Irritability, Negative Life Events, and the Course of Anxiety and Depressive Symptoms in a Clinical Sample of Youth: A Longitudinal Study

ObjectiveIrritability, the tendency to react with anger, and the experience of negative life events (NLE) have independently been associated with the emergence of anxiety and depression. This study investigated how irritability and cumulative effects of NLE interactively predict the course of anxiety and depression in the context of common psychiatric disorders.MethodStudy participants were 432 youth with no psychiatric diagnosis or with a diagnosis of an anxiety disorder, attention-deficit/hyperactivity disorder, or disruptive mood dysregulation disorder. At baseline, we assessed NLE, parent and youth reports of irritability and anxiety, and youth reports of depression. Symptoms were annually reassessed for up to 4 years.ResultsIn youth without psychiatric diagnoses but with elevated baseline irritability, the presence of NLE predicted decreasing anxiety, while the absence of NLE predicted increasing anxiety. In youth with an anxiety disorder, elevated baseline irritability predicted decreasing anxiety independent of NLE, while a large cumulative effect of NLE predicted increasing depression. NLE predicted persisting mild anxiety in attention-deficit/hyperactivity disorder and persisting mild depressive symptoms in disruptive mood dysregulation disorder.ConclusionThese findings suggest that, particularly in nonreferred samples, NLE might moderate the relation between irritability and future anxiety such that irritability/anger in the context of NLE can positively affect the course of anxiety. Future work replicating this finding while repeatedly measuring NLE and rigorously controlling for potentially confounding effects of treatment is warranted. Irritability, the tendency to react with anger, and the experience of negative life events (NLE) have independently been associated with the emergence of anxiety and depression. This study investigated how irritability and cumulative effects of NLE interactively predict the course of anxiety and depression in the context of common psychiatric disorders. Study participants were 432 youth with no psychiatric diagnosis or with a diagnosis of an anxiety disorder, attention-deficit/hyperactivity disorder, or disruptive mood dysregulation disorder. At baseline, we assessed NLE, parent and youth reports of irritability and anxiety, and youth reports of depression. Symptoms were annually reassessed for up to 4 years. In youth without psychiatric diagnoses but with elevated baseline irritability, the presence of NLE predicted decreasing anxiety, while the absence of NLE predicted increasing anxiety. In youth with an anxiety disorder, elevated baseline irritability predicted decreasing anxiety independent of NLE, while a large cumulative effect of NLE predicted increasing depression. NLE predicted persisting mild anxiety in attention-deficit/hyperactivity disorder and persisting mild depressive symptoms in disruptive mood dysregulation disorder. These findings suggest that, particularly in nonreferred samples, NLE might moderate the relation between irritability and future anxiety such that irritability/anger in the context of NLE can positively affect the course of anxiety. Future work replicating this finding while repeatedly measuring NLE and rigorously controlling for potentially confounding effects of treatment is warranted.