No abstract

Formerly depressed adolescents with the risk factors identified in this study are at elevated risk for recurrence of major depressive disorder during young adulthood and therefore warrant continued monitoring and preventive or prophylactic treatment.

Background Limited information exists regarding the long-term development of comorbidity between Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD; abuse/dependence). Using a representative prospective study, we examine multiple aspects pertaining to MDD+AUD comorbidity, with a focus on the relation between disorders across periods (adolescence, early adulthood, adulthood) and cumulative impairments by age 30. Method 816 participants were diagnostically interviewed at ages 16, 17, 24, and 30. Results Rates of comorbid MDD+AUD were low in adolescence (2%), but increased in early adulthood (10%) and adulthood (7%). Rates of cumulative comorbidity were elevated (21%). Most individuals with a history of MDD or AUD had the other disorder, except for women with MDD. Prospectively, adolescent AUD predicted early adult MDD, while early adult MDD predicted adult AUD. Compared to pure disorders, MDD+AUD was associated with higher risk of alcohol dependence, suicide attempt, lower global functioning, and life dissatisfaction. Conclusions Lifetime rates of comorbid MDD+AUD were considerably higher than in cross-sectional studies. Comorbidity was partly explained by bidirectional and developmentally-specific associations and predicted selected rather than generalized impairments. Clinically, our findings emphasize the need to always carefully assess comorbidity in patients with MDD or AUD, taking into account concurrency and developmental timing.

The hypotheses that externalizing disorders would be co-morbid with other externalizing disorders and that internalizing disorders would be co-morbid with other internalizing disorders was partially supported. Co-morbidities between subthreshold disorders and between subthreshold disorders and full syndrome should impact future research and clinical practice. The assessment of subthreshold disorders needs to include the assessment of other subthreshold and full-syndrome conditions.

The reliability and validity of Schneider's (1958) construct of depressive personality was evaluated in a sample of 177 outpatients, who were administered structured diagnostic and family history interviews, an extensive battery of inventories, and a 6-month follow-up assessment. The criteria for depressive personality had moderate to good interrater reliability, internal consistency, and test-retest stability, and the assessment of depressive personality traits was not influenced by patients' clinical states. In addition, preliminary support for the convergent and discriminant validity of the depressive personality construct was obtained. Although there were significant relations between the depressive personality and Diagnostic and Statistical Manual of Mental Disorders (3rd ed. and rev. 3rd ed.; American Psychiatric Association, 1980, 1987) diagnoses of dysthymia, the depressive personality was not entirely subsumed by existing mood disorders.