Depression from preschool to adolescence – five faces of stability

Abstract

Background The term ‘stability’ has different meanings, and its implications for the etiology, prevention, and treatment of depression vary accordingly. Here, we identify five types of stability in childhood depression, many undetermined due to a lack of research or inconsistent findings. Methods Children and parents (n = 1,042) drawn from two birth cohorts in Trondheim, Norway, were followed biennially from ages 4–14 years. Symptoms of major depressive disorder (MDD) and dysthymia were assessed with the Preschool Age Psychiatric Assessment (only parents) and the Child and Adolescent Psychiatric Assessment (age 8 onwards). Results (a) Stability of form: Most symptoms increased in frequency. The symptoms’ importance (according to factor loadings) was stable across childhood but increased from ages 12–14, indicating that MDD became more coherent. (b) Stability at the group level: The number of symptoms of dysthymia increased slightly until age 12, and the number of symptoms of MDD and dysthymia increased sharply between ages 12–14. (c) Stability relative to the group (i.e., ‘rank‐order’) was modest to moderate and increased from ages 12–14. (d) Stability relative to oneself (i.e., intraclass correlations) was stronger than stability relative to the group and increased from age 12–14. (e) Stability of within‐person changes: At all ages, decreases or increases in the number of symptoms forecasted similar changes two years later, but more strongly so between ages 12–14. Conclusions Across childhood, while most symptoms of MDD and dysthymia become more frequent, they are equally important. The transition to adolescence is a particularly vulnerable period: The depression construct becomes more coherent, stability increases, the level of depression increases, and such an increase predicts further escalation. Even so, intervention at any time during childhood may have lasting effects on reducing child and adolescent depression.

Longitudinal relations between impaired executive function and symptoms of psychiatric disorders in childhood

“…There is no ready explanation as to why the effect appears during adolescence and not before. However, at least for emotional disorders, cognitively related symptoms (e.g., low self‐esteem feelings of guilt and hopelessness) and disorders (e.g., generalized anxiety) tend to increase during late middle childhood and adolescence (Morken et al., 2021 ; Steinsbekk et al., 2021 ), thus possibly taxing working memory to a larger extent than before. Increasing demands are likely placed on working memory in the late middle school and high school, and the above working memory problems may additionally become more evident to teachers (which we used as raters) at these ages than earlier.…”

“…Furthermore, although executive functions begin to emerge early in life, they continue to develop during the school years and adolescence (Diamond, 2013 ). The prevalence of different types of psychiatric disorders and symptoms also change from preschool to adolescence (Morken, Viddal, Ranum, & Wichstrom, 2021 ; Steinsbekk, Ranum, & Wichstrom, 2021 ). The relation between executive functions and the various mental health problems might thus also change during this period.…”

Prevalence and course of anxiety disorders and symptoms from preschool to adolescence: a 6‐wave community study

“…Stability of symptoms and disorders may be divided into homotypic (same disorder) and heterotypic (cross‐disorder) forms. Morken, Viddal, Ranum, and Wichstrom (2020) identified five different meanings of the term ‘stability’ with differing implications for intervention, of which we address three: (a) stability relative to the group (i.e., ‘rank order’ correlation); (b) stability relative to oneself (i.e., intraclass correlation); and (c) stability of within‐person changes . The first has to some extent been addressed in previous research, whereas the latter two have not been examined before.…”

Reciprocal relations between dimensions of Oppositional defiant problems and callous-unemotional traits

“…Irritability and CU traits have different developmental interpretations. Irritability is common throughout childhood and adolescence (Morken et al, 2021 ) and only if very frequent and dysregulated is considered abnormal, whereas CU traits are not developmentally normative and are considered risk factors for conduct problems and their persistence and severity (Wakschlag et al, 2018 ).…”