Consequences of depression during adolescence: marital status and marital functioning in early adulthood

In previous studies, depression has been associated with both marital status and marital distress. Unfortunately, given the cross-sectional design of most of this research, the temporal nature of these associations is unclear. The authors examined the marital functioning of young adults as a function of whether they received psychiatric diagnoses of major depressive disorder or nonaffective psychiatric disorder during adolescence. Depression during adolescence was found to predict higher rates of marriage among younger women and subsequent marital dissatisfaction. This pattern of results appears to be specific to depression: The presence during adolescence of a nonaffective psychiatric disorder was unrelated to subsequent marital functioning. These findings highlight the potentially adverse consequences of depression in adolescence and underscore the importance of prevention and early treatment efforts.

Prenatal and perinatal influences on risk for psychopathology in childhood and adolescence

The relationship between a range of prenatal and perinatal events and risk for psychopathology in offspring was examined. Prenatal and perinatal events investigated included maternal experiences, health, and substance use during pregnancy, obstetric complications, feeding practices, and infant health during the first year of life. Offspring diagnosis was based on structured interviews conducted with 579 adolescents on two occasions. Risk for later psychopathology was associated with a number of prenatal and perinatal factors. Major depression was associated with not being breast fed and maternal emotional problems during the pregnancy. Anxiety was chiefly associated with fever and illness during the first year of life and maternal history of miscarriage and stillbirth. Disruptive behavior disorder was associated with poor maternal emotional health during the pregnancy and birth complications. Risk for substance use disorder was associated with maternal use of substances during the pregnancy. Mediating effects of maternal depression, maternal-child conflict, and physical symptoms in the child, and moderating effects of gender of child and parental education were also evaluated. The limitations of this study are discussed and future research directions are suggested.

Gender differences in anxiety disorders and anxiety symptoms in adolescents

Gender differences in anxiety were examined in a large sample of adolescents that included 1,079 who had never met criteria for any disorder, 95 who had recovered from an anxiety disorder, and 47 who had a current anxiety disorder. Participants were examined on a wide array of psychosocial measures. There was a preponderance of females among current and recovered anxiety disorder cases, but not among those who had never experienced an anxiety disorder. The female preponderance emerges early in life, and retrospective data indicate that at age 6, females are already twice as likely to have experienced an anxiety disorder than are males. Psychosocial variables that were correlated with both anxiety and gender were identified. Statistically controlling for these variables did not eliminate the gender differences in prevalence or anxiety symptom means.

Axis II psychopathology as a function of Axis I disorders in childhood and adolescence

OBJECTIVE

To examine the occurrence of elevated personality disorder (PD) dimensional scores in a community sample of young adults as a function of the occurrence of Axis I disorders through age 18 years.

METHOD

299 individuals who had been interviewed regarding Axis I disorders twice while in adolescence (first when 14 through 18 years of age) were carefully assessed regarding Axis I and II psychopathology at age 24.

RESULTS

The prevalence of PD diagnoses was relatively low (3.8% in participants with a history of Axis I versus 1.7% in participants with no Axis I history). The occurrence of all four Axis I diagnostic categories (major depression, anxiety disorders, disruptive behavior disorders, substance use disorders) in childhood and adolescence was associated with elevated PD dimensional scores. The likelihood of elevated PD dimensional scores increased as a function of the number of Axis I disorders. Elevated PD scores were significantly associated with a negative course of major depression.

CONCLUSIONS

Although the rates of PDs were low, the findings suggest a substantial degree of association between early-onset Axis I disorders and Axis II psychopathology in young adulthood. More research is needed to develop assessment and treatment recommendations addressing the early manifestations of PDs.

Is psychopathology associated with the timing of pubertal development?

OBJECTIVE

This investigation tested whether the timing of pubertal development was associated with concurrent and prior experiences of psychopathology (symptoms and disorders) in adolescent boys and girls.

