Irritability is one of the most common and distressing problems teenagers and their families face.

Its main symptom is an excessive reaction to negative emotional stimuli, resulting in temper outbursts and severe irritable mood.

While current treatment options such as psychotherapy and medications are helpful for some, they can be inaccessible or poorly tolerated.

Our new research, based on a double-blinded, placebo-controlled clinical trial, shows broad-spectrum micronutrients (vitamins and minerals) can significantly reduce severe irritability in teenagers. Teens with severely disruptive behaviour experienced especially large improvements.

This offers a safe, scalable and biologically grounded alternative to conventional psychiatric treatments.

Urgent need for more effective treatments

Irritability cuts across many psychiatric presentations, including anxiety, depression, attention deficit/hyperactivity disorder (ADHD) and other disruptive behaviour disorders.

The need for interventions that directly target irritability, have fewer side effects and are available to all communities is urgent.

Statistics on mental health in young people are especially concerning. Youth mental health has been declining globally over the past two decades and has now reached a “dangerous phase”, according to a Lancet commission.

Despite this, research consistently highlights a lack of effective and accessible treatments for severely irritable youth. This suggests a significant unmet public health need.

Our research findings are based on the Balancing Emotions of Adolescents with Micronutrients (BEAM) trial, in which 132 unmedicated teenagers (aged 12 to 17) with moderate to severe irritability were randomly assigned to micronutrients (taken as four pills three times a day) or an active placebo for eight weeks. They were monitored monthly online by a clinical psychologist.

The placebo response was high, suggesting that simply participating in the study helped many teens feel able to improve their behaviour. But micronutrients still outperformed the placebo across key clinical measures such as irritability, emotional reactivity and overall improvement.

We saw the strongest effects in teenagers with disruptive mood dysregulation disorder (DMDD), with 64% responding to micronutrients compared to 12.5% on placebo. This demonstrates an unusually large effect for a psychiatric intervention.

Parents of participants receiving micronutrients rated the teens’ conduct and prosocial behaviour much higher compared with those of teens on placebo.

Micronutrient treatment was also associated with more rapid improvements in clinician‑rated irritability, parent‑reported dysphoria and teen‑reported quality of life, stress and prosocial behaviours.

One of the most notable and reassuring findings was that suicidal ideation, which about a quarter of study participants reported at the start of the trial, improved over time for both groups, but with a greater change for teens on micronutrients. Self-harm behaviour also decreased for both groups.

Only one side effect differed significantly between groups: diarrhoea was more common on micronutrients (20.9%) than placebo (6.2%). But this side effect was typically temporary and resolved by taking the nutrients with food and water.

A minority (fewer than 10%) found swallowing pills a challenge. Other side effects reported equally in both groups included occasional headaches, stomach aches or a dry mouth. These tended to dissipate within the first few weeks.

Socioeconomic background matters

The response to treatment was moderated by the teens’ socioeconomic status.

Participants from lower socioeconomic backgrounds were more likely to benefit from micronutrients. This is particularly meaningful for both clinical practice and public health.

Lower socioeconomic status is typically associated with greater exposure to nutritional insufficiencies, chronic stress, reduced access to health services and higher rates of mental health difficulties.

Our findings suggest micronutrients may help address underlying nutritional vulnerabilities that may be more prevalent or more severe in disadvantaged groups.

This pattern also indicates that micronutrient supplementation, if publicly funded, could function as a low‑cost, scalable intervention, with the potential to reduce health inequities.

Many evidence‑based psychosocial or pharmacological treatments require resources – time, transportation, specialist access – that disproportionately disadvantage lower‑income families.

In our trial, all meetings between the psychologist and the teen with their family were conducted online and the micronutrients were couriered across the country, making this intervention accessible, particularly to rural communities.

Micronutrients may represent an intervention that is both accessible and responsive to the specific needs of youth who are most at risk yet often least well served by traditional care pathways.

This study was developed alongside Māori health providers and fits within a tikanga (traditional) Māori framework. It had a high percentage of Māori participants (27%) and worked closely with them, their families and health providers to assist in improving mental health outcomes.

The BEAM trial provides robust evidence that a simple nutritional approach can meaningfully improve symptoms, including emotional reactivity, conduct difficulties and even suicidal ideation.

These results are relevant for parents, clinicians, teachers and policymakers seeking safe and practical interventions, especially for young people who cannot access or do not respond well to existing treatments. The results also highlight important equity implications, as teens from lower income families showed stronger responses.

Our results cast a new lens on the cause of some psychiatric problems, often conceptualised as chemical imbalances or family dysfunction. They reframe some cases of irritability as a possible nutritional and metabolic vulnerability, one that might be addressed with greater attention to the quality of our food alongside some supplementation with broad-spectrum micronutrients.

Julia J Rucklidge, Professor of Psychology, University of Canterbury; Angela Sherwin, PhD Candidate in Psychology, University of Canterbury; Joseph Boden, Professor of Psychology, Director of the Christchurch Health and Development Study, University of Otago, and Roger Mulder, Professor of Psychiatry, University of Otago

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.

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Former US First Lady Michelle Obama revealed in her memoir she had a miscarriage. UK singer-songwriter and actor Lily Allen has gone on the record about her stillbirth.

