Frustration remains one of life’s guarantees – as long as there are traffic jams, stubbed toes, and people talking in movie theatres, we’ll always have something to feel frustrated about.

Yet for some people, these experiences of frustration can be so frequent, intense, and impairing that they reflect a larger problem. We refer to this pattern of elevated proneness to anger and frustration as irritability. Symptoms of irritability are quite common, both in the community (Karlovich et al., 2024) and in clinical settings (Freeman et al., 2016). In fact, one study found that nearly 60% of families seeking therapy for their child identified irritability as one of their top clinical problems – a rate that is higher than other common challenges like anxiety, depression, and defiance (Evans et al., 2023a). Research also shows that irritability in childhood predicts poorer mental health outcomes later in development, highlighting its status as a public health concern (Leibenluft et al., 2024).

However, most of this research has been conducted in the United States (US) and United Kingdom (UK), and we still know relatively little about what irritability looks like in other countries (Tseng et al., 2026). A recent study by Silver and colleagues (2025) aimed to address this gap by investigating adolescent irritability in population samples drawn from nine different countries: Bulgaria, Georgia, China, Ireland, Mexico, Panama, Serbia, Spain, and the United Arab Emirates.

Methods

Silver et al. (2025) analysed data from the 2018 Programme for International Student Assessment (PISA; Kastberg et al., 2021), a multi-national survey focused on youth mental health and well-being. Participating adolescents (ages 15-16; N = 56,234) in nine countries were asked about their irritability: “In the past six months, how frequently have you experienced the following: Irritability or bad temper?”. The survey also measured adolescents’ life satisfaction, bullying, and various other symptom areas (e.g., anxiety, depression, sleep, stomach pain), as well as socioeconomic status and gender. The data were analysed using linear mixed effects models, which allowed the researchers to examine whether differences in irritability across people might reflect systematic differences across countries.

Results

Approximately 36% of participating adolescents reported that they “rarely or never” experienced irritability, with estimates for individual countries ranging from 29% to 44.9%. At the other extreme, about 10% of youth (6.9% to 14.5% across countries) reportedly experienced irritability “about every day”.

Overall, in most countries, about 40% of adolescents reported experiencing irritability at least once a week. Interestingly, irritability showed a high degree of consistency across countries; less than 1% of the total variance in irritability was explained by average group-level differences between countries. In other words, when the countries (i.e., the groups) were compared, they were largely the same in terms of irritability prevalence.

Regarding person-level differences, irritability ratings were significantly higher in girls than in boys – a result that was consistent across the nine countries. This means that when looking at individuals within a country, there were often significant gender differences. Adolescents who reported higher levels of irritability also tended to endorse symptoms in other domains. Moreover, irritability was linked to depression (“feeling depressed”), and this correlation was higher than irritability’s correlation with other types of symptoms. Within individual countries, irritability showed particularly strong associations with depression, nervousness (“feeling nervous”), and anxiety (“feeling anxious”). Associations with somatic symptoms (such as aches, pains, and sleep difficulties) tended to be smaller, although these were still moderate and statistically significant.

Finally, irritability was linked to higher levels of bullying and lower levels of life satisfaction, and there was no association with socioeconomic status. These results were also consistent across countries, though certain effects were stronger in some countries than in others. In particular, irritability’s association with bullying was stronger in China and Bulgaria, and the association with life satisfaction was stronger in China and United Arab Emirates.

A young boy in class, frowning

Conclusions

The authors concluded that irritability in adolescence is a common phenomenon that shows little variation across diverse cultural contexts. Around 40% of adolescents in most countries experienced irritability at least once a week, suggesting that irritability is a normal emotion that can occur in response to daily events. However, about 10% of adolescents reported experiencing irritability every day, reflecting a pattern of chronic irritability that may warrant professional attention.

Overall, these findings highlight the importance of irritability at an international level, underscoring the need for broader research, policy, and practice initiatives focused on youth irritability and mental health.

A globe centred on Africa

Strengths and limitations

A major strength of this study is their use of a large, multinational dataset from the PISA study, allowing for one of the first population-based characterisations of the prevalence of adolescent irritability in countries other than the US and UK. Given the use of two-stage sampling strategies (i.e., first schools were selected to ensure representativeness, and then students were randomly selected within each school) and weighted analyses, the findings can be interpreted as generalisable to the population. The analytic approach accounted for the nested data structure, allowing the researchers to tease apart the person-level versus country-level aspects of the results. Importantly, the authors went beyond questions of irritability’s prevalence – they also examined its associations with a range of other key variables. The findings were interpreted appropriately, with a keen eye towards what the results suggest about the understanding of irritability across different cultural contexts.

This study also has some limitations. Irritability and other symptoms were measured using only a single item, and only by self-report. Although this approach supports feasibility by decreasing participant burden and making it more likely for the study to be completed, the use of full-length instruments and multiple informants would allow for more robust measurement and a more comprehensive picture of irritability across cultures. The data were also cross-sectional, so it is not possible to speak to the role of time or causation. The dataset did not allow the authors to look at externalising symptoms or other aspects of youth mental health, so we are unable to extrapolate how results may differ across the spectrum of mood and behaviour problems. Finally, there was no representation in South America or Africa, and the included countries tended to be middle or higher income, so results may not generalise to more diverse contexts.

A young boy writing in a notebook

Implications for practice

Frustration remains one of life’s guarantees. Occasional feelings of irritability are to be expected, yet chronic irritability can be a clinically impairing problem. This much is clear – at least, it is clear in the settings where irritability has been studied. But critical questions about irritability across borders – how common it is, what it looks like, and what it’s associated with – have been somewhat murkier. Silver et al. (2025) help to clarify this picture. The main takeaway was that there was limited variability in adolescent irritability across countries. It was also striking that, at the individual level, irritability was not associated with families’ socioeconomic status in any country, as prior research has found associations between lower socioeconomic status and higher mood and behaviour problems in youth (Reiss, 2013).

