Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder

Kerstin Konrad; Gregor Kohls; Sarah Baumann; Anka Bernhard; Anne Martinelli; Katharina Ackermann; Areti Smaragdi; Karen Gonzalez‐madruga; Amy Wells; Jack C. Rogers; Ruth Pauli; Roberta Clanton; Rosalind Baker; Linda Kersten; Martin Prätzlich; Helena Oldenhof; Lucres Jansen; Anneke Kleeven; Aitana Bigorra; Amaia Hervas; Iñaki Kerexeta‐lizeaga; Eva Sesma‐pardo; Miguel Angel Gonzalez‐torres; Réka Siklósi; Roberta Dochnal; Zacharias Kalogerakis; Mara Pirlympou; Leonidas Papadakos; Harriet Cornwell; Wolfgang Scharke; Dimitris Dikeos; Aranzazu Fernández‐rivas; Arne Popma; Christina Stadler; Beate Herpertz‐dahlmann; Stephane A. De Brito; Graeme Fairchild; Christine M. Freitag

doi:10.1111/jcpp.13428

Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder

Kerstin Konrad
, Gregor Kohls
, Sarah Baumann
, Anka Bernhard
, Anne Martinelli
, Katharina Ackermann
, Areti Smaragdi
, Karen Gonzalez‐madruga
, Amy Wells
, Jack C. Rogers
, Ruth Pauli
, Roberta Clanton
, Rosalind Baker
, Linda Kersten
, Martin Prätzlich
, Helena Oldenhof
, Lucres Jansen
, Anneke Kleeven
, Aitana Bigorra
, Amaia Hervas

Iñaki Kerexeta‐lizeaga, Eva Sesma‐pardo, Miguel Angel Gonzalez‐torres, Réka Siklósi, Roberta Dochnal, Zacharias Kalogerakis, Mara Pirlympou, Leonidas Papadakos, Harriet Cornwell, Wolfgang Scharke, Dimitris Dikeos, Aranzazu Fernández‐rivas, Arne Popma, Christina Stadler, Beate Herpertz‐dahlmann, Stephane A. De Brito, Graeme Fairchild, Christine M. Freitag

JARA - Jülich Aachen Research Alliance
University Hospital RWTH Aachen
University Hospital Frankfurt
Centre of Addiction and Mental Health Toronto ON Canada
King's College London
Cardiff University
University of Birmingham
University Psychiatric Clinics Basel
VU University Medical Center
Child and Adolescent Mental Health Service University Hospital Mutua Terrassa Barcelona Spain
Basurto University Hospital
University of Szeged
National and Kapodistrian University of Athens
RWTH Aachen University

Research output: Contribution to journal › Article › peer-review

66 Citations (SciVal)

Abstract

Background:
Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the ‘gender paradox’ and ‘delayed-onset pathway’ hypotheses of female CD.

Methods:
As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9–18 years), compared to 864 sex- and age-matched typically developing controls.

Results:
Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/hyperactivity disorder. In line with the ‘gender paradox’ hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the ‘delayed-onset pathway’ hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology.

Conclusions:
Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the ‘gender paradox’ and ‘delayed-onset pathway’ hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.

Original language	English
Pages (from-to)	218-228
Number of pages	11
Journal	Journal of Child Psychology and Psychiatry
Volume	63
Issue number	2
Early online date	19 May 2021
DOIs	https://doi.org/10.1111/jcpp.13428
Publication status	Published - 28 Feb 2022

Bibliographical note

Funding Information:
The authors thank all participants and their families for taking part in this study. This study was funded by the European Commission's Seventh Framework Programme (FP7/2007‐2013) under Grant Agreement no. 602407 (FemNAT‐CD coordinator: Christine Freitag, University Hospital Frankfurt).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1111/jcpp.13428Licence: CC BY-NC

Cite this

Konrad, K., Kohls, G., Baumann, S., Bernhard, A., Martinelli, A., Ackermann, K., Smaragdi, A., Gonzalez‐madruga, K., Wells, A., Rogers, J. C., Pauli, R., Clanton, R., Baker, R., Kersten, L., Prätzlich, M., Oldenhof, H., Jansen, L., Kleeven, A., Bigorra, A., ... Freitag, C. M. (2022). Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder. Journal of Child Psychology and Psychiatry, 63(2), 218-228. https://doi.org/10.1111/jcpp.13428

Konrad, K, Kohls, G, Baumann, S, Bernhard, A, Martinelli, A, Ackermann, K, Smaragdi, A, Gonzalez‐madruga, K, Wells, A, Rogers, JC, Pauli, R, Clanton, R, Baker, R, Kersten, L, Prätzlich, M, Oldenhof, H, Jansen, L, Kleeven, A, Bigorra, A, Hervas, A, Kerexeta‐lizeaga, I, Sesma‐pardo, E, Angel Gonzalez‐torres, M, Siklósi, R, Dochnal, R, Kalogerakis, Z, Pirlympou, M, Papadakos, L, Cornwell, H, Scharke, W, Dikeos, D, Fernández‐rivas, A, Popma, A, Stadler, C, Herpertz‐dahlmann, B, De Brito, SA, Fairchild, G & Freitag, CM 2022, 'Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder', Journal of Child Psychology and Psychiatry, vol. 63, no. 2, pp. 218-228. https://doi.org/10.1111/jcpp.13428

