Subthreshold depressive disorder in adolescents: predictors of escalation to full-syndrome depressive disorders

J Am Acad Child Adolesc Psychiatry. 2009 Jul;48(7):703-710. doi: 10.1097/CHI.0b013e3181a56606.


Objectives: Subthreshold depressive disorder is one of the best established risk factors for the onset of full-syndrome depressive disorders. However, many youths with subthreshold depressive disorder do not develop full-syndrome depression. We examined predictors of escalation to full-syndrome depressive disorders in a community sample of 225 adolescents with subthreshold depressive disorder.

Method: Criteria for subthreshold depressive disorder were an episode of depressed mood or loss of interest or pleasure lasting at least 1 week and at least two of the seven other DSM-IV-associated symptoms for major depression. Participants were assessed four times from mid-adolescence to age 30 years using semistructured diagnostic interviews.

Results: The estimated risk for escalation to full-syndrome depressive disorders was 67%. Five variables accounted for unique variance in predicting escalation: severity of depressive symptoms, medical conditions/symptoms, history of suicidal ideation, history of anxiety disorder, and familial loading for depression. Adolescents with three or more risk factors had an estimated 90% chance of escalating to full-syndrome depressive disorder, compared with 47% of adolescents with fewer than three risk factors.

Conclusions: These data may be useful in identifying a subgroup of youths with subthreshold depressive disorder who are at especially high risk for escalating to full-syndrome depressive disorders.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Affect*
  • Child
  • Comorbidity
  • Cross-Sectional Studies
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / genetics
  • Depressive Disorder / psychology
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / genetics
  • Depressive Disorder, Major / psychology
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders
  • Disease Progression
  • Female
  • Genetic Predisposition to Disease / genetics
  • Genetic Predisposition to Disease / psychology
  • Health Surveys
  • Humans
  • Kaplan-Meier Estimate
  • Longitudinal Studies
  • Male
  • Mass Screening / statistics & numerical data
  • Multivariate Analysis
  • Oregon
  • Personality Assessment / statistics & numerical data
  • Proportional Hazards Models
  • Psychometrics
  • Risk
  • Young Adult