The hidden burden: self-reported irritability in adolescent girls signals higher psychiatric risk

Most research on pediatric irritability focuses on children and/or relies on parent reports. We examined how self-reported irritability in adolescents influences the prevalence, sex distribution and correlates of irritability relative to children and parent reports.

Using data from Mental Health of Children and Young People Survey 2017 in England we contrasted the prevalence of irritability, encompassing irritable mood and temper outbursts, in 2,740 adolescents aged 12-17 (50.3% females), based on parent- and self-report, with that of 4,141 children aged 5-11 (49.4% females) based on parent-report. We examined associations of irritability with mental health problems and impairment.

Parents reported similar prevalence of irritability in adolescent males (14-23%) and females (14-22%), but higher levels of irritability in males (20-25%) than females (15-19%) during childhood. In contrast, adolescent females self-reported more irritable mood (29%, 95%CI 26-31) than males (23%, 95%CI 20-25) and parents. Self-reported irritability in adolescent females was associated with greater emotional problems (irritable mood, b = 0.27, SE = 0.10, p = 0.011; temper outbursts: b = 0.25, SE = 0.11, p = 0.022) and impairment (irritable mood, b = 0.31, SE = 0.10, p = 0.001; temper outbursts: b = 0.31, SE = 0.08, p < 0.001) compared to males. Irritable mood in adolescent females was associated with a higher increase of psychiatric disorders (b = 0.35, SE = 0.15, p = 0.020) compared to males.

Age, sex, and informant are sources of heterogeneity in irritability reporting, and must be considered in the assessment and understanding of irritability-related psychopathology. Longitudinal design studies with comprehensive assessments of irritability across a broad age range are warranted to elucidate its developmental trajectory and causal relationships with other psychopathological symptoms.