Age of onset and course of major depressive disorder: associations with psychosocial functioning outcomes in adulthood

Abstract

Background Major depressive disorder (MDD) that onsets by adolescence is associated with various deficits in psychosocial functioning. However, adolescent-onset MDD often follows a recurrent course, which may drive its associated impairment. Methods To tease apart these two clinical features, we examined the relative associations of age of onset (adolescent versus adult) and course (recurrent versus single episodes) of MDD with a broad range of psychosocial functioning outcomes assessed in early adulthood. Participants comprised a large, population-based sample of male and female twins from the Minnesota Twin Family Study (N = 1,252) assessed prospectively from ages 17 to 29. Results A recurrent course of MDD predicted impairment in a number of psychosocial domains in adulthood, regardless of whether it onset in adolescence or adulthood. In contrast, adolescent-onset MDD showed less evidence of impairment in adulthood after accounting for recurrence. Individuals with both an adolescent onset and recurrent episodes of MDD represented a particularly severe group with pervasive psychosocial impairment in adulthood. Conclusions The negative implications of adolescent-onset MDD for psychosocial functioning in adulthood appear to be due primarily to its frequently recurrent course, rather than its early onset, per se. Results highlight the importance of considering both age of onset and course for understanding MDD and its implications for functioning, as well as in guiding targeted intervention efforts.

Premorbid risk factors for major depressive disorder: Are they associated with early onset and recurrent course?

“…We are aware of only two studies, from our own group, that explicitly compared personality traits for early-onset and later-onset MDD. Although we found higher negative emotionality for both early- and later-onset MDD relative to no MDD (Wilson et al, 2014; Wilson et al, in press), and we also found that negative emotionality in adolescence prospectively predicted the onset of MDD in adulthood (Wilson et al, 2014), we found little evidence of differences in negative emotionality or positive emotionality in adulthood as a function of age of onset once course was accounted for (Wilson et al, in press). A handful of studies have considered effects of personality traits for the course of depressive disorders.…”

“…Wilson et al (2014) found that negative emotionality was concurrently and prospectively associated with both recurrent/chronic MDD and nonrecurrent/nonchronic MDD, relative to no MDD, but positive emotionality was concurrently and prospectively associated only with recurrent/chronic MDD (regardless of whether it onset early or later). Wilson et al (in press) explicitly compared personality traits for recurrent and single-episode MDD, and found that recurrent MDD predicted lower positive emotionality and higher negative emotionality. Notably, Wilson et al (in press) found the lowest positive emotionality and highest negative emotionality for individuals with early-onset, recurrent MDD.…”

“…Wilson et al (in press) explicitly compared personality traits for recurrent and single-episode MDD, and found that recurrent MDD predicted lower positive emotionality and higher negative emotionality. Notably, Wilson et al (in press) found the lowest positive emotionality and highest negative emotionality for individuals with early-onset, recurrent MDD. Consistent with these results, Durbin, Klein, Hayden, Buckley, and Moerk (2005) found that positive emotionality was lower among young children of parents with early-onset or recurrent/chronic depressive disorders relative to parents with later-onset or nonrecurrent/nonchronic depressive disorders.…”

“…A number of studies suggest particularly severe dysfunction for early-onset and recurrent MDD, including concurrent and prospective associations with alcohol, nicotine, and illicit substance use and abuse, and antisocial behavior (Hammen, Brennan, Keenan-Miller, & Herr, 2008; Lewinsohn, Rohde, Seeley, Klein, & Gotlib, 2003; Sihvola et al, 2008; Wilson et al, in press); relationship impairment (Hammen, Brennan, & Keenan-Miller, 2008; Hammen, Brennan, Keenan-Miller et al, 2008; Jonsson et al, 2011; Lewinsohn et al, 2003; Puig-Antich et al, 1993; Weissman et al, 1999; Wilson et al, in press) and intimate partner violence (Jonsson et al, 2011); lower rates of graduation, less educational attainment, greater unemployment, and lower income (Breslau, Michael, Nancy, & Kessler, 2008; Fergusson, Boden, & Horwood, 2007; Fergusson & Woodward, 2002; Jonsson et al, 2011; Lewinsohn et al, 2003); and poorer mental health, more acute and chronic health conditions, and more visits to health professionals (Bardone, Moffitt, Caspi, Dickson, & Silva, 1996; Copeland, Shanahan, Worthman, Angold, & Costello, 2012; Keenan-Miller, Hammen, & Brennan, 2007; Lewinsohn, Seeley, Hibbard, Rohde, & Sack, 1996; Marmorstein, Iacono, & Legrand, in press; Wilson et al, in press). …”

Comments on Hankin BL. Adolescent depression: Description, causes, and interventions. Epilepsy & Behavior 2006;8:102-114

“…The significant increase in adolescence of mood disorders, particularly depression, as well as suicidal [5] and other self-harm behaviors [6], and the impact on all areas of adolescent functioning underscore the public health risk of this age group. The association of recurrent adolescent depression with adult depression and dysfunction [7], as well as with selfharm behaviors [8], emphasizes the importance of early identification and treatment of youth at risk for depression.…”