Psychosocial impairment in offspring of depressed parents

BACKGROUND

Offspring of depressed parents experience impairment in a number of domains of functioning. Few studies have examined the impact of both maternal and paternal depression and co-morbid psychopathology on offspring functioning.

METHOD

Oregon Adolescent Depression Project participants were administered diagnostic interviews and completed measures of psychosocial functioning during adolescence (mean = 16.6, S.D. = 1.19) and again during young adulthood (mean = 24.5, S.D. = 0.51). Diagnostic interviews were also conducted with the mothers and fathers of the target individual.

RESULTS

After controlling for relevant demographic characteristics, parental co-morbid psychopathology, and offspring psychopathology, maternal depression was associated with higher levels of physical symptoms (beta = 0.14, S.E. = 0.07) during adolescence, and higher levels of minor stressors (beta = 2.52, S.E. = 1.07) and a greater risk for using mental health services (OR 1.86, 95% CI 1.14-3.03) in young adulthood. Paternal depression was associated with offspring experiencing more major stressors (beta = 0.27, S.E. = 0.07), having lower perceived social competence (beta = -0.17, S.E. = 0.08), and being more likely to attempt suicide (OR 2.65, 95% CI 1.19-5.92) during adolescence, as well as lower perceived social competence (beta = -1.21, S.E. = 0.49) in young adulthood.Conclusions. Offspring of depressed parents demonstrate impairment in a variety of domains, even after controlling for the effects of their own psychopathology. Further research on the mechanisms that lead to these impairments, as well as the role of these impairments in the subsequent development of psychopathology, is warranted.

Association of parental depression with psychiatric course from adolescence to young adulthood among formerly depressed individuals

The authors examined whether parental major depressive disorder (MDD) is associated with course of depression and other psychopathology among formerly depressed adolescents as they enter adulthood. The sample consisted of 244 individuals (age 24) in a longitudinal study who had experienced MDD by 19. Maternal MDD was associated with MDD recurrence, chronicity and severity, anxiety disorders, and (among sons only) lower psychosocial functioning in offspring between the ages of 19 and 24. Paternal MDD was associated with lower functioning. Sons of depressed fathers had elevated suicidal ideation and attempt rates in young adulthood. Recurrent paternal MDD was associated with depression recurrence in daughters but not sons. The impact of parental MDD on offspring could not be attributed to characteristics of the offspring's depression prior to age 19.

Psychopathology in the adolescent and young adult offspring of a community sample of mothers and fathers with major depression

BACKGROUND

There is a large literature indicating that the offspring of mothers with Major Depressive Disorder (MDD) are at increased risk for depression. However, much less is known about the effects of paternal MDD on offspring psychopathology.

METHOD

We addressed this issue using a large community sample of parents and their adolescent and young adult offspring (n = 775). Parents and offspring were independently assessed with semi-structured diagnostic interviews. Offspring were interviewed three times from mid-adolescence to age 24 years.

RESULTS

Maternal MDD was significantly associated with offspring MDD. Paternal MDD was also significantly associated with MDD in offspring, but only among offspring with depressive episodes of moderate or greater severity. These effects persisted after controlling for socio-economic status, family intactness, and non-mood disorders in both parents. Rates of MDD were particularly elevated in offspring of mothers and fathers with early-onset MDD, and offspring of fathers with recurrent MDD. The magnitude of the associations between MDD in parents and offspring was generally in the small-to-medium range.

CONCLUSIONS

These results confirm previous findings of elevated risk of MDD in the offspring of depressed mothers. In addition, the results suggest that MDD in fathers is associated with increased risk of depression in offspring, but that it is limited to MDD episodes in offspring of moderate or greater severity.

Respiratory symptoms and mental disorders among youth: results from a prospective, longitudinal study

OBJECTIVE

To determine the relationship between respiratory symptoms and mental disorders among youth in the community, and to investigate possible mechanisms of these linkages.

