Implications for preventive policies

The evidence on the course of early-onset depressive disorders also has implications for preventive policies. For example, it may be that intensive work with at-risk groups, such as the children of depressed parents, will reduce the risk of depression in the children. Unfortunately, so far, data are lacking on the extent to which primary preventive interventions are, in fact, protective, so it may be better to concentrate on the early recognition and intensive treatment of the first episode of depression (Harrington & Clark, 1998). There is some evidence that in adults the earlier the intervention, the shorter the episode (Kupfer et al., 1989). It remains to be seen whether the same will be found in juvenile depression.

Finally, it should be noted that much of the impairment associated with depression occurs below the threshold for MDD (Harrington & Clark, 1998; Pickles et al., 2001). Therefore, future preventive programmes may need to focus as much on symptoms as on disorders.

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