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Summary affective disorders depression P2
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The document includes a summary of the required literature for depression p2 from clinical specialization course, 'affective disorders'. NOTE: exam grade 9.3
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1. Can major depression be found and diagnosed in children, how can it be treated,and how does this differ from adults?
- What types of treatment are available for depression in children and adolescents and
how do they compare in terms of clinical efficacy?
- How do different treatments for children differ in terms of Acceptability (number of
patients discontinuing treatment)?
- How do different treatments for children differ in terms of suicidal ideation?
- How can a diagnosis of depression at a young age produce unfavorable results later on?
Pointers: use the mental ELF blog to summarize, interpret and understand Zhou paper, don't
focus too much on separate studies in review papers, focus mainly on groups of pharmacy
(SSRIs vs TCA vs other.)
Pre Discussion notes:
Birth → excessive crying
Up to 1 year → withdrawal into self, weight loss, slow growth, inactivity, vacant expression,
inability to interact, excessive crying
1 - 3 years → irritable, nightmares and night-time panic attacks, excessively clingy, defiant, less
inclination to play, extremely anxious
3 - 5 yearsv→ distressed, weight loss, depressive symptoms, motor deficiencies, tired very
quickly, suicidal thoughts, frequent withdrawal into self, angry, listless, irritable, sickly
6 - 12 years → little enjoyment, listless, low self-esteem, tired very quickly, suicidal thoughts,
frequent withdrawal into self, irritable, difficult to motivate, motor deficiencies, criminal behaviour,
gets angry and hostile quickly, hyperactive, many anxieties, poor performance at school
12 - 18 years → volatile, gets angry quickly, low self-esteem, poor school performance, criminal
behaviour, tendency towards alcohol, drugs or medicine addiction, excessive or risky sexual
behaviour, frequent withdrawal into self, excessive eating and sleeping, suicidal tendencies
, David Fergusson 2002
MENTAL HEALTH, EDUCATIONAL, and SOCIAL ROLE OUTCOMES OF ADOLESCENTS
WITH DEPRESSION
Background info and previous research
Prevalence of depression in adolescence: around 1% to 8% of young people experience their
first episode of major depression by age 16
There is emerging evidence to suggests that young people showing early-onset depression or
depressive tendencies are at risk for several adverse outcomes such as:
- Further depressive episode
- Impaired social functioning
- Low academic achievement
- Other mental health problems such as anxiety disorders, substance abuse and suicidal
behaviors
But what are the pathways linking early depression to later outcomes? 3 of them are suggested:
(A) Direct effect of depression on later outcomes
E.g. depression may lead to imapired educational achievement and reduced life opportunities
(B) Noncausal link, and reflect the presence of antecedent factors that are associated with
increased risk of depression
E.g. early exposure to child abuse – increased risk of depression later in life (and thus reduced
life opportunities etc. depending on the extent to depression will be correlated with such
outcomes by the end of this research (research question1))
(C ) The link is mediated by the presence of comorbid disorders or other intervening
variables
Aim of the study
(1) To what extent are young people who develop depression in mid adolescence (age
14-16) at increased risk of subsequent mental disorders, academic underachievement,
and reduced life opportunities
(2) What are the pathways that may link adolescent depression to later outcomes? Direct,
indirect, mediated by comorbid disorders?
Subjects and methods
Data gathered from a longitudinal study including 1265 young people whose data were recorded
from 4 months to 16 years of age - 301 of the members were excluded
Adolescent depression → self-reported depression was assessed between ages 14 to 15 and
15 to 16, as well as parent-reported depression
,Psychiatric, educational, and social outcomes at age 16-21 → psychiatric outcomes (members
were later on interviewed about – substance abuse, other anxiety symptoms, symptoms of
nicotine dependence, alcohol abuse or dependence, suicidal behavior) & educational and social
role outcomes
Confounding factors → to assess the extent to which associations between adolescent
depression and later outcomes could be explained by the effects of confounding variables, the
following variables were included as covariates in the analysis:
- Family social background (maternal educational achievement and family socioeconomic
status at birth
- Family functioning (sexual abuse or parental change e.g. divorce)
- Individual functioning (neuroticism, intellectual ability, association with delinquent or
substance-abusing peers)
NOTE: confounding variable: the distortion of the association between the independent and
dependent variables because a third variable is independently associated with both
E.g. lack of exercise → weight gain – there is an association indeed, but sex and the amount of
food intake could be confounding variables
& comorbid psychiatric disorders and behavior → anxiety, alcohol abuse, conduct disorders, as
well as early cigarette smoking
Results
Relationships between adolescent depression and later outcomes (evidence for direct link
A)
Adolescents with depression were indeed at increased risk of
- Later depression, anxiety disorders, nicotine dependence, alcohol abuse or
dependence, suicidal behavior [odds ratios ranged from 1.2 to 4.5, highest being
depression, then anxiety, followed by suicide attempt]
- School failure, reduced likelihood of entering a university, pursuing another form of
tertiary education, higher rates of unemployment later in life, and early parenthood [odds
ratios ranged from 0.6 to 3.7, highest being early parenthood]
The results were independent of social backgrout, family circumstances, individual
characteristics, and comorbid disorders —-- evidence for direct link, consistent with previous
studies
Also, → No significant INTERACTIONS between depression and sex were found. Therefore the
relationship between adolescent depression and later outcomes was similar for girls and boys
HOWEVER, for most outcomes there was a significant MAIN EFFECT of sex, reflecting the fact
that rates of subsequent psychiatric, educational, and social role outcomes varied in
sex-specific ways.
E.g. males are more likely to abuse substances regardless of whether they have had adolescent
depression or not.
, Social, familial and individual factors associated with depression in early adolescence
Adolescents with and without depression had similar socioeconomic backgrounds. On the other
hand
- Adolescent with depression were significantly more likely to have been exposed to
sexual abuse and paretal change, have lower IQ at age 9, show tendencies to
neuroticism, and reported higher rates of devient peer involvement in adolescence
- Those with depression showed higher rates of comorbid anxiety disorders, conduct
disorders, and alcohol abuse as well as increased likelihood to smoke cigarettes
Relationships between depression in adolescence and later outcomes, adjusted for
confounding factors - evidence for the indirect link B
The results suggest two conclusions with regards to this part. (1) there was evidence of a clear
and specific continuity from adolescent depression to later depression, anxiety, even after
controlling for confounding factors and comorbid disorders
(2) the associations between adolescent depression and OTHER outcomes (nicotine
dependence, alcohol abuse, suicide, educational unachievement etc.) WERE explained by
confounding factors such as parental change, childhood sexual abuse, IQ, neuroticism etc.
SO, adolescent depression was associated with adverse psychiatric, educational and social
outcomes, and this association reflected antecedent social background, familial, and personal
factors.
Early depression → later depression DIRECT link
Early depression → other outcomes, INDIRECT link explained by aforementioned factors
Further implications: it is known that depression is a recurrent disorder, and this study proves
that those who have experienced depression in adolescence (+ the given confounding
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