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Abstract
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We thank Shuai Wang and colleagues for identifying a critical research gap concerning the association between childhood trauma and disruptive mood dysregulation disorder (DMDD). DMDD is characterised by severe recurrent temper outbursts and chronic irritability and was first introduced as a diagnostic category in DSM-5, published in 2013.
We have now examined whether DMDD is associated with trauma exposure in children aged 11 years in the 2004 Pelotas Birth Cohort. Of the 3367 children with complete data, 80 (2·4%) were diagnosed with DMDD, which is similar to previously reported estimates in community samples.1
Of these, 42 (52·5%) had experienced at least one traumatic event up to age 11 years, including 22 (27·5%) exposed to interpersonal trauma and 21 (26·3%) to non-interpersonal trauma.
When examining associations between trauma and DMDD, we addressed missing data using multivariate imputation by chained equations with 100 imputed data sets. Missing data were imputed for trauma up to ages 6 and 11 years, psychiatric diagnoses at ages 6 and 11 years (including DMDD at age 11 years), and potential confounders (including child sex, maternal relationship status, maternal skin colour, maternal smoking, maternal alcohol consumption, maternal education, family income, maternal depression, and the subscales of the Child Behaviour Checklist at age 48 months to assess previous mental health symptoms).
In analyses based on imputed data (N=4229), trauma exposure up to age 11 years was associated with increased odds of DMDD (odds ratio [OR] 2·21 [95% CI 1·44-2·40], p=0·0030). This association attenuated slightly but remained when accounting for confounders (OR 1·96 [1·26-3·03], p=0·0028) and when additionally adjusting for previous mental health symptoms (OR 1·70 [1·07-2·70], p=0·0251). When examining trauma subtypes up to age 11 years (exposure up to age 6 years was not examined due to low frequencies), interpersonal trauma was consistently associated with increased odds of DMDD, even when adjusting for confounders and previous mental health problems (OR 1·83 [1·03-3·24], p=0·0394). By contrast, non-interpersonal trauma was associated with increased odds of DMDD in unadjusted analysis (OR 1·89 [1·10-3·25], p=0·0205), but not in adjusted analyses. Finally, to establish temporality, when examining trauma exposure up to age 6 years, childhood trauma was not associated with DMDD at age 11 years. However, just 14 children diagnosed with DMDD were exposed to trauma up to age 6 years; thus, these analyses had limited power...
Language: en |