METHODS

Data were drawn from the Oregon Adolescent Depression Project (n = 1,709), a longitudinal study of adolescents in the community. Multiple logistic regression analyses were used to examine the cross-sectional and longitudinal associations between respiratory symptoms and mental disorders at baseline, and linkages between respiratory symptoms at baseline and the onset of specific mental disorders at follow-up. Additional analyses were performed to examine the strength and specificity of the relationship between respiratory symptoms and mental disorders. The potential roles of hypochondriasis, functional impairment, and cigarette smoking in the associations between respiratory symptoms and mental disorders were investigated.

RESULTS

Respiratory symptoms were associated with a significantly increased odds of any mental disorder (odds ratio (OR) = 1.9), specifically any depressive disorder (OR = 1.9), major depression (OR = 1.9), any substance use disorders (OR = 1.6), panic attacks (OR = 3.1), and attention deficit/hyperactivity disorder (ADHD) (OR = 5.8) at baseline. Respiratory symptoms at between 1987 and 1989 (Time 1) were associated with significantly increased risk of the onset of any mental disorder a year later (Time 2) (OR = 2.1). While demographic differences, hypochondriasis, functional impairment, and cigarette smoking contributed to the relationships between respiratory symptoms and mental disorders, these associations persisted after adjusting for these factors.

CONCLUSIONS

The results suggest evidence of an association between respiratory symptoms and mental disorders among youth in the community. While demographic differences, hypochondriasis, functional impairment, and cigarette smoking may contribute to the linkage, these factors do not appear to completely explain the association. Future studies that can replicate these findings and include an examination of other possible mechanisms for these patterns of comorbidity, such as shared familial vulnerability or other environmental risk factors (e.g., childhood behavioral risk factors), are needed next.

Is major depressive disorder or dysthymia more strongly associated with bulimia nervosa?

OBJECTIVE

Research on adult samples has found that the comorbidity between depression and eating disorders exceeds the comorbidity of any other Axis I disorder and eating disorders. Few studies have investigated the specific associations of major depression versus dysthymia with eating disorders.

METHOD

This sample consisted of 937 adolescents who were repeatedly assessed until the age of 24.

RESULTS

Analyses revealed that dysthymia was a stronger correlate with bulimia than major depression, even while controlling for other mood disorders and a history of depression and dysthymia.

CONCLUSIONS

The presence of dysthymia in adolescence might be a possible risk factor for the development of bulimia nervosa.

Psychiatric disorders, familial factors, and cigarette smoking: II. Associations with progression to daily smoking

This study examined (a) associations of progression to daily cigarette smoking with lifetime psychopathology, regular smoking by family members, and psychopathology in family members, (b) the degree to which disorders precede or follow progression to daily smoking, and (c) whether daily smokers differ as a function of nicotine dependence. Among 941 participants interviewed at three time points, 722 (77%) had experimented with cigarette smoking, 391 of whom (54%) progressed to daily smoking. Lifetime psychiatric diagnoses were obtained at each assessment. Biological parents and full siblings were interviewed for lifetime psychopathology and regular smoking. Progression to daily smoking was associated with lower parental education, major depression, alcohol and drug use disorders, attention-deficit/hyperactivity disorder (ADHD) or disruptive behavior disorders, antisocial personality disorder symptoms, regular smoking by father (but not mother or sibling), and one measure of psychopathology in family members (externalizing disorders, which consisted of ADHD, conduct disorder, oppositional defiant disorder, and antisocial personality disorder). When composite measures of internalizing disorders, externalizing disorders, familial smoking, and familial psychopathology were examined in a single model, only the externalizing disorders composite remained associated with both daily smoking and nicotine dependence. Only ADHD consistently preceded the onset of daily smoking. Nicotine dependence was associated with drug use disorders and alcohol use disorders. In conclusion, externalizing disorders had the strongest associations, both with progression to daily smoking among adolescents who initiate smoking and with nicotine dependence among the daily smokers. Limitations of the present study and future research directions are noted.

Is pubertal timing associated with psychopathology in young adulthood

OBJECTIVE

This investigation tested whether the timing of puberty continued to be associated with experiences of psychopathology (symptoms and disorders) from mid-adolescence into young adulthood.

