Risk Factors Associated with Longitudinal Trajectories of Mania Symptoms in Youth

Objective. Mania symptoms in youth predict poor long-term mental health outcomes, yet their developmental trajectories and associated risk factors remain unclear. Methods. Leveraging data from the Adolescent Brain Cognitive Development Study (N=10,474; 9-10 years at baseline; 48% female, 65% white), we used latent growth mixture models to identify trajectories of mania symptoms across two years in early adolescence. We used multinomial logistic regressions to examine associations between trajectories and risk factors across mental and physical health, cognition, and family/environmental domains. Results. We identified four trajectories: No Symptoms (44%), Low (34%), Moderate (16%), and High/Fluctuating Mania Symptoms (6%). Individuals with elevated mental health symptoms (adjusted odds ratio [aOR] = 7.30-18.50), physical health symptoms (aOR = 1.70-9.06), cognitive impairments (aOR = 1.29), and adverse family/environmental factors (aOR = 1.32-2.13) were more likely to be in the High/Fluctuating Symptoms trajectory. Several risk factors also differentiated the High/Fluctuating Symptoms group from the Low and Moderate trajectories. Combined, all risk factors explained 35% of the variance in trajectory membership. Conclusions. Severe and fluctuating trajectories of mania symptoms in early adolescence are associated with multiple mental, physical, cognitive, family and environmental risk factors, underscoring the need for holistic approaches to risk prediction in youth.