METHOD

A large (N = 1,709) community sample of high school students were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children as adapted for use in epidemiological studies. Adolescents also completed a questionnaire battery covering a range of psychosocial variables.

RESULTS

Analyses tested whether pubertal timing was associated with present and lifetime history of mental disorders, psychological symptoms, and psychosocial functioning. As hypothesized, early-maturing girls and late-maturing boys showed more evidence of psychopathology than other same-gender adolescents.

CONCLUSIONS

Early-maturing girls had the poorest current and lifetime history of adjustment problems, indicating that this pattern of pubertal development merits attention by mental health providers and researchers.

Comparability of telephone and face-to-face interviews in assessing axis I and II disorders

OBJECTIVE

The present study examined the comparability of data obtained by telephone and face-to-face interviews for diagnosing axis I and II disorders.

METHOD

Sixty young adults from the community were interviewed face-to-face and over the telephone regarding axis I disorders; another 60 subjects were interviewed twice regarding axis II disorders. The order of interviews was counterbalanced, and subjects with a history of disorder were oversampled. Agreement between telephone and face-to-face interviews was contrasted with interrater values, which were obtained by having a second interviewer rate a recording of the original interview.

RESULTS

Interrater reliability was excellent. Agreement between telephone and face-to-face assessment was excellent for anxiety disorders and very good for major depressive disorder and alcohol and substance use disorders; agreement was problematic, however, for adjustment disorder with depressed mood. Strong support was shown for the validity of the axis II telephone assessment format. Small but consistent trends were noted for lower rates of psychopathology reported in the second interview.

CONCLUSIONS

This is the first study in which telephone and face-to-face assessments of axis I and II psychopathology were conducted with the same subjects assigned to conditions in a counterbalanced manner. The present findings provide qualified justification for the use of telephone interviews to collect axis I and II data. The apparent concerns do not appear sufficient to override the economic and logistic advantages of telephone interviewing.

Depression-related psychosocial variables: are they specific to depression in adolescents?

Although the psychosocial difficulties associated with adolescent depression are relatively well known, the extent to which these problems are specific to depression has received little attention. The authors examined the specificity to depression of a wide range of psychosocial variables in the following 3 groups of adolescents: depressed cases (n = 48), nonaffective disorder cases (n = 92), and never mentally ill participants (n = 1,079). The authors found 3 of the 44 variables assessed in this study to be strongly specific to depression, and only the depressed participants exhibited more problematic functioning than did the never mentally ill controls. Three variables are as follows: self-consciousness, self-esteem, and a reduction in activities because of physical illness or injury. Eight variables were more strongly associated with depression than with nonaffective disorder, and 8 variables characterized both depressed and nonaffective disorder adolescents. Implications of these findings for psychosocial theories of depression are discussed.

Sex differences, attributional style, and depressive symptoms among adolescents

This study examined attributional style, sex and depressive symptoms and diagnosis in high school students. The results revealed that (1) for females and males, higher levels of depressive symptoms correlated with a more depressive attributional style; (2) females and males who met diagnostic criteria for a current depressive disorder evidenced more depressogenic attributions than psychiatric controls, and never had past depressed adolescents; (3) although no sex differences in terms of attributional patterns for positive events, negative events, or for positive and negative events combined emerged, sex differences were revealed on a number of dimensional scores; (4) across the Children's Attributional Style Questionnaire (CASQ) subscale and dimensional scores, the relation between attributions and current self-reported depressive symptoms was stronger for females than males; and (5) no Sex x Diagnostic Group Status interaction effects emerged for CASQ subscale or dimensional scores. Implications of the complex findings from this large-scale, methodologically sophisticated study was addressed.

Depression-related psychosocial variables: are they specific to depression in adolescents?

