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First Episode of Depression in Children at Low and High Familial Risk for Depression

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ABSTRACT

Objective

To examine the development of first-onset major depressive disorder (MDD) in children at high and low familial risk for depression in a prospective study.

Method

High-risk children (n = 76) who were free of any lifetime affective disorder and had at least one first-degree and one second-degree relative with a lifetime history of childhood-onset, recurrent, bipolar, or psychotic depression were included. Low-risk children (n = 63) were included if they were free of any lifetime psychiatric disorder and had no first-degree relatives and fewer than 20% of their second-degree relatives with a lifetime affective disorder. Children and their parents were assessed in a prospective design using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version (K-SADS-E). The average interval between follow-up interviews was 18 months, and the average follow-up period was 6 years.

Results

High-risk children had approximately a threefold increased risk of developing first-onset MDD compared with low-risk children (odds ratio = 3.21). The average age of new-onset MDD was 14.0 ± 2.9 years (range 9.5–19.5 years). Above and beyond the familial loading for MDD, mother's lifetime anxiety disorder (odds ratio = 2.84) and lifetime behavioral disorder (odds ratio = 3.25) in the child significantly added to the risk of developing a first-onset MDD.

Conclusions

Having high familial loading for affective disorders, a mother with and anxiety disorder, and a behavioral disorder in the child all significantly contributed to the risk of developing depression.

Section snippets

METHOD

Children aged 6 to 13 years who were participating in a larger project examining the psychobiological aspects of childhood depression were included (see Birmaher et al., 2000, for complete details). Before participating in the initial and follow-up components of the study, subjects and their parents were required to sign assents and informed consents respectively, in compliance with the requirements of the University of Pittsburgh Institutional Review Board.

Rates of First-Onset MDD in High-Risk and Low-Risk Children

The risk for first-onset MDD after the initial assessment is depicted in Figure 1. The risk for first-onset MDD was significantly greater among the high-risk children compared to the low-risk children (odds ratio [OR] = 3.21, 95% confidence interval [CI] = 1.22–8.45, χ21 = 6.21, p ≤ .02). The corresponding cumulative survival rates (mean ± standard error) during the entire follow-up were 0.53 ± 0.14 for the high-risk subjects and 0.86 ± 0.06 for the low-risk subjects. Among those children

DISCUSSION

In this study, we found that children with a significant family history of depression had approximately a threefold increased risk for developing a first episode of depression compared to children of low-risk families (survival rate 0.47 versus 0.14, respectively). Above and beyond the familial risk for MDD, mother's lifetime anxiety and having a behavioral disorder increased the risk for developing MDD.

REFERENCES (53)

  • H Orvaschel

    Early-onset psychiatric disorder in high risk children and increased familial morbidity

    J Am Acad Child Adolesc Psychiatry

    (1990)
  • H Orvaschel et al.

    Retrospective assessment of prepubertal major depression with the K-SADS-E

    J Am Acad Child Psychiatry

    (1982)
  • M Radke-Yarrow et al.

    Young children of affectively ill parents: a longitudinal study of psychosocial development

    J Am Acad Child Adolesc Psychiatry

    (1992)
  • ND Ryan et al.

    Stimulatory tests of growth hormone secretion in prepubertal major depression: depressed versus normal children

    J Am Acad Child Adolesc Psychiatry

    (1994)
  • CE Sylvester et al.

    The diagnostic interview for children and personality inventory for children in studies of children at risk for anxiety disorders or depression

    J Am Acad Child Adolesc Psychiatry

    (1987)
  • RD Todd et al.

    Genetic studies of affective disorders: should we be starting with childhood onset probands?

    J Am Acad Child Adolesc Psychiatry

    (1993)
  • MT Tsuang et al.

    Transmission of affective disorders: an application of segregation analysis to blind family study data

    J Psychiatr Res

    (1985)
  • MM Weissman et al.

    Psychopathology in the children (ages 6–18) of depressed and normal parents

    J Am Acad Child Psychiatry

    (1984)
  • Z Welner et al.

    School-aged children of depressed parents: a blind and controlled study

    J Affect Disord

    (1988)
  • DE Williamson et al.

    A case-control family history study of depression in adolescents

    J Am Acad Child Adolesc Psychiatry

    (1995)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-revised (DSM-III-R)

    (1987)
  • J Biederman et al.

    High rate of affective disorders in probands with attention deficit disorder and in their relatives: a controlled family study

    Am J Psychiatry

    (1987)
  • B Birmaher et al.

    Growth hormone secretion in children and adolescents at high risk for major depressive disorder

    Arch Gen Psychiatry

    (2000)
  • B Birmaher et al.

    Neuroendocrine response to 5-hydroxy-l-tryptophan in prepubertal children at high risk of major depressive disorder

    Arch Gen Psychiatry

    (1997)
  • KC Burke et al.

    Age at onset of selected mental disorders in five community populations

    Arch Gen Psychiatry

    (1990)
  • WJ Chambers et al.

    The assessment of affective disorders in children and adolescents by semistructured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode version

    Arch Gen Psychiatry

    (1985)
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    This research was supported by NIMH grants P01-MH41712 (Dr. Ryan) and K01-MH001957 (Dr. Williamson).

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