Subthreshold Depressive Disorder in Adolescents: Predictors of Escalation to Full-Syndrome Depressive Disorders

Abstract

Objectives-Subthreshold depressive disorder is one of the best established risk factors for the onset of full-syndrome depressive disorders. However, many youths with subthreshold depressive disorder do not develop full-syndrome depression. We examined predictors of escalation to fullsyndrome depressive disorders in a community sample of 225 adolescents with subthreshold depressive disorder.Method-Criteria for subthreshold depressive disorder were an episode of depressed mood or loss of interest or pleasure lasting at least 1 week and at least two of the seven other DSM-IV-associated symptoms for major depression. Participants were assessed four times from mid-adolescence to age 30 years using semistructured diagnostic interviews.Results-The estimated risk for escalation to full-syndrome depressive disorders was 67%. Five variables accounted for unique variance in predicting escalation: severity of depressive symptoms, medical conditions/symptoms, history of suicidal ideation, history of anxiety disorder, and familial loading for depression. Adolescents with three or more risk factors had an estimated 90% chance of escalating to full-syndrome depressive disorder, compared with 47% of adolescents with fewer than three risk factors.Conclusions-These data may be useful in identifying a subgroup of youths with subthreshold depressive disorder who are at especially high risk for escalating to full-syndrome depressive disorders.There is growing recognition of the significance of subthreshold depressive disorders in children, adolescents, and adults. [1][2][3] These conditions have been referred to using a variety of terms (e.g., subthreshold depression, minor depression, recurrent brief depression, subsyndromal symptomatic depression) and defined in a variety of ways (e.g., minimum number of symptoms range from 2 to 4; minimum durations range from several days to 2 weeks). 3,4 Despite the lack of consensus regarding terminology and criteria, subthreshold depressive disorders seem to be common in children and adolescents; the 12-month prevalence ranges from 3% to 7%, 1,5,6 and the lifetime prevalence through late adolescence is as high as 26%. 7 Subthreshold depressive disorder in youths is associated with substantial functional 2,5,8 and a twofold to fourfold increase in the risk for developing full threshold depressive disorders. 1,6,[8][9][10] In light of these findings, prevention and early intervention programs often target youths with subthreshold depressive disorders. 11,12 Although intervention may be indicated for youngsters with subthreshold depression who experience significant impairment regardless of their risk for escalation, the major goal of most such programs is to prevent the development of fullsyndrome depression. However, many youths with subthreshold depression do not develop full-syndrome depressive disorders even after years of follow-up. 1,2,6 Hence, it may be useful to identify factors that predict the escalation from subthreshold to full-syndrome depressive disorders to refine the sel...

Subthreshold Depression and Regional Brain Volumes in Young Community Adolescents

“…7 Conversely, there was no difference between boys and girls with subthreshold depression regarding depression outcome, in agreement with previous studies. 4,5 However, our results further suggest that smaller GM volumes in the mPFC region mediated a substantial part of the relation between subthreshold-depression at age 14 and high depression scores (indicating pathology) at age 16 in girls only. Thus, the risk of developing depression might be enhanced in girls who have a reduced mPFC volume.…”

“…These characteristics were constant over time with the follow-up two years later, denoting the consistency and stability of the definition criteria used herein. Particularly, the follow-up findings confirm that adolescents with subthreshold depression are more likely to convert to depression later on 5 and have an increased risk of self-harm. 7 These findings should be seen in the light of the following limitations.…”

“…2 Adolescents with subclinical, subthreshold depressive symptoms may have clinically relevant depressive symptoms and experience substantial distress or impairment, though not meeting criteria for a diagnosis of major depressive disorder (MDD). 3 Despite the different definitions of subthreshold depression used in the literature, based on the number, duration, and impact on functioning of symptoms, 3 there is consistent evidence that subthreshold depression strongly predicts MDD in adulthood, 1,4,5 with an estimated risk for escalation to full-syndrome disorder of 67%. 5 Furthermore, while depressive symptom rates are similar in prepubescent boys and girls, a strong female preponderance in the prevalence of subthreshold and clinical depression emerges after puberty, 6,7 suggesting that there might be sex differences in the neural circuitry underlying depression.…”

Asian Student Depression in American High Schools

“…This variable was similarly dichotomized as ''yes'' versus ''no.'' While not sufficient for diagnostic purposes, these questions capture the predictors of clinical depression among adolescents (Klein, Shankman, Lewinsohn, & Seeley, 2009).…”

Parental Behaviors During Family Interactions Predict Changes in Depression and Anxiety Symptoms During Adolescence

“…A better understanding of the development of internalizing symptoms in adolescence is important because elevated levels of such symptoms have been found to significantly increase risk for the development of depression and anxiety disorders over time (e.g., Klein et al 2009;Pine et al 1999). Furthermore, there is evidence to suggest that children and adolescents with elevated levels of depression and anxiety symptoms experience significant disability even when their symptoms do not meet criteria for a diagnosis (Angold et al 1999).…”