TY - JOUR
T1 - Child and adolescent clinical features as forerunners of adult-onset major depressive disorder
T2 - Retrospective evidence from an epidemiological sample
AU - Wilcox, Holly C.
AU - Anthony, James C.
N1 - Funding Information:
We thank Dr. Li-Shiun Chen and Dr. William W. Eaton for their assistance. This work was funded by research training grants T32 DA07292 and F31 DA14454 from the National Institute on Drug Abuse and research grant R01 MH47447 from the National Institute of Mental Health.
PY - 2004/10/1
Y1 - 2004/10/1
N2 - Background: Adult-onset cases of DSM-III-R major depressive disorder (MDD) often have had a history of mood disturbances and allied clinical features during childhood or adolescence. This study seeks to illuminate these early-life disturbances, as recalled and reported by adult-onset MDD cases (i.e. those whose first episode of MDD occurred after age 18) and non-cases. Methods: Our research group has re-assessed survivors in the Baltimore Epidemiologic Catchment Area (ECA) community sample roughly 13.5 years after first diagnostic assessments in 1981. Of the 1920 participants, 150 were found to have a history of adult-onset MDD; 1755 were sub-threshold with respect to DSM criteria or reported few or no depression-related problems. Survival analysis was used to plot and study the cumulative occurrence of each clinical feature of depression from age 6 through 18 years for cases of adult-onset MDD versus non-cases. Results: The earliest and most frequently occurring forerunners of adult-onset MDD were persistent depressed mood, anhedonia, feelings of worthlessness, and thoughts of death or suicide, with persistent anhedonia and worthlessness having a special prognostic value. One-third of adult-onset cases of MDD reported at least one clinical feature before age 19 versus only 7.3% of non-cases. Limitations: The study's estimates are based on retrospective recall, although a life chart methodology sought to reduce recall inaccuracies. Conclusions: The ECA follow-up sample data, though based on retrospection, provide new details about early forerunners of adult-onset depression from a sample of survivors. When they appear in children or adolescents, persistent anhedonia and persistent feelings of worthlessness merit special attention. These two clinical features, in particular, may help predict later risk of adult-onset major depression.
AB - Background: Adult-onset cases of DSM-III-R major depressive disorder (MDD) often have had a history of mood disturbances and allied clinical features during childhood or adolescence. This study seeks to illuminate these early-life disturbances, as recalled and reported by adult-onset MDD cases (i.e. those whose first episode of MDD occurred after age 18) and non-cases. Methods: Our research group has re-assessed survivors in the Baltimore Epidemiologic Catchment Area (ECA) community sample roughly 13.5 years after first diagnostic assessments in 1981. Of the 1920 participants, 150 were found to have a history of adult-onset MDD; 1755 were sub-threshold with respect to DSM criteria or reported few or no depression-related problems. Survival analysis was used to plot and study the cumulative occurrence of each clinical feature of depression from age 6 through 18 years for cases of adult-onset MDD versus non-cases. Results: The earliest and most frequently occurring forerunners of adult-onset MDD were persistent depressed mood, anhedonia, feelings of worthlessness, and thoughts of death or suicide, with persistent anhedonia and worthlessness having a special prognostic value. One-third of adult-onset cases of MDD reported at least one clinical feature before age 19 versus only 7.3% of non-cases. Limitations: The study's estimates are based on retrospective recall, although a life chart methodology sought to reduce recall inaccuracies. Conclusions: The ECA follow-up sample data, though based on retrospection, provide new details about early forerunners of adult-onset depression from a sample of survivors. When they appear in children or adolescents, persistent anhedonia and persistent feelings of worthlessness merit special attention. These two clinical features, in particular, may help predict later risk of adult-onset major depression.
KW - Adolescent
KW - Children
KW - Epidemiologic studies
KW - Major depression
KW - Natural history
KW - Survival analysis
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U2 - 10.1016/j.jad.2003.10.007
DO - 10.1016/j.jad.2003.10.007
M3 - Article
C2 - 15465572
AN - SCOPUS:4744359663
SN - 0165-0327
VL - 82
SP - 9
EP - 20
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
IS - 1
ER -