A Multilevel Mediational Model of the Association of Neighborhood Deprivation With Risk for Nonaffective Psychosis

Abstract

disturbance continues for at least 2 years in adults but only 1 year in children. Age further defines different subtypes of dysthymia, based on whether the onset is early (before age 21 years) or late (after age 21 years). These differences in age at onset and time course are fairly arbitrary, but they emphasize the importance of age when making a diagnosis.Of particular relevance in the context of the study is the onset specifier. This specifier was in large part the result of studies conducted by Akiskal, 5 who proposed that early-onset dysthymia is a low-grade characterological form of depression that develops gradually, whereas late-life dysthymia is an acute and more severe form of the disorder.Although the early-onset vs late-onset specifier was not included for major depressive disorder, it has been suggested that a similar distinction should also be made for this disorder. 6 Accordingly, early-onset chronic major depression might be a more severe form and associated with greater comorbidities than the late-onset subtype. This would explain why treat-ments are less effective in early-onset subtype of the disorder and therefore also in children and adolescents.It is unclear why age appears to distinguish different forms of depressive states. It is quite possible that hormonal changes, and especially the influence of estrogen and testosterone on brain function and development among girls around puberty, might explain some of the results. 7 Other possible explanations might be associated with the physical changes that occur during sexual maturity and the associated social conflicts and stress around gender roles. 3 Whatever the reason, age (and sex) is a critical factor that needs to be considered for the diagnosis and treatment of depression. It is quite possible that we are dealing with different disorders, depending on the age and sex of the patient. 8 Therefore, the same treatment might not be equally effective for all individuals at all ages. This questions the idea that depression is a monolithic entity and supports the call for a paradigm shift toward precision medicine in psychiatry.