Although the psychosocial difficulties associated with adolescent depression are relatively well known, the extent to which these problems are specific to depression has received little attention. The authors examined the specificity to depression of a wide range of psychosocial variables in the following 3 groups of adolescents: depressed cases (n = 48), nonaffective disorder cases (n = 92), and never mentally ill participants (n = 1,079). The authors found 3 of the 44 variables assessed in this study to be strongly specific to depression, and only the depressed participants exhibited more problematic functioning than did the never mentally ill controls. Three variables are as follows: self-consciousness, self-esteem, and a reduction in activities because of physical illness or injury. Eight variables were more strongly associated with depression than with nonaffective disorder, and 8 variables characterized both depressed and nonaffective disorder adolescents. Implications of these findings for psychosocial theories of depression are discussed.

Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents

We examine the lifetime comorbidity among anxiety disorders, and between anxiety disorders and other mental disorders, in a large (n = 1,507) community sample of high school students on whom extensive diagnostic data were available. Three diagnostic groups were formed: those with a lifetime anxiety disorder (n = 134); those with a nonanxiety disorder (n = 510); and those who had never met criteria for a mental disorder (n = 863). The intra-anxiety comorbidity rate was relatively low (18.7%), and was strongly associated with being female (92%). The lifetime comorbidity between anxiety and other mental disorders (primarily MDD) was substantial (73.1%) and was not associated with being female.

Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults

The efficacy of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screener for clinical depression was examined in a sample of 1,005 community-residing adults (age range = 50-96). Presence of a depressive disorder was determined by diagnostic interview. Analyses revealed that neither age, gender, cognitive impairment, functional impairment, physical disease, nor social desirability had a significant negative effect on the psychometric properties or screening efficacy of the CES-D. These results indicate that there was no significant degradation in the ability of the CES-D to screen for depression among community-residing elderly adults. This conclusion must be tempered by the fact that the sample did not include participants with the more disabling forms of cognitive or functional impairment and physical illness.

Correspondence between adolescent report and parent report of psychiatric diagnostic data

OBJECTIVE

To examine the degree of agreement between parent and adolescent report of major psychiatric disorders in the adolescent (14 to 18 years of age).

METHOD

A total of 281 parent-adolescent pairs were interviewed separately regarding psychopathology in the adolescent.

RESULTS

The kappa values for parent-adolescent agreement on the disorders ranged from .19 for alcohol abuse/dependence to .79 for conduct disorder, with an average kappa of .42. Excellent agreement was found for conduct disorder and the core symptom of anorexia; good agreement was found for separation anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant disorder, substance abuse/dependence, and the core symptom for bulimia; poor agreement was found for major depression, dysthymia, anxiety disorders other than separation anxiety, alcohol abuse/dependence, and the infrequent core symptoms of bipolar and obsessive-compulsive disorders. Parent-adolescent agreement was not influenced by gender, current adolescent age, parental education level, disorder onset age, or severity of disorder.

CONCLUSIONS

For detecting cases of adolescent psychopathology, there are clear advantages to the current consensus position that combines adolescent and parent report, especially for externalizing disorders. However, if forced to choose one informant, assessing the adolescent will result in the detection of more diagnosed cases.

Relationship of physical disease and functional impairment to depression in older people

Physical disease is commonly considered a risk factor for depression among older adults. However, this pattern is not consistently supported, and a theoretical framework for understanding such a relationship has not been articulated. P.M. Lewinsohn, H. Hoberman, L. Teri, and M. Hautzinger's (1985) integrative model of depression predicts that disease will be a risk factor for depression only when disease results in functional impairment, and that impairment in the absence of disease is also a risk factor for depression. The authors tested these predictions in a community-based sample of older adults followed longitudinally and found that functional impairment was a significant risk factor for depression, regardless of disease status. Disease was not a significant predictor of major depression, nor did it interact with impairment to predict depression.