Both miscarriage and stillbirth are sadly familiar terms for pregnancy loss. They can be traumatic life events for the prospective parents and family, and their impacts can be long-lasting. But the terms can be confused.

Here are some similarities and differences between miscarriage and stillbirth, and why they matter.

Let’s start with some definitions

In broad terms, a miscarriage is when a pregnancy ends while the fetus is not yet viable (before it could survive outside the womb).

This is the loss of an “intra-uterine” pregnancy, when an embryo is implanted in the womb to then develop into a fetus. The term miscarriage excludes ectopic pregnancies, where the embryo is implanted outside the womb.

However, stillbirth refers to the end of a pregnancy when the fetus is normally viable. There may have been sufficient time into the pregnancy. Alternatively, the fetus may have grown large enough to be normally expected to survive, but it dies in the womb or during delivery.

The Australian Institute of Health and Welfare defines stillbirth as a fetal death of at least 20 completed weeks of gestation or with a birthweight of at least 400 grams.

Internationally, definitions of stillbirth vary depending on the jurisdiction.

How common are they?

It is difficult to know how common miscarriages are as they can happen when a woman doesn’t know she is pregnant. There may be no obvious symptoms or something that looks like a heavier-than-normal period. So miscarriages are likely to be more common than reported.

Studies from Europe and North America suggest a miscarriage occurs in about one in seven pregnancies (15%). More than one in eight women (13%) will have a miscarriage at some time in her life.

Around 1–2% of women have recurrent miscarriages. In Australia this is when someone has three or more miscarriages with no pregnancy in between.

Australia has one of the lowest rates of stillbirth in the world. The rate has been relatively steady over the past 20 years at 0.7% or around seven per 1,000 pregnancies.

Who’s at risk?

Someone who has already had a miscarriage or stillbirth has an increased risk of that outcome again in a subsequent pregnancy.

Compared with women who have had a live birth, those who have had a stillbirth have double the risk of another. For those who have had recurrent miscarriages, the risk of another miscarriage is four-fold higher.

Some factors have a u-shaped relationship, with the risk of miscarriage and stillbirth lowest in the middle.

For instance, maternal age is a risk factor for both miscarriage and stillbirth, especially if under 20 years old or older than 35. Increasing age of the male is only a risk factor for stillbirth, especially for fathers over 40.

Similarly for maternal bodyweight, women with a body mass index or BMI in the normal range have the lowest risk of miscarriage and stillbirth compared with those in the obese or underweight categories.

Lifestyle factors such as smoking and heavy alcohol drinking while pregnant are also risk factors for both miscarriage and stillbirth.

So it’s important to not only avoid smoking and alcohol while pregnant, but before getting pregnant. This is because early in the pregnancy, women may not know they have conceived and could unwittingly expose the developing fetus.

Why do they happen?

Miscarriage often results from chromosomal problems in the developing fetus. However, genetic conditions or birth defects account for only 7-14% of stillbirths.

Instead, stillbirths often relate directly to pregnancy complications, such as a prolonged pregnancy or problems with the umbilical cord.

Maternal health at the time of pregnancy is another contributing factor in the risk of both miscarriage and stillbirths.

Chronic diseases, such as high blood pressure, diabetes, hypothyroidism (underactive thyroid), polycystic ovary syndrome, problems with the immune system (such as an autoimmune disorder), and some bacterial and viral infections are among factors that can increase the risk of miscarriage.

Similarly mothers with diabetes, high blood pressure, and untreated infections, such as malaria or syphilis, face an increased risk of stillbirth.

In many cases, however, the specific cause of pregnancy loss is not known.

How about the long-term health risks?

Miscarriage and stillbirth can be early indicators of health issues later in life.

For instance, women who have had recurrent miscarriages or recurrent stillbirths are at higher risk of cardiovascular disease (such as heart disease or stroke).

Our research has also looked at the increased risk of stroke. Compared with women who had never miscarried, we found women with a history of three or more miscarriages had a 35% higher risk of non-fatal stroke and 82% higher risk of fatal stroke.

Women who had a stillbirth had a 31% higher risk of a non-fatal stroke, and those who had had two or more stillbirths were at a 26% higher risk of a fatal stroke.

We saw similar patterns in chronic obstructive pulmonary disease or COPD, a progressive lung disease with respiratory symptoms such as breathlessness and coughing.

Our data showed women with a history of recurrent miscarriages or stillbirths were at a 36% or 67% higher risk of COPD, respectively, even after accounting for a history of asthma.

Why is all this important?

Being well-informed about the similarities and differences between these two traumatic life events may help explain what has happened to you or a loved one.

Where risk factors can be modified, such as smoking and obesity, this information can be empowering for individuals who wish to reduce their risk of miscarriage and stillbirth and make lifestyle changes before they become pregnant.

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More information and support about miscarriage and stillbirth is available from SANDS and Pink Elephants.

Gita Mishra, Professor of Life Course Epidemiology, Faculty of Medicine, The University of Queensland; Chen Liang, PhD student, reproductive history and non-communicable diseases in women, The University of Queensland, and Jenny Doust, Clinical Professorial Research Fellow, School of Public Health, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.