Discontinuity And Recovery Developmental discontinuities

The findings thus far suggest that juvenile depressive disorders show significant continuities over time. Nevertheless, the available data also suggest that many depressed young people will not go on to have another episode, and so it is important to consider the reasons for discontinuity. There is a surprising lack of knowledge on this issue, but some limited evidence is available.

The first point to make is that there may be developmental differences in the continuity of depressive disorders. Interest in the possibility of such differences has been increased by the finding of marked age differences in the prevalence of affective phenomena such as depression, suicide, and attempted suicide (Harrington et al., 1996). Thus, for example, it seems that depressive disorders show an increase in frequency during early adolescence (Angold et al., 1998). The reasons for these age trends are still unclear, but there is some evidence that they are accompanied by developmental differences in continuity. Thus, in our child-to-adult follow-up of depressed young people, continuity to major depression in adulthood was significantly stronger in pubescent/postpubertal depressed probands than in prepubertal depressed subjects (Harrington et al., 1990). All five cases of bipolar disorder in adulthood occurred in the postpubertal group. Similarly, Kovacs et al. (1989) reported that among patients who had recovered from their index episode of major depression, older children would go into a new episode faster than younger ones. Other studies, too, have found that older age predicts greater persistence of depression (Goodyer et al., 1997b; Sandford et al., 1995).

What do these differences mean? Clearly, the association with age, puberty, or both suggests that maturational factors could play an important part. For example, perhaps the relative cognitive immaturity of younger children protects them from the development of cognitive "scars" arising from an episode of depression. Or, it may be that the massive changes in sex-hormone production that occur around the time of puberty are involved. However, it would be unwise to dismiss the effects of environment altogether. After all, puberty is associated not only with maturational changes but also with marked changes in social/family environment (Buchanan et al., 1992). Indeed, there is evidence that children who develop depression are more likely to be those from families in which there is much discord and expressed emotion than depressed adolescents (Harrington et al., 1997). It could be that for depression to occur at a developmentally inappropriate period (that is, early childhood), stressors need to be particularly severe.

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