Psychosocial characteristics of adolescents with a past history of dysthymic disorder: comparison with adolescents with past histories of major depressive and non-affective disorders, and never mentally ill controls

Little is known about the psychosocial functioning of persons who have recovered from dysthymic disorder. Such information might be useful in identifying trait markers for dysthymia, and for guiding continuation and maintenance treatment. We explored this issue using data from the Oregon Adolescent Depression Project, a large community-based study of the epidemiology of psychiatric disorders in a high school population. Four groups of adolescents were identified: 38 with a past history of dysthymic disorder; 217 with a past history of major depressive disorder; 142 with a past history of non-affective disorders; and 1079 with no lifetime history of psychopathology. The groups were compared on an extensive battery of psychosocial variables. The most consistent and diagnostically specific finding was that adolescents with a past history of dysthymic disorder reported having a significantly lower level of social support from friends than each of the other three groups of adolescents. Adolescents with a past history of dysthymic disorder also reported significantly higher levels of depressive, internalizing and externalizing symptoms and daily hassles than adolescents with no lifetime history of psychopathology. In addition, they reported higher levels of depressive symptoms and self-consciousness, but fewer externalizing symptoms than adolescents with a past history of non-affective disorders. These data suggest that adolescents with dysthymic disorder continue to experience significant difficulties in psychosocial functioning even after recovery.

Relationship of physical disease and functional impairment to depression in older people

Physical disease is commonly considered a risk factor for depression among older adults. However, this pattern is not consistently supported, and a theoretical framework for understanding such a relationship has not been articulated. P.M. Lewinsohn, H. Hoberman, L. Teri, and M. Hautzinger's (1985) integrative model of depression predicts that disease will be a risk factor for depression only when disease results in functional impairment, and that impairment in the absence of disease is also a risk factor for depression. The authors tested these predictions in a community-based sample of older adults followed longitudinally and found that functional impairment was a significant risk factor for depression, regardless of disease status. Disease was not a significant predictor of major depression, nor did it interact with impairment to predict depression.

Cigarette smoking, major depression, and other psychiatric disorders among adolescents

OBJECTIVE

To examine cross-sectionally and prospectively relationships of cigarette smoking with major depressive disorder (MDD), controlling for comorbidity in a community sample of adolescents.

METHOD

A representative sample of 1,709 adolescents (aged 14 through 18 years) was assessed by using semistructured diagnostic interviews on two occasions, approximately 1 year apart. Logistic regression analyses were used to examine cross-sectionally and prospectively the relationships between smoking and each psychiatric disorder, while statistically controlling for the other disorders.

RESULTS

Cross-sectional analyses revealed significant relationships of drug abuse/dependence and disruptive behavior disorders with adolescent smoking, even after the co-occurrence of all other disorders was controlled. Prospectively, smoking was found to increase the risk of developing an episode of MDD and drug abuse/dependence, after adjusting for other disorders. Finally, only lifetime prevalence of MDD remained a significant predictor of smoking onset, after controlling for other disorders. Gender did not moderate any of the relationships between psychopathology and smoking.

CONCLUSIONS

The results suggest important relationships between cigarette smoking and psychiatric disorders among adolescents, particularly with regard to MDD, drug abuse/dependence, and disruptive behavior disorders. These findings have important clinical implications, both for psychiatric care and for smoking prevention and cessation efforts with adolescents.

Distinguishing between state-dependent and non-state-dependent depression-related psychosocial variables

The goals of this study were: (a) to determine which among a set of depression-related psychosocial variables are state-dependent; (b) to examine whether state-trait distinctions among psychosocial variables are a function of gender; and (c) to test the hypothesis that state-dependence of psychosocial variables is mostly evident in people with a history of clinical depression. Altogether, 562 participants residing in two communities completed a battery of psychosocial measures at point of entry into the study (T1) and after an average interval of 8.3 months (T2). The state-dependence of psychosocial variables was examined in two groups of participants: (a) low-high (LH: those who were low on the Center for Epidemiologic Studies Depression Scale at T1 and high at T2; N = 45); and (b) high-low (HL: those who were high at T1 and low at T2; N = 64). The following variables were found to be state-dependent: engagement in pleasant and unpleasant events; frequency of social contacts; dissatisfaction with oneself, one's neighborhood dwelling and one's friends; irrational beliefs, and positive and negative expectancies. In contrast, the following variables were not state-dependent: dissatisfaction with family and job, perception of control, and external attributions for positive and negative events. State-dependence was not moderated by age, gender or a history of depression. Possible explanations for why some variables are state-dependent and others are not state-dependent are offered.

