Subthreshold Symptoms of Depression in Preadolescent Girls Are Stable and Predictive of Depressive Disorders

Abstract

Objective-Given the risk for adolescent depression in girls to lead to a chronic course of mental illness, prevention of initial onset could have a large impact on reducing chronicity. If symptoms of depression that emerge during childhood were stable and predictive of later depressive disorders and impairment, then secondary prevention of initial onset of depressive disorders would be possible.Method-Drawing from the Pittsburgh Girls Study, an existing longitudinal study, 232 nine-yearold girls were recruited for the present study, half of whom screened high on a measure of depression at age 8 years. Girls were interviewed about depressive symptoms using a diagnostic interview at ages 9, 10, and 11 years. Caregivers and interviewers rated impairment in each year.Results-The stability coefficients for DSM-IV symptom counts for a 1-to 2-year interval were in the moderate range (i.e., intraclass coefficients of 0.40-0.59 for continuous symptom counts and Kendall τ-b coefficients of 0.34-0.39 for symptom level stability). Depressive disorders were also relatively stable at this age. Poverty moderated the stability, but race and pubertal stage did not.©2008 by the American Academy of Child and Adolescent Psychiatry.Correspondence to Dr. Kate Keenan, Department of Psychiatry, MC 3077, Room W-415, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; e-mail: E-mail: kkeenan@yoda.bsd.uchicago.edu. Disclosure: The authors report no conflicts of interest. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAmong the girls who did not meet criteria for a depressive disorder at age 9 years, the odds of meeting criteria for depressive disorders and for demonstrating impairment at age 10 or 11 years increased by 1.9 and 1.7, respectively, for every increase in the number of depression symptoms.Conclusions-Early-emerging symptoms of depression in girls are stable and predictive of depressive disorders and impairment. The results suggest that secondary prevention of depression in girls may be accomplished by targeting subthreshold symptoms manifest during childhood. Keywords girls; childhood; depression; DSM-IV; predictionDepressive disorders are one of the most common mental disorders among adolescents. Prevalence of depression increases dramatically from 1% in childhood to 8% in adolescents, with a lifetime prevalence in adolescents of 15% to 20%, which is comparable to that found in adults. 1 It is primarily girls who account for the increase in adolescence, 2,3 evidencing a 2:1 sex difference in depression that continues throughout the reproductive years. 4 Initial episodes of depression are more severe and longer in duration for girls than for boys, 5 and girls who experience depression for the first time in childhood or adolescence, compared with females with onsets later in life, have a prolonged period of risk for future episodes. 6 Depressive disorders continue to be among the most common disorders for females later in life and are cited as the leading ca...

Subthreshold depression in children and adolescents – a systematic review

“…Still, studies of late adolescence Fergusson et al, 2005;Shankman et al, 2009;Lewinsohn et al, 2000) produce results similar to the adult studies, and population-based taxometric analyses suggest that depression may be viewed dimensionally also in children and adolescents (Hankin et al, 2005). Recent studies suggest that childhood and adolescent SD is associated with severe impairment (Keenan et al, 2008;Gonzalez-Tejera et al, 2005), and with future risk of developing MDD (Rohde et al, 2009;Johnson et al, 2009) similar to findings in adult populations. Hence, if SD in children and adolescents is a precursor to MDD, it would be an obvious target for indicated preventive intervention (aimed at individuals with subthreshold symptoms) (Munoz et al, 2010).…”

“…The three studies examining impairment as an outcome of SD all found it to be enhanced (Johnson et al, 2009;Oldehinkel et al, 1999;Keenan et al, 2008). Johnson et al (2009) found that SD in adolescence was associated with clinical impairment at age 33 (Johnson et al, 2009).…”

“…These studies both used the Children's Global Assessment Scale, and found that baseline impairment was increased equally in SD and MDD youth (Keenan et al, 2008, Gonzalez-Tejera et al, 2005. The third study validated a new impairment measure: the Child and Adolescent Social and Adaptive Functioning Scale (CASAFS) (Price et al, 2002).…”

“…Baseline impairment was assessed in three studies, of which two had impairment requirements in their SD criteria (Keenan et al, 2008;Gonzalez-Tejera et al, 2005;Price et al, 2002). These studies both used the Children's Global Assessment Scale, and found that baseline impairment was increased equally in SD and MDD youth (Keenan et al, 2008, Gonzalez-Tejera et al, 2005.…”

A Qualitative Study of the Prodrome to First-Episode Major Depressive Disorder in Adolescents

“…Some of our adolescent sample (8 of 29), described changes occurring a year or more prior to the onset of MDD. Some prospective studies in children and adolescents show that the presence of depressive symptoms at a given time point is associated with the onset of MDD a year or more afterwards [24,25,26]. Our results demonstrate that in some participants, these symptoms may be prodromal to depression rather than a resolved episode that is a risk factor for later depression or a pre-existing vulnerability.…”