Youth Depression Onset Predicted by Anxiety, Family History, Adversity

Fear and anxiety showed the strongest correlation with development of major depression in children.

Irritability and fear or anxiety have emerged as significant precursors to adolescent depression in children of depressed parents, according to research published in JAMA Psychiatry. Displays of low mood or disruptive behavior, however, did not significantly precede or predict major depressive disorder in these children.

Other significant antecedents to an adolescent’s first episode of major depressive disorder included poverty, recent psychosocial adversity, a greater amount of family history of depression, and more severe depression in their parent with the condition, but these were not as interrelated as hypothesized by the authors.

“The indicators of social risk predicted MDD independent of correlated familial risk, parental depression severity, and clinical antecedents in the child, wrote Frances Rice, PhD, of Cardiff University in Wales and her colleagues. “This result has important implications for treatment and prevention and highlights the need to resolve not only clinical phenomena in the child but also wider contextual difficulties.”

The researchers tracked the biological children of parents with depression in 337 families over 4 years, from April 2007 to March 2011, who saw doctors at United Kingdom family practices. Among these families, 315 mothers and 22 fathers had experienced at least 2 episodes of major depressive disorder, and the researchers studied 197 daughters and 140 sons between ages 9 and 17. (In families with multiple children between these ages, the researchers chose the youngest children.)

After excluding families in which the children had already experienced depression or had another psychiatric disorder or intellectual disability, the researchers were able to follow up on 279 of 304 families overall. They used the Child and Adolescent Psychiatric Assessment (CAPA) and the Screen for Child Anxiety Related Emotional Disorders to evaluate the children’s low mood, fear/anxiety, and irritability and disruptive behavior. They also collected data on household income and the psychosocial adversity the children had experienced in the previous year.

The researchers used the DSM-IV to define major depressive disorder as showing at least 5 depressive symptoms. The researchers determined children’s risk of depression based on the severity of their parents’ condition and the number of relatives they had with depression.

At follow-up, the children had an average 1.85 symptoms of depression, and 20 had developed their first episode of major depression: 6 boys and 14 girls, together at an average age of 14.

Both irritability and fear/anxiety showed a significant correlation with first-time major depression, but after adjustment for other factors, disruptive behavior and low mood did not predict depression. Specifically, fear and anxiety symptoms showed the strongest link with development of major depression.

As expected, the severity of parental depression and a greater amount of family history of depression both predicted a child’s development of the disorder.  Poverty and recent adverse events directly affected the children’s new major depression diagnoses. “In addition, economic disadvantage and recent psychosocial adversity were associated with the clinical antecedents,” the authors added.

“Our findings suggest that primary prevention methods for depression in groups with high familial risk will need to include effective treatment of parental depression, irritability and fear/anxiety in the child and consider social risk factors,” the authors concluded. “Family-based programs may be indicated in children at high familial risk of depression because parental depression is associated with social adversity (poverty and stress exposure) and moderates the effectiveness of preventive programs focusing on the child.”

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Rice F, Sellers R, Hammerton G, Eyre O, et al. Antecedents of New-Onset Major Depressive Disorder in Children and Adolescents at High Familial Risk. JAMA Psychiatry. 2016; doi:10.1001/jamapsychiatry.2016.3140