METHOD

At age 24, 931 participants from a large community sample, who had been interviewed twice during adolescence, completed a telephone interview (assessing Axis I disorders and elevated antisocial and borderline personality traits) and a mailed questionnaire battery.

RESULTS

Analyses tested whether pubertal timing was associated with lifetime and current history of mental disorders and psychosocial functioning in young adulthood. As expected, young women who had been early maturers had higher rates of lifetime history of disorder along with current elevation of psychosocial symptoms compared with women who were on-time maturers. Young men who had been late maturers, compared with other men, had elevated onset of disruptive behavior and substance use disorders during the transition to adulthood.

CONCLUSIONS

Early maturing females are at unique risk of persistent difficulty during adolescence and should be targeted for preventive efforts. Late maturation among males may be associated with a late-onset pathway for deviant behavior or substance abuse.

Psychiatric disorders, familial factors, and cigarette smoking: III. Associations with cessation by young adulthood among daily smokers

The present study examined whether lifetime psychopathology, regular smoking and psychopathology in family members, and smoking characteristics were associated with successful cessation among daily smokers. A sample of 941 young adults was interviewed for lifetime psychopathology and smoking at three time points; biological parents and siblings were interviewed once for lifetime psychopathology and regular smoking. Within the subset of 242 daily smokers with complete data, most (83%) had tried to quit at least once, although only 22% met our definition of successful cessation (no smoking during the 12 months prior to turning age 25 years). Successful cessation was positively associated with being married and having a higher household income in young adulthood, and negatively associated with lifetime major depressive disorder, elevated antisocial personality disorder symptoms, a family history of drug and alcohol use disorder, and nicotine dependence (for women but not men). Marital status, nicotine dependence (for women but not men), and male gender were significant in multivariate analyses; the effect for major depressive disorder approached significance (p=.052). None of the measures of familial smoking were associated with successful smoking cessation. In conclusion, whereas almost all Axis I disorders in our two previous papers were associated with smoking initiation and progression to daily smoking, major depressive disorder and antisocial personality disorder symptoms were the only psychiatric conditions negatively associated with successful cessation. The causal nature of the significant associations and the degree to which modification of these factors increases the probability of future smoking cessation deserve further attention.

The prevalence and co-morbidity of subthreshold psychiatric conditions

BACKGROUND

In previous studies of subthreshold conditions, co-morbidity has been largely ignored. The purpose was to examine rates of co-morbidity among subthreshold disorders and between subthreshold and full-syndrome disorders for the major non-psychotic classes of disorders from DSM-IV.

METHOD

Participants came from the Oregon Adolescent Depression Project (mean age=16.6 years; females=52.1%). On the basis of a diagnostic interview (K-SADS), participants were assigned to eight subthreshold disorders (MDD, bipolar, eating, anxiety, alcohol use, substance use, conduct, ADHD).

RESULTS

Of the 1704 adolescents in the analyses, 52.5% had at least one subthreshood disorder. Of those, 40.0% had also experienced a co-morbid subthreshold condition, and 29.9% of those had a second co-morbid subthreshold condition. Of those with a subthreshold, 36.4% also had a full syndrome. The subthreshold forms of externalizing disorders were co-morbid with each other. As expected, subthreshold anxiety was co-morbid with subthreshold MDD but subthreshold anxiety was also co-morbid with subthreshold alcohol, conduct, and ADHD. The pattern of co-morbidities was nearly identical for males and females.

CONCLUSIONS

The hypotheses that externalizing disorders would be co-morbid with other externalizing disorders and that internalizing disorders would be co-morbid with other internalizing disorders was partially supported. Co-morbidities between subthreshold disorders and between subthreshold disorders and full syndrome should impact future research and clinical practice. The assessment of subthreshold disorders needs to include the assessment of other subthreshold and full-syndrome conditions.

Family study of chronic depression in a community sample of young adults

OBJECTIVE

The validity of the distinctions between dysthymic disorder, chronic major depressive disorder, and episodic major depressive disorder was examined in a family study of a large community sample of young adults.

