Major depressive disorder in older adolescents: Prevalence, risk factors, and clinical implications
Section snippets
Brief description of the data sets
Since 1985, we have been conducting a large, prospective, epidemiologic study entitled the Oregon Adolescent Depression Project (OADP). The OADP consists of a representative sample of 1,709 high school students who completed a diagnostic interview and a wide array of psychosocial measures when they were 14 to 18 years of age (Time 1, or T1). Approximately 1 year later (T2), 1,507 (88%) of the participants returned for a second diagnostic interview and questionnaire assessment. Participants were
Frequency of MDD Symptoms
Researchers previously thought that children and adolescents, when depressed, would exhibit different symptoms than adults (e.g., “masked” depression; Welner, 1978) However, the trend over the past 20 years has been increasingly toward viewing MDD in children, adolescents, and adults as similar, as reflected in the DSM-III-R and DSM-IV, which emphasize the commonalities in MDD across the age span. To examine the manifestation of an episode of MDD in adolescence, we calculated the relative
Epidemiology of depression
Data from the OADP provide estimates of the basic parameters of MDD epidemiology including point prevalence (i.e., percentage in an episode of MDD at a given point in time), lifetime prevalence (i.e., percentage who have experienced an MDD episode during their lifetime), and incidence (i.e., percentage who are not depressed at the beginning of an observation period who develop an MDD episode during a specified period of time; in our case, 1 year). Incidence rates are customarily divided into
Comorbidity of depression
Interest in the co-occurrence, or comorbidity, of psychiatric disorders is a rather recent phenomenon. First introduced into the medical literature by Feinstein (1970), comorbidity refers to the fact that patients with one disorder may be at elevated risk for a second disorder and this co-occurrence may affect the course of the two disorders. Comorbidity is said to exist either when persons with a current disorder have an elevated prevalence of other current disorders (concurrent comorbidity),
Psychosocial variables associated with becoming, with being, and with having been depressed
Our research has allowed us to examine the psychosocial characteristics of adolescents before, during, and after an episode of MDD. Knowledge of each of these phases is important.
Proposed etiologic model of depression
Our research has been guided by a social learning conceptualization which was developed on the basis of findings with adults (Lewinsohn, Hoberman, Teri, & Hautzinger, 1985) and which is currently being revised to incorporate findings from our adolescent studies (Lewinsohn, Solomon, Seeley, & Zeiss, 1998b). In this framework, depression is conceptualized as the end result of environmentally initiated changes in behavior, affect, and cognitions. Antecedent risk factors (e.g., macro and micro
Assessment and screening
Several questions remain regarding the assessment of depression and other psychopathology in adolescents. One important issue concerns the necessary sources of information. There is longstanding and widespread agreement that assessment of child psychopathology should be based on multiple sources of information, generally including the child and the parent and, if possible, a teacher. Multiple informants are thought to be useful for several reasons: (a) young children may be developmentally
Treatment and prevention
Given that we now have a reasonably good understanding of the phenomenology and epidemiology of depression in adolescents, understand the correlates and risk factors for this disorder, and have excellent screening and assessment procedures, our attention turns to treatment utilization and intervention efficacy for depression in this age group. Our research with the OADP indicates that 61% of community adolescents with MDD receives some type of treatment (Lewinsohn, Rohde, & Seeley, in press),
Conclusions and recommendations
We want to end by summarizing some of the conclusions and recommendations that we feel are justified by our findings.
- 1.
The magnitude of adolescent depression (prevalence but especially incidence) is much larger than had been thought. Depression in the adolescent population is clearly a major mental health problem that is often under-recognized.
- 2.
Depression during adolescence is associated with numerous negative psychosocial consequences. Depression seriously interferes with effective functioning.
Acknowledgements
This research was supported by National Institute of Mental Health Grants MH41278 and MH40501. We thank Betty Merten for her assistance in reviewing an earlier draft of the manuscript.
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