The course of major depressive disorder from childhood to young adulthood: Recovery and recurrence in a longitudinal observational study

Abstract

Background The episodic nature of major depressive disorder (MDD) in clinically referred adults has been well-characterized, particularly by the NIMH Collaborative Depression Study. Previous work has established that MDD also is episodic prior to adulthood, but no study has yet provided comprehensive information on the actual course of MDD in clinically referred juveniles. Thus, the present investigation sought to characterize recovery, recurrence, and their predictors across multiple episodes of MDD in initially 8- to 13-year-old outpatients (N=102), and to estimate freedom from morbidity (“well-time”) across the years. Method Clinically referred youngsters with MDD were repeatedly assessed in an observational study across two decades (median follow up length: 15 years). Survival analytic techniques served to model recovery from the 1st, 2nd and 3rd lifetime episodes of MDD, the risk of developing the 2nd, 3rd, and 4th episodes, and the effects of traditional psychosocial and clinical predictors of outcomes. “Well-time” across the follow-up and its predictors also were examined. Results Recovery rates ranged from 96% to 100% across MDD episodes; episode lengths ranged from 6 to 7 months. Up to 72% of those recovered from the first episode of MDD had a further episode; median inter-episode intervals were about 3 to 5 years. No single demographic, social, or clinical variable, nor treatment, consistently predicted recovery/recurrence. Psychiatric morbidity over time derived mostly from non-affective disorders, which, however, did not alter the course of MDD. Limitations The sample was relatively small and power to detect small effects further declined with each MDD episode recurrence. Conclusions Echoing findings on adults, the course of pediatric-onset MDD in this clinical sample was unequivocally episodic. Traditional course predictors had limited temporal stability, highlighting the need to examine novel predictor variables. The ongoing risk of depression episodes into the second and third decades of life suggests that prevention efforts should start in late childhood.

A prognostic index for long-term outcome after successful acute phase cognitive therapy and interpersonal psychotherapy for major depressive disorder

“…Based on previous research, we expected the number of previous episodes and childhood maltreatment to be identified as predictors as well (Berwian et al., ; Hardeveld et al., ; Kovacs et al., ; Nanni et al., ). However, our selection methods did not identify these variables.…”

“…First of all, evidence is inconclusive for several predictors, including stressful life events, a family history of MDD, severity of the depressive episode, and comorbidity (e.g., dysthymia and personality pathology, Burcusa & Iacono, ; Hardeveld et al., ; Hardeveld, Spijker, De Graaf, Nolen, & Beekman, ). Only a few predictors have been repeatedly found to relate to an unfavorable long‐term course of MDD, namely the number of previous episodes, residual symptoms, and childhood maltreatment (Berwian, Walter, Seifritz, & Huys, ; Hardeveld, Spijker, De Graaf, Nolen, & Beekman, ; Kovacs, Obrosky, & George, ; Nanni, Uher, & Danese, ). Second, several studies have shown that the risk of recurrence of MDD depends on the combination of multiple predictors each having a small prognostic effect (van Loo et al., ; Wang et al., ).…”

Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation

“…Unipolar depression is characterized as a recurrent disease [36]. Phases with mild to severe symptoms (episodes) alternate with phases without, or with only minimal, symptoms (remission) [37,38].…”

Comorbid anxiety moderates the relationship between depression history and prefrontal EEG asymmetry

“…Consistent with previous research (Barlow, 1991;Heller, Nitschke, Etienne, & Miller, 1997;Nitschke, Heller, Palmieri, & Miller, 1999;Watson, 2005), we defined anxious apprehension as excessive worry for the future and verbal rumination about negative expectations, reflected in generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), or separation anxiety disorder (SAD). We focused on COD, given its strong association with restingstate prefrontal EEG activity (Shankman & Klein, 2003) and because individuals with COD are at very high risk for recurrent depression and lifetime anxiety disorders (Kovacs, Obrosky, & George, 2016;Maser & Cloninger, 1990).…”