Continuities in the long term

It seems, then, that both depressive symptoms and depressive disorder show significant continuity over time. Do these continuities extend into adulthood? The available data suggest that they do. Harrington et al. (1990) followed up 63 depressed children and adolescents on average 18 years after their initial contact. The depressed group had a substantially greater risk of depression after the age of 17 years than a control group who had been matched on a large number of variables, including non-depressive symptoms and measures of social impairment. This increased risk was maintained well into adulthood and was associated with significantly increased rates of attending psychiatric services and of using medication, as compared to the controls. Depressed children were no more likely than the control children to suffer non-depressive disorders in adulthood, suggesting that the risk of adult depression was specific and unrelated to comorbidity with other psychiatric problems. Raoetal. (1995) also found high rates of recurrence of major depression in a clinical sample of depressed adolescents who were followed up 7 years later. Weissman and colleagues reported similar findings (Weissman et al., 1999).

Continuity from childhood into adult life has also been found in community surveys, such as the Dunedin Multidisciplinary Health and Development Study (DMHDS). In the DMHDS, mental health data were gathered at ages 11, 13, 15, 18, and 21 years. Follow-back longitudinal analyses found that subjects with a mood disorder at age 21 years were much more likely to have a history of previous mood disorder than of non-depressive disorders earlier in life (Newman et al., 1996). Similarly, prospective longitudinal analyses from the Oregon Adolescent Depression Project (Lewinsohn et al., 1999) found significant continuity from late adolescence (age 17 years) into early adult life (age 24 years). Thus, major depression in young adulthood was significantly more common in subjects who had had major depression in late adolescence than subjects who had had non-affective mental disorders or no psychiatric disorder (average annual rate 9.0%, 5.6%, and 3.7%, respectively). About 45% of adolescents with a history of major depression developed a new episode of depression between the ages of 19 and 24. In the New York longitudinal study (Cohen et al., 1993a; 1993b), anxiety or depression in adolescence predicted anxiety or depression in early adult life (Pine et al., 1998). Most adult anxiety or depression was preceded by earlier anxiety or depression. The British birth cohort follow-up of individuals born in 1946 found that evidence of affective disturbance at ages 13 and 15 years was a strong predictor of major affective disorder in middle life (Os et al., 1997).

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