METHOD

First-degree relatives (N=2,615) of 30 probands with dysthymic disorder, 65 probands with chronic major depressive disorder, 313 probands with episodic major depressive disorder, and 392 probands with no history of mood disorder were assessed by using direct interviews and informant reports.

RESULTS

The rates of major depressive disorder were significantly greater among the relatives of probands with dysthymic disorder and chronic major depressive disorder than among the relatives of probands with episodic major depressive disorder, who in turn exhibited a higher rate of major depressive disorder than the relatives of probands with no history of mood disorder. The relatives of probands with dysthymic disorder had a significantly higher rate of dysthymic disorder than the relatives of probands with no history of mood disorder, and the relatives of probands with chronic major depressive disorder had a significantly higher rate of chronic major depressive disorder than the relatives of probands with no history of mood disorder. However, the relatives of the three groups of probands with depression did not differ on rates of dysthymic disorder and chronic major depressive disorder.

CONCLUSIONS

Chronic depression is distinguished from episodic depression by a more severe familial liability. This familial liability may contribute to the more pernicious course of chronic depression.

Bipolar disorders during adolescence

OBJECTIVE

To examine the incidence, correlates, course and family history of bipolar disorder (BD) and subthreshold BD in adolescents.

METHOD

Structured diagnostic interviews were conducted with a large community sample of adolescents and their first-degree relatives, and the adolescents were re-evaluated as young adults.

RESULTS

The first lifetime onset of BD and subthreshold BD almost always occurred in adolescence. Adolescent BD and subthreshold BD were associated with elevated impairment, comorbidity, and suicide attempts. Adolescents with BD were at increased risk for BD, and adolescents with subthreshold BD were at increased risk for major depressive disorder (MDD) in young adulthood. Relatives of BD adolescents had elevated rates of subthreshold BD and MDD, and relatives of subthreshold BD adolescents had elevated rates of BD and MDD.

CONCLUSION

'Classical' BD clearly exists in adolescence, but there is also a spectrum of milder bipolar conditions. Remediating and preventing BD in adolescents should be a high public health priority.

Comparability of self-report checklist and interview data in the assessment of stressful life events in young adults

The purpose of this study was to evaluate the incremental value of conducting an interview to assess stressful life events over the self-report questionnaire approach, first by examining the degree to which life events reported on a questionnaire met inclusion criteria in a detailed stress interview, and second, by comparing the magnitude of prospective associations with depression symptoms for the two different assessment procedures. Data from the Oregon Adolescent Depression Project were examined, in which 191 community-residing young adults (55% female; M age=23.6, SD=0.6) completed a mailed questionnaire assessing the frequency with which 33 life events had occurred to them or to other important people in their lives prior to the diagnostic and stress interviews. An average of 67.5% of events occurring to self met criteria for classification as a life event on the stress interview, as did 19.7% of the events occurring to others. Events having a large effect on the participant had a greater likelihood of meeting inclusion criteria on the stress interview. Contrary to expectation, stress scores from the interview assessment did not result in stronger associations with depression. Recommendations for assessment of stressful life events are offered.

A Cross-Cultural Investigation of Cognitions and Depressive Symptoms in Adolescents

Adolescents (N=2,272) from Hong Kong and the United States provided information regarding their depressive symptoms, cognitions (self-efficacy, negative cognitive errors, and hopelessness), and stressful events between 2 surveys 6 months apart. Depressive symptoms and hopelessness were higher, and self-efficacy and negative cognitive errors were lower in Hong Kong than in the United States. Cognitions were associated with concurrent depressive symptoms and predicted depressive symptoms 6 months later in both cultures. The "reverse" model was also supported with more variance predicted by depressive symptoms to later cognitions than from cognitions to depressive symptoms. There was some support for the hypothesis that self-efficacy is less salient in collective compared with individualistic cultures. These findings extend cognitive theories of depression to a non-Western culture.

Family study of subthreshold depressive symptoms: risk factor for MDD?

