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BackgroundThere is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms.MethodsThe total population of 16–17-year-olds in Uppsala, Sweden, was screened for depression in 1991–1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later.ResultsSomatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders.ConclusionsSomatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms.

Our findings support a role for family stress in development of both overweight and underweight among young children. This is likely to be attributed to behavioural mechanisms but a more direct metabolic influence of stress could also be involved.

Contrary to what previous research has suggested, adolescent depression and its consequences might be particularly destructive to subsequent higher education in males.

The self-report questionnaire Center for Epidemiological Studies-Depression Child (CES-DC) was used for screening depression in Swedish 16-17 year olds during their first year in high school. Completed questionnaires were produced by 2272 students (92% of the population). The mean score was 13.2 (boys 9.9; girls 16.5). Factor analysis gave the same factors for boys and girls with a strong main factor for depressed mood. High scores of 30 or above were found in 240 cases (10.3%). Of those, 204 (85%) and the same number of controls with low scores were interviewed with the Diagnostic Interview for Children and Adolescents (DICA-R-A). Depressive diagnosis during the last year was confirmed in 71% of high scores and 15% of low scorers. Beck's depression inventory with cut off at score 16 was used in the same material with equal result. Used with high cut off scores the CES-DC was specific enough for discovering depressive disorder.

This study demonstrates that somatic symptoms are common in adolescent depression. Multiple somatic symptoms within depression imply a higher severity in terms of duration, depth and psychiatric comorbidity. The strong correlation with suicidal plans, suicidal attempts and disruptive behaviour is concerning.

A total population of high-school students aged 16-17 years in a Swedish town was screened for depression and previous suicide attempts, and 2300 students (93.3%) participated. Those with high depression scores (12.3%) and previous suicide attempts (2.4%), as well as controls matched for gender and education, were interviewed for diagnosis (DICA-R-A), and 88.8% participated. The 1-year prevalence of major depression was 5.8% and the lifetime prevalence was 11.4%, with four girls being represented for every boy. A depression lasting for at least 1 year was the most common type. Dysthymia was found in 2% (two girls for every boy). Short hypomanic episodes were present in 13.2% of those with a lifetime diagnosis of major depression.

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