Depressed adolescents grown up

JAMA. 1999 May 12;281(18):1707-13. doi: 10.1001/jama.281.18.1707.


Context: Major depressive disorder (MDD) that arises in adolescence impairs functioning and is associated with suicide risk, but little is known about its continuity into adulthood.

Objective: To describe the clinical course of adolescent-onset MDD into adulthood.

Design and participants: Prospective case-control study. Seventy-three subjects had onset of MDD based on systematic clinical assessment during adolescence (Tanner stage III-V) and 37 controls had no evidence of past or current psychiatric disorders, and also were assessed in adolescence (assessment years: 1977-1985). Follow-up was conducted 10 to 15 years after the initial assessment by an independent team without knowledge of initial diagnosis (follow-up years: 1992-1996).

Setting: Cases were identified at Columbia Presbyterian Hospital, New York City, NY; controls were recruited from the community.

Main outcome measures: Suicide and suicide attempts, psychiatric diagnoses, treatment utilization, and social functioning.

Results: Clinical outcomes of adolescent-onset MDD into adulthood compared with control subjects without psychiatric illness include a high rate of suicide (7.7%); a 5-fold increased risk for first suicide attempt; a 2-fold increased risk of MDD, but not other psychiatric disorders; an increased occurrence of psychiatric and medical hospitalization; and impaired functioning in work, social, and family life. Thirty-seven percent of those with adolescent MDD survived without an episode of MDD in adulthood vs 69% of the control participants (relative risk, 2.2 [95% confidence interval, 1.0-4.7; P<.05]).

Conclusion: There is substantial continuity, specificity, morbidity, and potential mortality from suicide into adulthood in adolescent-onset MDD patients. Now that empirically based guides to their treatment are becoming available, early identification and treatment seems warranted.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Case-Control Studies
  • Depressive Disorder, Major* / physiopathology
  • Depressive Disorder, Major* / therapy
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Prospective Studies
  • Risk
  • Statistics, Nonparametric
  • Suicide / statistics & numerical data
  • Suicide, Attempted / statistics & numerical data