BACKGROUND

Family study data from a large community sample of young adults and their first-degree relatives were used to examine three questions regarding the relation between subthreshold depression (SubD) and major depressive disorder (MDD): (a) is there an elevated rate of MDD in the relatives of probands with SubD? (b) does SubD aggregate in the families of probands with MDD and SubD? (c) is the relationship between SubD and familial psychopathology specific to MDD?

METHODS

A total of 941 probands were assessed twice during adolescence and then at age 24. Direct and informant information was obtained on 2750 first-degree relatives of 840 probands.

RESULTS

The rate of MDD in the relatives of probands with SubD (24.3%) was significantly lower than the relatives of probands with MDD (31.9%) but was significantly higher than the relatives of probands with no history of mood disorder (NMD; 20.2%). Relatives of MDD, SubD and NMD probands did not differ on rates of SubD (9.0, 9.4 and 9.0%, respectively). Familial aggregation of psychopathology in SubD probands was specific to MDD.

LIMITATIONS

The primary limitation may be the absence of a standardized definition and assessment procedure for the SubD category. In addition, the sample size, although large, may have been inadequate to detect smaller associations or the moderating effects of sex.

CONCLUSION

The results data support the view that SubD occupies a milder position on a continuum with MDD.

Psychosocial functioning of young adults who have experienced and recovered from major depressive disorder during adolescence

The authors examined whether adolescent major depressive disorder (MDD) was associated with difficulties in young adult functioning and whether differences would remain significant after accounting for nonmood disorder, MDD recurrence, functioning in adolescence, or current mood state. A total of 941 participants were assessed twice during adolescence and at age 24. In unadjusted analyses, adolescent MDD was associated with most young adult functioning measures. Associations were not due to interactions with adolescent comorbidity, but differences in global functioning and mental health treatment appeared as a result of MDD recurrence. Accounting for levels of functioning in adolescence or for current depression at age 24 eliminated the remaining associations. The implications of these findings for efforts to prevent MDD in adolescence are discussed.

Family study of co-morbidity between major depressive disorder and anxiety disorders

BACKGROUND

Numerous studies have documented high rates of co-morbidity between major depressive disorder (MDD) and the anxiety disorders (ANX). However, the reason for this is unclear. Family studies provide one potentially useful approach for addressing this issue.

METHOD

We explored six explanations of the co-morbidity between MDD and ANX using a family study of a large community sample of young adults and their first-degree relatives. Participants included 112 probands with a lifetime history of both MDD and one or more ANX, 290 probands with a history of MDD but no ANX, 43 probands with a history of one or more ANX but no MDD. 352 probands with no lifetime history of either MDD or ANX, and the probands' 2608 first-degree relatives. Probands were assessed using semi-structured diagnostic interviews on two occasions in adolescence and a third time at age 24. Diagnostic data on relatives were collected using both direct and family history interviews.

RESULTS

Compared with controls, MDD aggregated in the families of probands with MDD, whether or not they had co-morbid ANX; ANX aggregated in the families of probands with ANX, regardless of whether they had co-morbid MDD; and co-morbid MDD/ANX aggregated only in the families of probands with both MDD and ANX. The relatives of probands with ANX alone had a significantly higher rate of ANX than the relatives of probands with MDD alone, although none of the other comparisons between the depressed and anxious groups were significant.

CONCLUSIONS

This pattern of findings is largely, although not completely, consistent with the view that MDD and ANX are transmitted independently within families, and suggests that the comorbidity between MDD and ANX is caused by non-familial aetiological factors.

Psychosocial adjustment in young adulthood of women who experienced an eating disorder during adolescence

OBJECTIVE

To examine the impact of an adolescent eating disorder on psychosocial adjustment in young adulthood.

METHOD

A randomly selected sample of high school girls was assessed on a wide array of psychosocial and diagnostic variables twice during adolescence (n = 891, n = 810), and a stratified subset (n = 539) was assessed during their 24th year. Based on their history of psychopathology before age 19, participants were categorized into (1) partial- or full-syndrome eating disorder (ED; n = 36); (2) non-comorbid major depressive disorder (MDD; n = 95); (3) non-mood disorder without ED or MDD (NMD; n = 64); and (4) no disorder (ND; n = 138).

