Subsequent social impairment

There are a number of reasons for thinking that early-onset depression might not only predict further depression, but also could be associated with effects on social and cognitive functioning. Thus, depression in young people is frequently accompanied by social withdrawal and irritability, and so depressed youngsters may find it more difficult to establish and maintain social relationships. In addition, symptoms such as loss of concentration and psychomotor retardation may interfere with the process of learning. This, in turn, might lead to low self-esteem and so on to further academic failure. Kovacs and Goldston (1991) pointed out that young people suffering from major depression are impaired for a significant proportion of the lifespan, and they are handicapped at a time when learning takes place rapidly. Perhaps, then, they will eventually show cognitive as well as social delays.

Several studies have examined the social outcomes of depressed young people. In one of the first systematic studies, Puig-Antich and his colleagues (Puig-Antich et al., 1985a; 1985b) found that impairment of peer relationships persisted for several months after recovery from depression. In the longer term, Kandel and Davies (1986) reported that self-ratings of dysphoria in adolescence were associated with heavy cigarette smoking, greater involvement in delinquent activities, and impairment of intimate relationships as young adults. Garber et al. (1988) found that depressed adolescent inpatients reported more marital and relationship problems when they were followed-up 8 years after discharge than non-depressed psychiatric control subjects.

These findings have important theoretical as well as clinical implications since they suggest that the social isolation and lack of a supporting relationship that have been found in cross-sectional studies of adult depression (Brown & Harris, 1978) may reflect social selection as much as social causation. However, none of these studies excluded the effects that childhood conduct problems, which are commonly associated with adolescent depression, could have on these outcomes. Harrington et al. (1991) found that juvenile depression seemed to have little direct impact on social functioning in adulthood, whereas comorbid conduct disorder was a strong predictor of subsequent social maladjustment. Similar findings were reported by Renouf and colleagues (Renouf et al., 1997) in an intensive longitudinal study of depressed children and non-depressed psychiatric controls. Social dysfunction associated with comorbid depression and conduct disorder seemed to be mainly related to the effects of conduct disorder. Bardone et al. (1998) found that adolescent conduct disorder predicted more smoking, sexually transmitted diseases, and early pregnancy in adult life. Adolescent depression only predicted tobacco dependence and more medical problems. The implication is that it is important to differentiate the course of depressive disorder from the course of other, comorbid disorders.

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