Cross-sectional and prospective relationships between physical morbidity and depression in older adolescents

OBJECTIVE

To examine cross-sectional and prospective associations between major depressive disorder (MDD), physical morbidity (disease and injury), health-related reductions in activities, and functional impairment in adolescents.

METHOD

Data on depression and health-related variables were available for a sample of 1,410 adolescents (aged 14 to 18 years) at point of entry into the study and approximately 1 year later.

RESULTS

Girls were more likely to have been treated for a disease and to have a health-related reduction in activities, whereas boys were more likely to have been treated for an injury. The expected cross-sectional associations were found between disease, reductions in activities, functional impairment, and depression, but the association between injury and depression was not significant. Prospective analyses suggest that functional impairment and disease are risk factors for future MDD and that MDD is a risk factor for future functional impairment and disease.

CONCLUSIONS

The robust prospective associations between MDD and functional impairment suggest that the impact of disease on depression is particularly strong when it disrupts important behavior patterns. Clinically, the results emphasize the importance of assessing health-related variables in depressed adolescents and of assessing depression in those with functional impairment or disease.

Hypomanic personality traits in a community sample of adolescents

The distribution and correlates of hypomanic personality traits were examined in a representative sample of 1709 adolescents. Hypomanic traits were assessed with an abbreviated version of Eckblad and Chapman's (1986) Hypomanic Personality Scale. Hypomanic traits were normally distributed and were slightly but significantly higher among females. Test-retest stability over a mean 14-month interval was 0.54. High scores were associated with elevated lifetime rates of mood, disruptive behavior and substance use disorders. Among subjects with no history of mood disorder, hypomanic traits were associated with a broad range of indices of psychosocial dysfunction, both concurrently and at 1-year follow-up. In addition, hypomanic personality traits predicted increased levels of impairment in a number of areas, including depressive and internalizing symptomatology, over the course of the follow-up. Finally, among subjects with a past history of major depression, hypomanic traits were associated with a higher level of depression at the initial assessment, greater symptomatology and impairment during their worst episode, and higher rates of attempted suicide, comorbid disruptive behavior disorders and recurrent major depressive episodes.

Alcohol consumption in high school adolescents: frequency of use and dimensional structure of associated problems

The goal of this paper is to present data regarding the occurrence of alcohol consumption and the relative prevalences and the factorial structure of DSM-IV symptoms of alcohol abuse/dependence in a sample of 1507 older (14-18 years) community adolescents. Participants were diagnostically assessed at two time points, approximately 1 year apart. Three-quarters of the sample had tried alcohol. Boys in general had greater usual frequency and quantity of alcohol consumption than girls and began drinking at an earlier age; girls with a diagnosis of alcohol abuse/dependence had a significantly earlier mean age of alcohol disorder onset and were more likely to have a relapse of alcohol disorder. However, gender differences in symptom prevalence were non-significant. Seventeen per cent of the sample had at least one alcohol abuse/dependence symptom. The most frequent symptoms included reduced activities because of alcohol use, consumed more than intended, and tolerance. Eight of the 11 symptoms made a unique contribution to the prediction of diagnosis in a multiple logistic regression analysis. Components analysis supported the general division of symptoms into the categories of abuse and dependence.

Psychiatric comorbidity with problematic alcohol use in high school students

OBJECTIVE

To delineate the degree to which various levels of problematic alcohol use are associated with psychiatric disorders in adolescents.

METHOD

The lifetime occurrence of psychiatric disorders was examined in a community sample of 1,507 older adolescents (aged 14 through 18 years) who were categorized according to their alcohol use (i.e., abstainers, experimenters, social drinkers, problem drinkers, and abuse/dependence group).