RESULTS

Discriminant function analysis identified a single significant function (variance = 57%) in which the ED group was significantly elevated (mean = 0.87, SD = 1.20) compared with the other three groups; the MDD (mean = 0.14, SD = 1.00) and NMD (mean = 0.17, SD = 0.99) group means were intermediary and differed from the ND group (mean = -0.40, SD = 0.95).

CONCLUSION

Despite apparent recovery of ED symptoms among most ED cases, women with a history of adolescent ED evidenced significant impairments in health, self-image, and important areas of social functioning. These findings underscore the clinical significance of adolescent ED.

The symptomatic expression of major depressive disorder in adolescents and young adults

Data from the Oregon Adolescent Depression Project were used to examine the symptomatic expression of major depressive disorder (MDD) as a function of age and gender. The objective was to investigate the phenomenological nature of MDD among a cohort of adolescents as they progressed into early adulthood. The analyses were based on 564 participants who had experienced MDD in their lifetime. No systematic differences in the relative rate of occurrence of specific symptoms across episodes and only minor symptom differences between male and female participants were found. Age did not significantly influence the symptom picture. Stability of specific symptoms and episode severity across episodes was low. The results are discussed within the context of a stressor-symptom matching model.

Psychiatric disorders, familial factors and cigarette smoking: I. Associations with smoking initiation

The aims of this study were to examine associations between smoking initiation (five cigarettes lifetime) and lifetime psychopathology, regular smoking by family members, and psychopathology in family members; to describe the degree to which the onset of the disorder precedes or follows smoking initiation; and to examine whether smoking initiators differ as a function of age of smoking onset. Nine hundred and forty-one participants were interviewed at three time points, beginning in high school and most recently at age 24. Lifetime psychiatric diagnoses were obtained at each assessment, as were data regarding smoking initiation. Biological parents and full siblings were interviewed for lifetime psychopathology and regular smoking. Most measures of lifetime psychopathology were associated with smoking initiation. Rates of initiation were especially elevated in participants with multiple disorders. Regular smoking by mother and a sibling (but not father) was associated significantly with smoking initiation, as were two of four measures of psychopathology in relatives. When all significant univariate variables were examined in a single model, drug use disorders, regular smoking by mother, and regular smoking by a sibling remained significantly associated with smoking initiation. Smoking initiation preceded approximately half of the examined diagnostic categories. Eleven variables differentiated early vs. late smoking initiators. Several interactions with gender were found. In every instance, smoking initiation was more strongly associated with the risk factor for young women than for young men. To our knowledge, this is the first time that the relations of psychopathology and familial factors with smoking initiation have been examined simultaneously or in this much detail. Results underscore the potential importance of assessing and treating psychiatric disorders in smoking prevention and cessation efforts.

The core of loneliness: lack of pleasurable engagement--more so than painful disconnection--predicts social impairment, depression onset, and recovery from depressive disorders among adolescents

Following past work, we proposed that loneliness possesses a bidimensional structure, with dimensions corresponding to lack of pleasurable engagement and painful disconnection. Moreover, we hypothesized that the distinction between lack of pleasurable engagement and painful disconnection would emerge in confirmatory factor analyses, in the pattern of relations of each facet to social impairment, in differential risk for the development of depressive disorders, and in differential rates of recovery from depressive disorders. Data from the Oregon Adolescent Depression Project were used to address these issues. Adolescents from high schools in urban and rural Oregon completed interviews and questionnaires on psychiatric status, loneliness, social functioning, and so forth, at one point in time and then again at a second session approximately a year later. Consistent with predictions, we found that the proposed bidimensional structure of loneliness represented a good fit to the covariance structure of loneliness items; the relation of lack of pleasurable engagement to social impairment exceeded that between painful disconnection and social impairment; and lack of pleasurable engagement, but not painful disconnection, was significantly related (in the expected directions) to onset of and recovery from depressive disorders. We discuss theoretical and clinical implications.

