participants had moderate baseline mood symptoms. Significant time-by-facial emotion recognition interactions revealed more recognition errors for child emotional expressions predicted lower baseline mania and stable/consistent trajectory; fewer recognition errors for child expressions predicted higher baseline mania and decreasing trajectory. In addition, more recognition errors for adult sad expressions predicted stable/consistent depression trajectory and decreasing mania; fewer recognition errors for adult sad expressions predicted decreasing depression trajectory and stable/consistent mania. Effects remained when controlling for baseline demographics and clinical variables. Facial emotion recognition may be an important brain/behavior mechanism, prognostic indicator, and intervention target for childhood-onset BD, which endures into young adulthood and is associated with mood trajectory.

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Acknowledgements

We gratefully acknowledge and thank the young adults for their time and effort participating in these studies, without which this research would not be possible.

Funding

This study was supported by E. P. Bradley Hospital and the National Institute of Mental Health grant R01MH087513 (PI: Dickstein). Young adult participants with BD were recruited from Brown University’s site of the Course and Outcome of Bipolar Youth (COBY) study R01MH59691 (PIs: Keller/Yen) and the Predicting Adult Outcomes in Bipolar Youth (PROBY) study R01MH112543 (PI: Yen). The funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

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Authors and Affiliations

  1. Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI, 02915, USA

    Heather A. MacPherson, Anastacia Y. Kudinova, Gracie A. Jenkins, Kerri L. Kim, Petya D. Radoeva, Anna C. Gilbert, Christine Barthelemy, Lena DeYoung & Daniel P. Dickstein

  2. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Heather A. MacPherson, Anastacia Y. Kudinova, Kerri L. Kim, Petya D. Radoeva, Shirley Yen, Heather Hower, Jeffrey Hunt, Martin B. Keller & Daniel P. Dickstein

  3. Department of Psychiatry, Massachusetts Mental Health Center, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Shirley Yen

  4. Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA

    Heather Hower

  5. Department of Psychiatry, School of Medicine, University of California, San Diego, CA, USA

    Heather Hower

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  1. Heather A. MacPherson
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  2. Anastacia Y. Kudinova
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  3. Gracie A. Jenkins
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  4. Kerri L. Kim
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  7. Christine Barthelemy
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  9. Shirley Yen
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  10. Heather Hower
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  11. Jeffrey Hunt
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  12. Martin B. Keller
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  13. Daniel P. Dickstein
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Corresponding author

Correspondence to Heather A. MacPherson.

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Conflicts of interest

Dr. Dickstein receives research support from NIMH and NARSAD. Dr. Yen receives research support from NIMH and NCCIH. Ms. Hower receives honorarium from the U.S. Department of Defense and UCSD, and research support from NIMH. Dr. Hunt receives honoraria from Wiley Publishers and LPG, and research support from NIMH. Dr. Keller receives research support from NIMH and donor gifts from The John J. McDonnell and Margaret T. O’Brien Foundation. Dr. Radoeva receives research support from AACAP. Drs. MacPherson, Kudinova, and Kim, and Ms. Jenkins, Gilbert, Barthelemy, and DeYoung declare that they have no conflicts of interest

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The described studies were both approved by the Institutional Review Boards of Bradley Hospital and Brown University.

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Informed consent was obtained from all individual participants included in these studies.

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MacPherson, H.A., Kudinova, A.Y., Jenkins, G.A. et al. Facial emotion recognition and mood symptom course in young adults with childhood-onset bipolar disorder. Eur Arch Psychiatry Clin Neurosci 271, 1393–1404 (2021). https://doi.org/10.1007/s00406-021-01252-0

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