Four trajectories can help predict adolescent depression outcomes

Several factors, including age at onset during adolescence, can differentiate the future course of adolescent depression, according to results of a longitudinal, population-based study published in The Lancet Psychiatry.

“For clinicians, it can be difficult to distinguish adolescents who will eventually develop persistent depression with poor adult outcomes from those whose depression will spontaneously remit,” Bryony Weavers, BSc, of the Wolfson Centre for Young People’s Mental Health at Cardiff University in the U.K., and colleagues wrote. “Given that depression is common and incidence in young people has risen sharply in recent years, characterizing this variation is important for informing treatment decisions and the allocation of finite clinical resources.”

The investigators sought to investigate adult outcomes of adolescent-onset trajectories of clinically significant depressive symptoms, as well as to pinpoint factors that differentiated trajectories that continue or resolve in adulthood. They analyzed data of 4,234 participants (63% female; mean age, 10.6 years at baseline and 25.8 years at the final timepoint) of the English population-based Avon Longitudinal Study of Parents and Children with available depressive symptom data. Participants provided self-reports of depression symptoms 10 times between ages 10.5 years and 25 years via the short Mood and Feelings Questionnaire. Further, they provided data on major depressive disorder episodes at ages 13 years, 15 years, 17.5 years and 25 years.

Weavers and colleagues used latent class growth analysis to characterize trajectories of depression symptoms. They assessed adult outcomes based on lifetime suicidal self-harm and functional impairment at age 24 years, as well as employment, education and the self-reported Strengths and Difficulties Questionnaire at age 25 years.

Results showed four depression trajectory classes, which were adolescent-persistent depression that began early in adolescence (7%), adolescent-limited depression that began later in adolescence and remitted by adult life (14%), adult-increasing depression (25%) and stable-low levels of depression (54%). The researchers noted an association between the adolescent-persistent class and poor adult outcomes for functional impairment (62%), suicidal self-harm (27%), mental health difficulties (25%) and not being in education, employment or training (16%).

They also reported an association between adolescent-limited depression and transient adolescent stress; however, functional impairment and mental health difficulties were similar to the stable-low group by early adulthood. Major depressive disorder polygenic score, adolescent educational attainment and any early childhood adversity that continued into adulthood differentiated the adolescent-persistent and adolescent-limited groups.

“This information could be clinically useful for distinguishing young people who will eventually develop persistent or recurrent depression with poor adult outcomes from those with depression that will spontaneously remit,” the researchers wrote.

In a related editorial, Alison Fogarty and Fiona Mensah, both of Intergenerational Health, Murdoch Children’s Research Institute, Australia, expanded on the implications of this study.

“Understanding how childhood antecedents and the lived experiences of young people can precipitate or heighten ongoing depressive symptoms as they transition through adolescence is central to providing holistic mental health care,” they wrote. “This study emphasizes the need for services that recognize and respond quickly to mental health distress in young people and maintain support over sustained periods of recovery and healing.”