Gender differences in eating disorder symptoms in young adults

OBJECTIVE

The major goal of this study was to identify problematic eating behaviors and attitudes in young men and compare them with those of young women.

METHOD

A community sample of young adults (n = 1,056) completed a questionnaire that contained the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorder Inventory, as well as probes for inappropriate compensatory behaviors, excessive exercise, and episodes of binge eating.

RESULTS

A five-factor structure fit both male and female samples. Women had substantially elevated scores on all of the factors except excessive exercise, for which men had significantly higher scores. The absolute proportion of men and women wanting or having sought treatment was very low. However, at comparable levels of problematic eating behaviors, women were more likely to have sought treatment than men.

DISCUSSION

The questionnaire used in this study encompasses symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders symptoms, which should prove useful in future research.

Development and natural history of mood disorders

To expand and accelerate research on mood disorders, the National Institute of Mental Health (NIMH) developed a project to formulate a strategic research plan for mood disorder research. One of the areas selected for review concerns the development and natural history of these disorders. The NIMH convened a multidisciplinary Workgroup of scientists to review the field and the NIMH portfolio and to generate specific recommendations. To encourage a balanced and creative set of proposals, experts were included within and outside this area of research, as well as public stakeholders. The Workgroup identified the need for expanded knowledge of mood disorders in children and adolescents, noting important gaps in understanding the onset, course, and recurrence of early-onset unipolar and bipolar disorder. Recommendations included the need for a multidisciplinary research initiative on the pathogenesis of unipolar depression encompassing genetic and environmental risk and protective factors. Specifically, we encourage the NIMH to convene a panel of experts and advocates to review the findings concerning children at high risk for unipolar depression. Joint analyses of existing data sets should examine specific risk factors to refine models of pathogenesis in preparation for the next era of multidisciplinary research. Other priority areas include the need to assess the long-term impact of successful treatment of juvenile depression and known precursors of depression, in particular, childhood anxiety disorders. Expanded knowledge of pediatric-onset bipolar disorder was identified as a particularly pressing issue because of the severity of the disorder, the controversies surrounding its diagnosis and treatment, and the possibility that widespread use of psychotropic medications in vulnerable children may precipitate the condition. The Workgroup recommends that the NIMH establish a collaborative multisite multidisciplinary Network of Research Programs on Pediatric-Onset Bipolar Disorder to achieve a better understanding of its causes, course, treatment, and prevention. The NIMH should develop a capacity-building plan to ensure the availability of trained investigators in the child and adolescent field. Mood disorders are among the most prevalent, recurrent, and disabling of all illnesses. They are often disorders of early onset. Although the NIMH has made important strides in mood disorders research, more data, beginning with at-risk infants, children, and adolescents, are needed concerning the etiology and developmental course of these disorders. A diverse program of multidisciplinary research is recommended to reduce the burden on children and families affected with these conditions.

Bipolar disorder in adolescence and young adulthood

The purpose of this article is to present findings from the Oregon Adolescent Depression Project regarding full-syndrome and subthreshold bipolar disorder (BD) in adolescence and young adulthood. BD first incidence peaked around age 14 years. Adolescent BD showed significant continuity across developmental periods and was associated with adverse outcomes during young adulthood. Subthreshold BD results provide partial support for a bipolar spectrum.

Clinical features of major depressive disorder in adolescents and their relatives: impact on familial aggregation, implications for phenotype definition, and specificity of transmission

Three questions were addressed using family study data from a community sample: (a) Which clinical features of major depressive disorder (MDD) in adolescents are associated with elevated rates of MDD in relatives? (b) Which features of MDD in relatives distinguish family members of depressed adolescents from relatives of adolescents without mood disorders (NMD)? and (c) Do depressed adolescents with particular features have higher proportions of depressed relatives with the same features? Participants included 268 MDD adolescents, 401 NMD adolescents, and their 2,202 first-degree relatives. Rates of MDD were highest among relatives of depressed adolescents with recurrent episodes and greater impairment. Depression severity best distinguished the relatives of depressed adolescents from relatives of controls. Specific clinical features did not aggregate in families.