Adolescent MDD Associated With Anxious-Depressive Symptoms in Childhood

young boy being held by mother
young boy being held by mother
Investigators sought to determine early warning signs in elementary school children to predict the development of MDD.

New data published in The Journal of Clinical Child & Adolescent Psychology demonstrated that children who later met criteria for major depressive disorder (MDD) were significantly more likely to demonstrate core features of depressive and anxiety disorders during their elementary school years.

Caregivers of 468 seventh graders retrospectively reported the manifestation of 14 distinct symptoms of depression and anxiety in their children from kindergarten to sixth grade. From these reports, researchers calculated childhood period prevalence for each symptom and performed discrete time survival analyses to compare the likelihood of certain symptoms in children with and without MDD onset by ninth grade. The prevalence of each symptom during the 7-year study window ranged between 20% (excessive guilt) and 50% (concentration problems), indicating that symptoms of depression and anxiety are common during childhood, despite a low occurrence of depressive disorders in later years.

Between fifth and ninth grade, 51 participants demonstrated the onset of MDD for a weighted 4-year period prevalence of 8.9% (95% CI, 6.5-12.1). This sample of adolescents had an elevated likelihood of 4 depression symptoms and 2 anxiety symptoms during childhood compared with those in whom MDD did not develop. Specifically, individuals with MDD showed a significantly higher likelihood of onset between kindergarten and sixth grade of sad mood (odds ratio [OR] 1.64; 95% CI, 1.03-2.61), anhedonia (OR 1.76; 95% CI, 1.09-2.84), fatigue (OR 2.34; 95% CI, 1.48-3.69), guilt and self-blame (OR 1.92; 95% CI, 1.08-3.40), excessive worrying (OR 2.20; 95% CI, 1.41-3.43), and social withdrawal (OR 1.73; 95% CI, 1.03-2.90). 

Of the remaining symptoms evaluated, none were found to be more prevalent during childhood in those in whom MDD later developed. Investigators also found that male children had a greater likelihood of childhood onset of sad mood (OR 1.50; 95% CI, 1.07-2.13), fatigue (OR 1.54; 95% CI, 1.07-2.22), and trouble concentrating (OR 1.46; 95% CI, 1.06-1.99). These data are consistent with current literature indicating a slightly higher risk for depression prior to adolescence in boys compared with girls.

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Researchers noted that parent-reported data may have been susceptible to symptom misclassification because of the potential for children to internalize symptoms. Investigators also suggested that future studies employ a longer study period to capture the peak incidence of MDD during adolescence. Still, these results may provide guidance on the timing and specificity of MDD symptom monitoring in children to allow for early intervention.


Gudmundsen GR, Rhew IC, McCauley E, Kim J, Vander Stoep A. Emergence of depressive symptoms from kindergarten to sixth grade. J. Clin. Child Adolesc Psychol. 2018:1-15.