Adolescent Depression: When to Intervene and With Whom

NEW YORK (Reuters Health) – New data from a long-running study shed light on trajectories of depressive symptoms experienced from adolescence to early adulthood, which could help pinpoint when to intervene in adolescent depression, and with whom.

“Depression often first emerges in adolescence and, for many, is a lifelong disorder. The long-term clinical course of depression is highly variable,” researchers note in The Lancet Psychiatry.

The team analyzed trajectories of adolescent depressive symptoms in 4,234 participants in the English population-based Avon Longitudinal Study of Parents and Children.

Self-reported depression symptoms were assessed on 10 occasions between age 10 and 25 years using the short mood and feelings questionnaire, and major depressive disorder episodes were assessed at 13, 15, 17.5 and 25 years.

Dr. Bryony Weavers and colleagues of the Wolfson Center for Young People’s Mental Health at Cardiff University identified four depression trajectory groups:

  • The “stable-low” group (54%) had depressive symptoms that remained low over the study period.

  • The “adult-increasing” group (25%) had symptoms that began later in adolescence and peaked in adult life.

  • The “adolescent-limited” group (14%) had depressive symptoms that began later in adolescence and remitted by early adulthood.

  • The “adolescent-persistent” group (7%) had early-onset depressive symptoms that persisted into adulthood.

The adolescent-persistent depression was associated with poor adult outcomes including functional impairment (62%), suicidal self-harm (27%), mental-health problems (25%), with 16% not in education, employment, or training, the researchers report.

Adolescent-limited depression was associated with transient adolescent stress, but by early adulthood functional impairment and mental-health difficulties were similar to the stable-low depression group, they note.

The persistent group also had higher rates of early adversity (childhood poverty and adverse experiences) than the limited group, and also had higher genetic liability to depression.

“Understanding how childhood antecedents and the lived experiences of young people can precipitate or heighten ongoing depressive symptoms as they transition through adolescence is central to providing holistic mental health care,” write Dr. Alison Fogarty and Dr. Fiona Mensah, with Murdoch Children’s Research Institute, Melbourne, Australia, in a linked comment.

“The mental health burden and impairment experienced by this cohort of young people accentuate the need for comprehensive sustained services. Specialist mental health care services might support only a proportion of these young people, prioritizing those with the most severe presentations,” they say.

“This study emphasizes the need for services that recognize and respond quickly to mental health distress in young people and maintain support over sustained periods of recovery and healing,” they conclude.

Funding for this research was provided by the Medical Research Council, Wolfson Center for Young People’s Mental Health, Wolfson Foundation.

SOURCE: and The Lancet Psychiatry, online October 18, 2021.

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