RESULTS

Increased alcohol use was associated with the increased lifetime occurrence of depressive disorders, disruptive behavior disorders, drug use disorders, and daily tobacco use. There was a trend for increased alcohol use in girls to be associated with anxiety disorders. More than 80% of adolescents with alcohol abuse/dependence had some other form of psychopathology. Alcohol disorders, in general, followed rather than preceded the onset of other psychiatric disorders. Comorbidity was associated with an earlier age of alcohol disorder onset and with greater likelihood of mental health treatment utilization.

CONCLUSIONS

Rates of psychiatric comorbidity with problematic alcohol use in adolescents are striking and represent an important therapeutic challenge.

The Life Attitudes Schedule Short Form: an abbreviated measure of life-enhancing and life-threatening behaviors in adolescents

An abbreviated version of the Life Attitudes Schedule (LAS) was developed, consisting of 24 items, each representing one cell of the original LAS theoretical matrix (4 content categories x 2 behavior types x 2 valence). Items were retained on the basis of high correlations with LAS total score and low correlations with gender. Psychometric properties of the LAS Short Form were robust and the Short Form total score correlated .93 with the original LAS total score. As with the original LAS, boys reported more injury-related behaviors than girls. Future research and clinical directions are suggested.

Symptoms of DSM-III-R major depression in adolescence: evidence from an epidemiological survey

OBJECTIVE

To examine the phenomenology of DSM-III-R major depression among adolescents diagnosed as "cases" in a community-based epidemiology study.

METHOD

A representative sample (N = 1,710) of older adolescents from several Oregon communities were interviewed using structured diagnostic schedules and DSM-III-R criteria in two annual assessments. Although the focus was depression, diagnoses were made for most child and adolescent psychiatric disorders.

RESULTS

Nearly 30% of the sample at baseline had at least one current symptom of DSM-III-R major depression, but only 2.6% received a diagnosis. The most prevalent symptoms at baseline were depressed mood, sleep, and thinking problems. For new, or incident cases, the most frequent symptoms involved depressed mood, anhedonia, and thinking problems. Among those adolescents who had experienced two episodes of major depression, there was low concordance across episodes for both diagnostic criteria and specific symptoms. Comparisons with six studies of adolescent patients indicate our community "cases" are phenomenologically very similar to clinical cases of major depression in treatment settings.

CONCLUSIONS

The results presented, along with those from other studies of adults and children, provide strong evidence that DSM criteria for major depression are appropriate for adolescents. That is, DSM-III-R symptom criteria are manifested by both youths and adults, although the relative frequency of these criterion symptoms appear to be age-related.

Continuity of psychopathology in a community sample of adolescents

OBJECTIVE

To examine the continuity between the primary (first) diagnosis and secondary (second) diagnosis of those adolescents who have more than one episode of psychiatric disorder. Data were examined to determine whether the second episode "breeds true" (i.e., remains within the same diagnostic category as the first) or involves a different disorder.

METHOD

The sample consisted of 236 youngsters selected from the larger (n = 1,507) population of adolescents (aged 14 through 18 years) from the Oregon Adolescent Depression Project who had been assessed on two occasions, approximately 1 year apart.

RESULTS

Results support the continuity hypothesis for the categories of disorder studied (major depression, anxiety, disruptive, substance use), with the exception of dysthymia. Primary dysthymia did not result in the diagnosis of secondary dysthymia, because most adolescents who had dysthymia had not recovered within the time frame of the study and were chronic cases, often with secondary anxiety. Also presented are data on age of onset of disorder (lowest for anxiety and highest for substance use) and information on remission intervals between episodes (well time) (lowest for substance use and highest for anxiety).

CONCLUSIONS

The findings are interpreted as providing support for the "breed true" hypothesis, although clearly not all second episodes are identical with the first. While the psychosocial factors examined did not predict the nature of the second disorder, this clearly needs further study.