Citation

Weissman MM, Wolk S, Goldstein RB, Moreau D, Adams P, Greenwald S, Klier CM, Ryan ND, Dahl RE, Wickramaratne P. J. Am. Med. Assoc. JAMA 1999; 281(18): 1707-1713.

Affiliation

Division of Clinical and Genetic Epidemiology, College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, New York 10032, USA. weissman@child.cpmc.columbia.edu

Copyright

(Copyright © 1999, American Medical Association)

DOI

unavailable

PMID

10328070

Abstract

CONTEXT: Major depressive disorder (MDD) that arises in adolescence impairs functioning and is associated with suicide risk, but little is known about its continuity into adulthood. OBJECTIVE: To describe the clinical course of adolescent-onset MDD into adulthood. DESIGN AND PARTICIPANTS: Prospective 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). SETTING: Cases were identified at Columbia Presbyterian Hospital, New York City, NY; controls were recruited from the community. MAIN OUTCOME MEASURES: Suicide and suicide attempts, psychiatric diagnoses, treatment utilization, and social functioning. RESULTS: Clinical 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]). CONCLUSION: There 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.

Language: en