Citation

Kalin NH. Am. J. Psychiatry 2021; 178(4): 275-279.

Copyright

(Copyright © 2021, American Psychiatric Association)

DOI

10.1176/appi.ajp.2020.21020186

PMID

unavailable

Abstract

Anxiety disorders and depression are among the most common psychiatric illnesses affecting youth. Anxiety disorders typically begin in childhood, whereas the onset of depression frequently occurs later during adolescence or early adulthood. These illnesses are highly comorbid, with pathological anxiety regularly preceding the development of depression. The lifetime prevalence of anxiety disorders when assessed in adolescents is reported to be as high as 32% (1), whereas the estimated 12-month prevalence of major depression in adolescents is approximately 13% (2). Prior to adolescence, the incidence of these disorders is the same between boys and girls; however, as girls mature and go through puberty, they are approximately twice as likely as boys to be diagnosed with anxiety and major depression. In addition to causing considerable suffering and impaired functioning, when severe, these illnesses can be life threatening. Tragically, 6,200 suicide deaths were reported in 2017 among U.S. adolescents and young adults from 15 to 24 years of age (3), and suicide is the second leading cause of death among individuals 10-34 years of age (4).

As with other psychiatric illnesses, the risks for developing anxiety disorders and major depression are due to interactions between heritable and nonheritable factors. It is estimated that the heritability of anxiety and major depression is between 30% and 40%, leaving a considerable amount of the risk to potentially modifiable environmental factors. Genome-wide association studies with increasingly large sample sizes continue to identify genes that help explain a portion of the heritability for anxiety and depression (5). However, it is important to note that a recent study has provided evidence questioning the validity of previous findings that have linked a number of the familiar, "usual suspect" candidate genes (e.g., polymorphisms of the gene for the serotonin transporter protein) to be strongly associated with anxiety and depression (6). Early life trauma, neglect, inadequate parenting, and ongoing stress are among the environmental factors that contribute to the likelihood of developing anxiety, depression, and other stress-related disorders. Adolescence is a particularly vulnerable period, as the psychosocial challenges of adolescence converge with rapid and substantial developmental changes in the brain and in hormones. Prior to the onset of anxiety disorders and major depression, at-risk phenotypes or personality traits such as behavioral inhibition (7) and neuroticism (8), which are also partially heritable, can be identified and provide an opportunity for developing early intervention strategies for children at risk...

Language: en

Keywords

Anxiety Disorders; Child/Adolescent Psychiatry; Depressive Disorders; Suicide and Self-Harm