If it is the case that the prevalence, manifestations, and correlates of irritability in one country mirror what they are in another, then the treatment approaches that are effective in one location may also be effective in others. This is good news: if fewer cross-cultural adaptations are needed, then treatments for irritability may be more readily implemented at a broad level across diverse groups. While effective interventions specifically designed for irritability are still limited, well-established treatment programs are likely to help. In particular, cognitive behavioural therapy (CBT) may be helpful for irritable adolescents with internalising presentations, and behavioural parent training may be helpful for irritable children with externalising presentations (Evans et al., 2023b).

Of relevance to clinicians, Silver et al. (2025) also found that irritability was higher in girls than in boys. The use of self-report measures may play a role here. As a rule, it is always a good idea to carry out youth clinical assessments by collecting data from multiple sources (such as parents and teachers, in addition to self-report; De Los Reyes et al., 2015). Parent- and teacher-report may be especially important among younger children, an age when irritable and disruptive behaviours are more common among boys (Burke et al., 2024). On the other side, Silver et al.’s (2025) findings add to a growing body of evidence showing that self-reported irritability may be higher among girls in adolescence (Vidal-Ribas et al., 2025).

Further work is needed to understand irritability across individuals and locations, including low-income countries and more specific cultural contexts. As we learn more about effective management and cross-cultural variability of irritability, evidence should lead to action. Initiatives that involve youth mental health screening in school and community settings could help address adolescent irritability and well-being across borders.

A teenage girl frowning at the camera with her arms crossed

Statement of interests

Dr Evans and Dr Silver have worked together as co-authors and as members of the Cross-Cultural Consortium on Irritability (C3I) Steering Committee. Shannon Shaughnessy and Spencer Evans have no conflicts of interest to declare. No AI tools were used in the preparation of this blog.

Edited by

Dr Nina Higson-Sweeney.

Links

Primary paper

Jamilah Silver, Ellen Leibenluft, Wan-Ling Tseng, Daniel N. Klein, Pablo Vidal‐Ribas, Reut Naim, Praveetha Patalay, Eoin McElroy & Argyris Stringaris (2025). A large multinational study of irritability in adolescents. Child and Adolescent Mental Health, 30(4), 352-363. https://doi.org/10.1111/camh.70008

Other references

Burke, J. D., Butler, E., Shaughnessy, S., Karlovich, A. R., & Evans, S. C. (2024). Evidence-based assessment of DSM-5 disruptive, impulse control, and conduct disorders. Assessment, 31(1), 75-93. https://doi.org/10.1177/10731911231188739

De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141(4), 858–900. https://dx.doi.org/10.1037/a0038498

Evans, S. C., Corteselli, K. A., Edelman, A., Scott, H., & Weisz, J. R. (2023a). Is irritability a top problem in youth mental health care? A multi-informant, multi-method investigation. Child Psychiatry & Human Development, 54(4), 1027-1041.  https://doi.org/10.1007/s10578-021-01301-8

Evans, S. C., Shaughnessy, S., & Karlovich, A. R. (2023b). Future directions in youth irritability research. Journal of Clinical Child & Adolescent Psychology, 52(5), 716-734. https://doi.org/10.1080/15374416.2023.2209180

Freeman, A. J., Youngstrom, E. A., Youngstrom, J. K., & Findling, R. L. (2016). Disruptive mood dysregulation disorder in a community mental health clinic: prevalence, comorbidity and correlates. Journal of Child and Adolescent Psychopharmacology, 26(2), 123-130. https://doi.org/10.1089/cap.2015.0061

Karlovich, A. R., Shaughnessy, S., Simmons, K., & Evans, S. C. (2023). Toward greater specificity in the nonspecific: Estimating the prevalence of diagnostic irritability and sleep symptoms in adolescents. Journal of Psychopathology and Clinical Science, 132(7), 820-832. https://doi.org/10.1037/abn0000870

Kastberg, D., Murray, G., Ferraro, D., Arieira, C., Roey, S., Mamedova, S., & Liao, Y. (2021). Technical Report and User Guide for the 2016 Program for International Student Assessment (PISA) Young Adult Follow-Up Study. NCES 2021-020. National Center for Education Statistics. https://eric.ed.gov/?id=ED613655

Leibenluft, E., Allen, L. E., Althoff, R. R., Brotman, M. A., Burke, J. D., Carlson, G. A., … & Stringaris, A. (2024). Irritability in youths: A critical integrative review. American Journal of Psychiatry, 181(4), 275-290. https://doi.org/10.1176/appi.ajp.20230256

Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Social science & medicine, 90, 24-31. https://doi.org/10.1016/j.socscimed.2013.04.026

Tseng, W. L., Bellaert, N., Benton, T. D., Brotman, M. A., Evans, S. C., Herrington, J. D., … & Leibenluft, E. (2025). Cross-Cultural Consortium on Irritability (C3I): An International Network for Research on Cultural Similarities and Differences in Irritability. JAACAP Open.  https://doi.org/10.1016/j.jaacop.2025.09.001

Vidal-Ribas, P., Krebs, G., Silver, J., Tseng, W. L., Ford, T., & Stringaris, A. (2025). The hidden burden: self-reported irritability in adolescent girls signals higher psychiatric risk. BMC Public Health, 25(1), 1832. https://doi.org/10.1186/s12889-025-23076-6

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