What Happens to Depressed Adolescents?

December 30, 2013

A look into longer-term clinical and psychosocial outcomes of depressive disorder in early adulthood, as well as clinical and demographic variables associated with recurrence and lack of remission.

[[{"type":"media","view_mode":"media_crop","fid":"21727","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9470270408284","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1530","media_crop_rotate":"0","media_crop_scale_h":"200","media_crop_scale_w":"200","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 4px; height: 180px; width: 180px;","title":" ","typeof":"foaf:Image"}}]]Depressive disorders are among the most common psychiatric diagnoses to emerge during adolescence. They can have a profound effect on key developmental tasks, such as educational achievement and social functioning. The disruption caused by adolescent depression is also known to affect health outcomes during young adulthood; however, few studies have tracked outcomes into this stage. My colleagues and I recently published a study that looked at the longer-term clinical and psychosocial outcomes of depressive disorder in early adulthood.1 In addition, clinical and demographic variables that were associated with recurrence and lack of remission were identified.

The study assessed 111 persons aged 17 to 24 years who had received a diagnosis of a unipolar depressive disorder during their adolescence (12 to 18 years). Participants were assessed after an average 5.7 years (range, 3 to 9 years) and were interviewed using a structured clinical interview. They also completed a battery of self-report measures. All participants formerly had been offered psychosocial and/or antidepressant medication treatment within clinical trials for the treatment of depression.

Almost all participants (92.6%) had full remission of their initial depressive disorder. However, one or more recurrences of unipolar depressive disorder were common (52.4%) and, on average, occurred after 2.9 years. The risk of recurrence increased steadily; 19.4% experienced a recurrence within 2 years and 39.8%, within 4 years. The severity of mental illness is reflected in the high rate of suicide attempts (27%) during the follow-up period. One patient died by suicide with a prescription drug overdose. Bipolar disorder was uncommon (in only 3.6%); however, given the mean sample age of 21.3 years, more cases may emerge in the coming years.

A diagnosis of a non–mood disorder during the follow-up period was more common (79%) than a diagnosis of a depressive disorder. Anxiety disorders were the most commonly diagnosed (50.5%), which is consistent with their ranking as the most common comorbidity at baseline. Rates of alcohol use disorder (28.7%) and eating disorder (14.9%) were notable, given that these disorders were largely excluded at baseline by study selection criteria.

At the time of the follow-up assessment, mean clinician-rated Global Assessment of Functioning indicated some mild symptoms or some difficulty in social, occupational, or school functioning. While only 58% completed high school, 77% had pursued further studies or vocational training. Periods of unemployment or not being involved in education/training were common, with about one-third reporting a period of more than 6 months. Additional treatment for mental health problems was sought by 71%: almost half were treated with an antidepressant medication, and 13% received an inpatient admission.

Analyses were performed to determine factors associated with failure to remit from the index depressive disorder and recurrence. Identification of such factors may inform efforts to prevent the sequelae of adolescent depression. Symptom remission failure at 2 years and by 4 years was associated with having a comorbid anxiety disorder at the end of the acute treatment phase of the clinical trial. Elevated self-reported depressive symptoms at the end of treatment were also associated with symptom remission failure.

Self-reported ratings of perceived ability to cope with depressive symptoms (self-efficacy) were associated with recurrence by 2 and 4 years’ follow-up. Elevated self-reported depressive symptoms and low socioeconomic status were also associated with recurrence by 4 years.

The high rate of recurrence of depressive symptoms, emergence of nondepressive disorders, and ongoing psychosocial challenges point to the need for a longer-term view of the management of adolescents with depressive disorders. Findings contribute to the development of a profile for detecting adolescents who may be at risk for relapse and recurrence. While help seeking was common following involvement in treatment within a randomized clinical trial, the findings suggest the need for research into treatment strategies that reduce risk of relapse and promote mental health during early adulthood. Factors found to contribute to higher levels of risk may inform intervention, such as more aggressive treatment of comorbid anxiety disorders and the development of a sense of self-efficacy.

Disclosures:

Dr Melvin is a Senior Lecturer at the Centre for Developmental Psychiatry and Psychology, School of Psychology & Psychiatry, Monash University, Australia. He reports no conflicts of interest concerning the subject matter of this article.

References:

1. Melvin GA, Dudley AL, Gordon MS, et al. What happens to depressed adolescents? A follow-up study into early adulthood. J Affect Disord. 2013;151:298-305.