Trajectories of Preschool Disorders to Full DSM Depression at School Age and Early Adolescence: Continuity of Preschool Depression

Abstract

Background Preschool-onset depression, a developmentally adapted form of depression arising between the ages of 3–6, has demonstrated numerous features of validity including characteristic alterations in stress reactivity and brain function. Notably, this validated syndrome with multiple clinical markers is characterized by sub-threshold DSM Major Depressive Disorder criteria, raising questions about its clinical significance. To clarify the utility and public health significance of the preschool-onset depression construct, diagnostic outcomes of this group at school age and adolescence were investigated. Methods We investigated the likelihood of meeting full DSM Major Depressive Disorder criteria in later childhood (i.e., ≥ age 6) as a function of preschool depression, other preschool Axis I disorders, maternal depression, parenting non-support and traumatic life events in a longitudinal prospective study of preschool children. Results Preschool-onset depression emerged as a robust predictor of DSM-5 Major Depressive Disorder in later childhood even after accounting for the effect of maternal depression and other risk factors. Preschool-onset conduct disorder also predicted DSM-5 Major Depressive Disorder in later childhood, but this association was partially mediated by maternal non-support, reducing the effect of preschool conduct disorder in predicting DSM depression by 21%. Discussion Study findings provide evidence that this preschool depressive syndrome is a robust risk factor for meeting full DSM criteria for Major Depressive Disorder in later childhood over and above other established risk factors. Preschool conduct disorder also predicted Major Depressive Disorder but was mediated by maternal non-support. Findings suggest that attention to preschool depression and conduct disorder in addition to maternal depression and exposure to trauma should now become an important factor for identification of young children at highest risk for later MDD who should be targeted for early interventions.

Physical Activity, Sedentary Behavior, and Symptoms of Major Depression in Middle Childhood

“…Thus, research with substantially larger samples is required to determine whether objectively measured MVPA would decrease the risk of MDD in community children. Nonetheless, because previous research has shown that there is a continuity in depressive symptoms from childhood to adolescence and later adulthood, 53 that an elevated level of MDD symptoms increases the risk of later MDD, 54,55 and that subclinical depression may entail substantial impairment (also in the long run), 56 our findings suggest that increasing MVPA at the population level may lead to reduced symptoms of depressionand the impairment that accompanies these symptoms in some children. Second, data were MNAR, which may have led to biased results.…”

Depression from childhood through adolescence: risk mechanisms across multiple systems and levels of analysis

“…Modal onset of first episodes of depression most commonly occur in middle to late adolescence (1, 2), and many adult depressive episodes represent recurrences of adolescent-onset depression (3). Compelling evidence shows that depression often begins much earlier than previously believed, including during preschool (4,5). Risk factors and processes first emerge, and then accumulate and crystalize over time, likely via dynamic developmental cascades starting with early adverse environments and then ongoing chronic and acute stressors that transact with these vulnerabilities across multiple systems and levels of analysis until these risks stabilize and consolidate.…”

A Longitudinal Study of Fathers’ and Young Children’s Depressive Symptoms

“…Some symptoms assessed by this scale (such as irritability and loneliness) cut across multiple diagnostic categories, and indeed, scores on the depression subscale were correlated with reports of overall externalizing symptoms; it is unclear whether this simply reflects the high comorbidity among emotional and behavioral diagnoses or a more critical measurement issue. Some researchers have found that current diagnostic criteria (used for children and adults) can be used to adequately assess depression in preschoolers (see Luby et al, 2014) and distinguish depression from certain behavioral disorders (Strickland et al, 2011); however, this research area is still in its infancy, and it is crucial that we learn more about how these symptoms develop and manifest themselves in very young children to aid early intervention efforts. Fifth, the study did not evaluate possible mechanisms of the link between fathers’ and children’s depression, such as parenting or family conflict.…”

“…One-year prevalence rates for MDD have been estimated at about 2% for children and 4–7% for adolescents (Costello et al, 2002), and approximately 15–20% of teenagers will experience MDD by the time they reach 18 years of age (Birmaher et al, 1996). Several researchers have found that children who experience depressive symptoms are at significantly higher risk for experiencing depression later in life (e.g., Harrington, Fudge, Rutter, Pickles, & Hill, 1990; McGee & Williams, 1988), and even depressive symptoms in preschool (assessed at ages 2–5) have been found to predict higher levels of depression and other internalizing problems several years later (Lavigne et al, 1998; Luby, Gaffrey, Tillman, April, & Belden, 2014; Mesman & Koot, 2001). …”