{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T13:50:31Z","timestamp":1792504231673,"version":"4.5.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T00:00:00Z","timestamp":1545177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005337","name":"American Academy of Child and Adolescent Psychiatry","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005337","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007229","name":"Harvard University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007229","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012292","name":"Gerstner Family Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012292","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011102","name":"Seventh Framework Programme","doi-asserted-by":"publisher","award":["602805"],"award-info":[{"award-number":["602805"]}],"id":[{"id":"10.13039\/100011102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["667302"],"award-info":[{"award-number":["667302"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["5R01MH101519"],"award-info":[{"award-number":["5R01MH101519"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["U01 MH109536-01"],"award-info":[{"award-number":["U01 MH109536-01"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study was to evaluate the morbidity of subthreshold pediatric bipolar (BP) disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a systematic literature search in November 2017 and included studies examining the morbidity of pediatric subthreshold BP. Extracted outcomes included functional impairment, severity of mood symptoms, psychiatric comorbidities, suicidal ideation and behaviors, and mental health treatment. We used meta\u2010analysis to compute the pooled standardized mean difference (SMD) for continuous measures and the pooled risk ratio (RR) for binary measures between two paired groups: subthreshold pediatric BP vs controls and subthreshold pediatric BP vs pediatric BP\u2010I.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eleven papers, consisting of seven datasets, were included. We compared subthreshold pediatric BP (N\u00a0=\u00a0244) to non\u2010BP controls (N\u00a0=\u00a01125) and subthreshold pediatric BP (N\u00a0=\u00a0643) to pediatric BP\u2010I (N\u00a0=\u00a0942). Subthreshold pediatric BP was associated with greater functional impairment (SMD\u00a0=\u00a00.61, CI 0.25\u20100.97), greater severity of mood symptomatology (mania: SMD\u00a0=\u00a01.88, CI 1.38\u20102.38; depression: SMD\u00a0=\u00a00.66, CI 0.52\u20100.80), higher rates of disruptive behavior (RR\u00a0=\u00a01.75, CI 1.17\u20102.62), mood (RR\u00a0=\u00a01.78, CI 1.29\u20102.79) and substance use (RR\u00a0=\u00a02.27, CI 1.23\u20104.21) disorders, and higher rates of suicidal ideation and attempts (RR\u00a0=\u00a07.66, CI 1.71\u201034.33) compared to controls. Pediatric BP\u2010I was associated with greater functional impairment, greater severity of manic symptoms, higher rates of suicidal ideation and attempts, and higher rates of mental health treatment compared to subthreshold pediatric BP. There were no differences between full and subthreshold cases in the severity of depressive symptoms or rates of comorbid disorders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Subthreshold pediatric BP disorder is an identifiable morbid condition associated with significant functional impairment including psychiatric comorbidities and high rates of suicidality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12734","type":"journal-article","created":{"date-parts":[[2018,11,27]],"date-time":"2018-11-27T15:32:14Z","timestamp":1543332734000},"page":"16-27","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["The morbidity of subthreshold pediatric bipolar disorder: A systematic literature review and meta\u2010analysis"],"prefix":"10.1111","volume":"21","author":[{"given":"Carrie A. H.","family":"Vaudreuil","sequence":"first","affiliation":[{"name":"Pediatric Psychopharmacology Program, Division of Child Psychiatry Massachusetts General Hospital Boston Massachusetts"},{"name":"Department of Psychiatry Massachusetts General Hospital, Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen V.","family":"Faraone","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences SUNY Upstate Medical University Syracuse New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura","family":"Di Salvo","sequence":"additional","affiliation":[{"name":"Pediatric Psychopharmacology Program, Division of Child Psychiatry Massachusetts General Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet R.","family":"Wozniak","sequence":"additional","affiliation":[{"name":"Pediatric Psychopharmacology Program, Division of Child Psychiatry Massachusetts General Hospital Boston Massachusetts"},{"name":"Department of Psychiatry Massachusetts General Hospital, Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Wolenski","sequence":"additional","affiliation":[{"name":"Pediatric Psychopharmacology Program, Division of Child Psychiatry Massachusetts General Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas W.","family":"Carrellas","sequence":"additional","affiliation":[{"name":"Pediatric Psychopharmacology Program, Division of Child Psychiatry Massachusetts General Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8233-663X","authenticated-orcid":false,"given":"Joseph","family":"Biederman","sequence":"additional","affiliation":[{"name":"Pediatric Psychopharmacology Program, Division of Child Psychiatry Massachusetts General Hospital Boston Massachusetts"},{"name":"Department of Psychiatry Massachusetts General Hospital, Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.110.079244"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.5498\/wjp.v5.i1.126"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"key":"e_1_2_7_5_1","volume-title":"Stata User's Guide: Release 9","author":"Stata Corporation","year":"2005"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2012.11.021"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12054"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2012.07.031"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1056-4993(02)00005-6"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2005.00260.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.63.10.1139"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2009.08101569"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2009.02129.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2009.158"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.109.074898"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.1746"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-014-0972-3"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291703001466"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/CHI.0b013e31819a1cbc"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12556"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2011.07.005"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2013.09.036"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12494"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.12"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2017.07.783"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2012.38"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2006.11.006"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.12m07674"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2015.0063"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2012.01029.x"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2015.0038"}],"container-title":["Bipolar Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fbdi.12734","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bdi.12734","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T06:50:07Z","timestamp":1694674207000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bdi.12734"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,19]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,2]]}},"alternative-id":["10.1111\/bdi.12734"],"URL":"https:\/\/doi.org\/10.1111\/bdi.12734","archive":["Portico"],"relation":{},"ISSN":["1398-5647","1399-5618"],"issn-type":[{"value":"1398-5647","type":"print"},{"value":"1399-5618","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,19]]},"assertion":[{"value":"2018-12-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}