Depressed Adolescents Grown Up

TLDR

Adolescent‑onset major depressive disorder impairs functioning and raises suicide risk, yet its persistence into adulthood is poorly understood. The study aimed to describe the long‑term clinical course of adolescent‑onset MDD into adulthood. A prospective case‑control design followed 73 adolescents with MDD and 37 psychiatrically healthy controls, assessed in 1977‑1985 and re‑evaluated 10‑15 years later by blinded investigators. Adolescent‑onset MDD was associated with a 7.7% suicide rate, five‑fold higher first‑attempt risk, doubled MDD recurrence, increased hospitalizations, and impaired social functioning, with only 37% remaining episode‑free versus 69% of controls, underscoring the need for early identification and treatment.

Abstract

ContextMajor depressive disorder (MDD) that arises in adolescence impairs functioning and is associated with suicide risk, but little is known about its continuity into adulthood.ObjectiveTo describe the clinical course of adolescent-onset MDD into adulthood.Design and ParticipantsProspective case-control study. Seventy-three subjects had onset of MDD based on systematic clinical assessment during adolescence (Tanner stage III-V) and 37 controls had no evidence of past or current psychiatric disorders, and also were assessed in adolescence (assessment years: 1977-1985). Follow-up was conducted 10 to 15 years after the initial assessment by an independent team without knowledge of initial diagnosis (follow-up years: 1992-1996).SettingCases were identified at Columbia Presbyterian Hospital, New York City, NY; controls were recruited from the community.Main Outcome MeasuresSuicide and suicide attempts, psychiatric diagnoses, treatment utilization, and social functioning.ResultsClinical outcomes of adolescent-onset MDD into adulthood compared with control subjects without psychiatric illness include a high rate of suicide (7.7%); a 5-fold increased risk for first suicide attempt; a 2-fold increased risk of MDD, but not other psychiatric disorders; an increased occurrence of psychiatric and medical hospitalization; and impaired functioning in work, social, and family life. Thirty-seven percent of those with adolescent MDD survived without an episode of MDD in adulthood vs 69% of the control participants (relative risk, 2.2 [95% confidence interval, 1.0-4.7; P<.05]).ConclusionThere is substantial continuity, specificity, morbidity, and potential mortality from suicide into adulthood in adolescent-onset MDD patients. Now that empirically based guides to their treatment are becoming available, early identification and treatment seems warranted.