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Risk factors for incident major depressive disorder in children and adolescents with attention-deficit/hyperactivity disorder

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Abstract

The greater burden of illness in youth with co-occurring attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) deserves further investigation, specifically regarding the influence of other psychiatric or medical conditions and the pharmacotherapies prescribed. A retrospective cohort design was employed, using South Carolina’s (USA) Medicaid claims’ dataset covering outpatient and inpatient medical services, and medication prescriptions between January, 1996 and December, 2006 for patients ≤17 years of age. The cohort included 22,452 cases diagnosed with ADHD at a mean age 7.8 years; 1,259 (5.6 %) cases were diagnosed with MDD at a mean age of 12.1 years. The probability of a child with ADHD developing MDD was significantly associated with a comorbid anxiety disorder (aOR = 3.53), CD/ODD (aOR = 3.45), or a substance use disorder (aOR = 2.31); being female (aOR = 1.77); being treated with pemoline (aOR = 1.69), atomoxetine (aOR = 1.31), or mixed amphetamine salts (aOR = 1.28); a comorbid obesity diagnosis (aOR = 1.29); not being African American (aOR = 1.23), and being older at ADHD diagnosis (aOR = 1.09). Those developing MDD also developed several comorbid disorders later than the ADHD-only cohort, i.e., conduct disorder/oppositional-defiant disorder (CD/ODD), at mean age of 10.8 years, obesity at 11.6 years, generalized anxiety disorder at 12.2 years, and a substance use disorder at 15.7 years of age. Incident MDD was more likely in individuals clustering several demographic, clinical, and treatment factors. The phenotypic progression suggested herein underscores the need for coordinated early detection and intervention to prevent or delay syndromal MDD, or to minimize its severity and associated impairment over time.

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Acknowledgments

Data acquisition was supported by a State Mental Health Data Infrastructure Grant (SAMHSA SM54192). Funding for the statistical analyses was provided through a Clinical Incentive Research Grant from the University of South Carolina, Office of the Provost. The views expressed do not necessarily represent those of the funding agency or official findings of the South Carolina Department of Health and Human Services (Medicaid).

Conflict of interest

Dr. Jerrell has received research grants from and served on national advisory boards for NIH, Eli Lilly, and Bristol Myers Squibb; Dr. McIntyre has received honoraria for speaking and served as a consultant to Schering-Plough, received research grants from Eli Lilly, Stanley Medical Research Institute, and National Alliance for Research on Schizophrenia and Depression, and served on advisory boards for AstraZeneca, Bristol Myers Squibb, France Foundation, GlaxoSmithKline, Janssen-Ortho, Solvay/Wyeth, Eli Lilly, Lundbeck, Organon, Biovail, Pfizer, and Shire. Dr. Park reports no competing interests. None of these entities had any involvement in this investigation.

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Authors and Affiliations

  1. Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 15 Medical Park, Suite 301, Columbia, SC, 29203, USA

    Jeanette M. Jerrell

  2. Department of Psychiatry, University of Toronto, Toronto, Canada

    Roger S. McIntyre

  3. Department of Pharmacology, University of Toronto, Toronto, Canada

    Roger S. McIntyre

  4. Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, USA

    Yong-Moon Mark Park

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Jerrell, J.M., McIntyre, R.S. & Park, YM.M. Risk factors for incident major depressive disorder in children and adolescents with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 24, 65–73 (2015). https://doi.org/10.1007/s00787-014-0541-z

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