The Impact of Emotional Abuse on Psychotic Symptoms and Cognitive Functioning in Adolescents with Severe Mood Disorders

Objectives: The impact of childhood abuse on cognitive functioning in adults with severe mood disorders has been well-established in the literature. In youth, however, the impact of abuse on cognitive functioning is less understood. Moreover, few studies have addressed the impact of emotional abuse, in-particular, on children with mood disorders. This study investigated the relationship between cognitive functioning (i.e., IQs, working memory and processing speed) and a history of abuse, in child and adolescent psychiatric inpatients diagnosed with mood disorders—with and without psychotic features (i.e., Major Depressive Disorder, MDD; Bipolar Disorders, BD; and, Mood Disorders Not Otherwise Specified, MD/NOS). Method: Retrospective chart reviews were conducted with closed medical records of 80 child and adolescent inpatients that were discharged from an intermediate care psychiatric hospital between 2009 stand 2012. Linear Regression Analyses, Multivariate Analysis of Variance (MANOVA), and Multivariate Analysis of Covariance (MANCOVA) were used to investigate associations between participants\u27: 1) diagnoses based on DSM-IV criteria (e.g., MDD, BD, and MD/NOS); 2) presence of psychotic features; 3) cognitive functioning (as measured by FSIQ, Coding, Symbol Search, and Digit Span); and, 4) history of abuse (e.g., physical abuse, sexual abuse, emotional abuse and neglect). Results: Contrary to expectations, there were no differences in terms of abuse-type or psychotic features when looking at any of the dependent variables of cognitive functioning. When controlling for abuse, males performed worse than females in regards to the Coding measure but there were no differences between genders in regards to cognitive functioning. Whites did better on intelligence, coding, and working memory than nonwhites when controlling for abuse. Hispanics did better on intelligence when compared to non-Hispanics when controlling for abuse. Finally, the MANCOVA results show that when looking at the four cognitive dependent variables together, there was not a significant difference across abuse-type nor for psychotic features. This indicates that abuse, when looked at collectively, may not be impacting cognitive functioning among hospitalized youth. These findings agree with Post et al. (2015) when we look at individual aspects of cognitive functioning. However, once all four aspects of cognitive functioning are included together, emotional abuse was also not a significant predictor. Previous studies have not found gender and racial differences in the impact of abuse on cognitive functioning in adolescents with mood disorders. However, this study found both gender and racial differences, especially in regards to Whites who showed higher functioning compared to other groups. Conclusions: There are few studies of the impact of abuse on cognitive functioning in children and adolescents with mood disorders, and this may be the first to include adolescent inpatients. However, the limited sample size, the lack of detailed information about the history of emotional abuse (including age at onset, intensity and duration) and the retrospective chart review methodology may limit the generalizability of results. Findings from this study contribute to client-centered treatment planning and intervention strategies for children and adolescents with severe mood disorders (with or without psychotic symptoms) with a history of emotional abuse and cognitive challenges. Keywords: Emotional abuse, Cognitive functioning, Psychotic symptoms, Mood disorders, Children (ages 5-12) and adolescents (ages 13-17)