@article{fb90298c3e7e4d758dc7e82232babf81,

title = "Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder",

abstract = "Background: Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the {\textquoteleft}gender paradox{\textquoteright} and {\textquoteleft}delayed-onset pathway{\textquoteright} hypotheses of female CD. Methods: As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9–18 years), compared to 864 sex- and age-matched typically developing controls. Results: Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/hyperactivity disorder. In line with the {\textquoteleft}gender paradox{\textquoteright} hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the {\textquoteleft}delayed-onset pathway{\textquoteright} hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology. Conclusions: Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the {\textquoteleft}gender paradox{\textquoteright} and {\textquoteleft}delayed-onset pathway{\textquoteright} hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.",

author = "Kerstin Konrad and Gregor Kohls and Sarah Baumann and Anka Bernhard and Anne Martinelli and Katharina Ackermann and Areti Smaragdi and Karen Gonzalez‐madruga and Amy Wells and Rogers, \{Jack C.\} and Ruth Pauli and Roberta Clanton and Rosalind Baker and Linda Kersten and Martin Pr{\"a}tzlich and Helena Oldenhof and Lucres Jansen and Anneke Kleeven and Aitana Bigorra and Amaia Hervas and I{\~n}aki Kerexeta‐lizeaga and Eva Sesma‐pardo and \{Angel Gonzalez‐torres\}, Miguel and R{\'e}ka Sikl{\'o}si and Roberta Dochnal and Zacharias Kalogerakis and Mara Pirlympou and Leonidas Papadakos and Harriet Cornwell and Wolfgang Scharke and Dimitris Dikeos and Aranzazu Fern{\'a}ndez‐rivas and Arne Popma and Christina Stadler and Beate Herpertz‐dahlmann and \{De Brito\}, \{Stephane A.\} and Graeme Fairchild and Freitag, \{Christine M.\}",

note = "Funding Information: The authors thank all participants and their families for taking part in this study. This study was funded by the European Commission's Seventh Framework Programme (FP7/2007‐2013) under Grant Agreement no. 602407 (FemNAT‐CD coordinator: Christine Freitag, University Hospital Frankfurt). ",

year = "2022",

month = feb,

day = "28",

doi = "10.1111/jcpp.13428",

language = "English",

volume = "63",

pages = "218--228",

journal = "Journal of Child Psychology and Psychiatry",

issn = "0021-9630",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "2",

}

TY - JOUR

T1 - Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder

AU - Konrad, Kerstin

AU - Kohls, Gregor

AU - Baumann, Sarah

AU - Bernhard, Anka

AU - Martinelli, Anne

AU - Ackermann, Katharina

AU - Smaragdi, Areti

AU - Gonzalez‐madruga, Karen

AU - Wells, Amy

AU - Rogers, Jack C.

AU - Pauli, Ruth

AU - Clanton, Roberta

AU - Baker, Rosalind

AU - Kersten, Linda

AU - Prätzlich, Martin

AU - Oldenhof, Helena

AU - Jansen, Lucres

AU - Kleeven, Anneke

AU - Bigorra, Aitana

AU - Hervas, Amaia

AU - Kerexeta‐lizeaga, Iñaki

AU - Sesma‐pardo, Eva

AU - Angel Gonzalez‐torres, Miguel

AU - Siklósi, Réka

AU - Dochnal, Roberta

AU - Kalogerakis, Zacharias

AU - Pirlympou, Mara

AU - Papadakos, Leonidas

AU - Cornwell, Harriet

AU - Scharke, Wolfgang

AU - Dikeos, Dimitris

AU - Fernández‐rivas, Aranzazu

AU - Popma, Arne

AU - Stadler, Christina

AU - Herpertz‐dahlmann, Beate

AU - De Brito, Stephane A.

AU - Fairchild, Graeme

AU - Freitag, Christine M.

N1 - Funding Information: The authors thank all participants and their families for taking part in this study. This study was funded by the European Commission's Seventh Framework Programme (FP7/2007‐2013) under Grant Agreement no. 602407 (FemNAT‐CD coordinator: Christine Freitag, University Hospital Frankfurt).

PY - 2022/2/28

Y1 - 2022/2/28

N2 - Background: Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the ‘gender paradox’ and ‘delayed-onset pathway’ hypotheses of female CD. Methods: As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9–18 years), compared to 864 sex- and age-matched typically developing controls. Results: Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/hyperactivity disorder. In line with the ‘gender paradox’ hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the ‘delayed-onset pathway’ hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology. Conclusions: Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the ‘gender paradox’ and ‘delayed-onset pathway’ hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.

AB - Background: Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the ‘gender paradox’ and ‘delayed-onset pathway’ hypotheses of female CD. Methods: As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9–18 years), compared to 864 sex- and age-matched typically developing controls. Results: Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/hyperactivity disorder. In line with the ‘gender paradox’ hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the ‘delayed-onset pathway’ hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology. Conclusions: Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the ‘gender paradox’ and ‘delayed-onset pathway’ hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.

U2 - 10.1111/jcpp.13428

DO - 10.1111/jcpp.13428

M3 - Article

SN - 0021-9630

VL - 63

SP - 218

EP - 228

JO - Journal of Child Psychology and Psychiatry

JF - Journal of Child Psychology and Psychiatry

IS - 2

ER -

Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder

Abstract

Bibliographical note

UN SDGs

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