Processes Involved In Continuity Direct persistence of the initial depression

The review thus far suggests that depression in young people is associated with a variety of adverse outcomes, particularly further episodes of depression and suicidal behaviour. What processes could underpin these strong continuities over time? The first point is that the strength and specificity of the continuities clearly support the idea that in some cases there may be direct persistence of the initial depression. At first sight, the finding that most cases of major depression among the young remit within a year (see below) would seem to suggest that direct persistence is uncommon. However, a detailed, 12-year prospective study of adults who had presented with major depression found that while only 15% had major depressive disorder (MDD)-level symptoms during the follow-up, 43% had subthreshold depression (Judd et al., 1998). The same may apply to depression in young people; major depression and dysthymia often overlap and one can lead to the other (Kovacs et al., 1994). The symptomatic course of depression seems to be malleable, and symptoms of major depression, dysthymia, and minor depression alternate over time in the same patients.

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