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Mental health outcome of long-term and episodic adolescent depression: 15-year follow-up of a community  sample
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. (von Knorring)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. (von Knorring)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. (von Knorring)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. (von Knorring)
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2011 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 130, no 3, 395-404 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Recent studies have highlighted the unfavourable natural course of chronic/long-term depression. We investigated the adult mental health outcome of adolescent depression, with specific focus on long-term and episodic adolescent major depression (MD). METHODS: A community sample of depressed adolescents and non-depressed peers was followed-up with a structured diagnostic interview after 15years. The participants (n=382) were divided into five groups depending on their status in adolescence: no depression (n=155); long-term MD (n=91); episodic MD (n=63); dysthymia (n=33); and subthreshold symptoms (n=40). Outcomes (age 19-31) included mood disorders, other mental disorders, suicidality, and treatment for mental disorders. RESULTS: The long-term group overall had a poorer outcome than the non-depressed group, with the episodic group in an intermediate position. The outcome of the dysthymic group was similar to that of the long-term group, while the subsyndromal group did not differ markedly from the non-depressed group. The long-term group was more likely than the episodic group to report adult anxiety disorders, multiple mental disorders, suicide attempts, and treatment; they also seemed to develop more persistent adult depressions, with a higher number of recurrent episodes and longer duration of antidepressant treatment. Even after adjustment for adolescent factors of clinical and etiological importance, the long-term group had a markedly less favourable outcome than the episodic group. LIMITATION: The participation rate at follow-up was 64.6%. CONCLUSION: Longstanding depression in adolescence is a powerful predictor of continued mental health problems in adulthood. It is now important to evaluate if early interventions can alter this severe course.

Place, publisher, year, edition, pages
2011. Vol. 130, no 3, 395-404 p.
Keyword [en]
Adolescent depression, Chronic depression, Follow-up, Mental health outcome
National Category
Neurosciences Neurology
Identifiers
URN: urn:nbn:se:uu:diva-147878DOI: 10.1016/j.jad.2010.10.046ISI: 000291192100005PubMedID: 21112639OAI: oai:DiVA.org:uu-147878DiVA: diva2:401073
Available from: 2011-03-01 Created: 2011-03-01 Last updated: 2017-12-11
In thesis
1. Adolescents with Depression Grown up: Education, Intimate Relationships, Mental Health, and Personality
Open this publication in new window or tab >>Adolescents with Depression Grown up: Education, Intimate Relationships, Mental Health, and Personality
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Unipolar depression, estimated to be the leading contributor to burden of disease in middle- and high-income countries, often has an onset in adolescence. The disorder is associated with substantial role impairment and is highly recurrent. This raises questions about both subsequent mental health and social outcome. In order to shed light on this, a community sample of adolescents with depression and non-depressed peers was followed-up after 15 years.

In 1991-93, first-year students in upper secondary school (age 16-17) in the town of Uppsala, Sweden, were screened for depression. Adolescents with positive screening and selected peers with negative screening (n=631 in total) were assessed regarding mental health, social situation, and personality. At around age 31, the participants were followed-up in both national registers (n=609) and personal interviews (n=409). Outcome regarding social factors, mental health, and personality was assessed.

At follow-up, the former depressed adolescents had completed higher education to a lesser extent than the former non-depressed adolescents. The females with adolescent depression were also at increased risk of subsequent abortion, divorce, single parenthood, and partner violence. Characteristics associated with depression in adolescence (such as poor school performance and disruptive disorders) seemed to contribute to the poor outcome in the social domain.

Regarding adult mental health, long-term depression in adolescence was associated with a particularly poor outcome. Compared to adolescents with shorter episodes of depression, those with long-term depression were more likely to report recurrent depression, suicidal ideation, and a range of other mental disorders in adulthood.

Measures of personality traits related to neuroticism (a tendency towards negative emotionality) were elevated during ongoing depression and anxiety disorders, but were normalized with remission. However, repeated depressive episodes seemed to leave the individual more vulnerable to stress.

It is now important to assess if early treatment can alter the poor outcome depicted in this thesis. Since social adversity, educational difficulties, and interpersonal problems accompany the depressive disorder from adolescence onward, it should also be investigated if interventions aimed at such contextual factors can prevent recurrence and improve quality of life.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 51 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 630
Keyword
Adolescent depression, Follow-up, Higher education, Childbearing, Intimate relationships, Recurrent depression, Personality development, Neuroticism, Social outcome, Community sample
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-134640 (URN)978-91-554-7967-1 (ISBN)
Public defence
2011-01-15, Sal IX, Universitetshuset, Övre Slottsgatan, Uppsala, 09:15 (Swedish)
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Available from: 2010-12-22 Created: 2010-11-30 Last updated: 2011-06-21Bibliographically approved

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