[Mood disorders in childhood and adolescence: continuities and discontinuities to adulthood]

Abstract

Studies in child and adolescent psychiatry show that both internalizing and externalizing problems tend to persist in adulthood, e.g. it has been found that almost 40% of the adolescents who were classified as deviant initially were still deviant 4 years later. In a more recent study, over a large period of 24 years, continuity of psychopathology was found from childhood into adulthood; anxious/ depressed and other problems in childhood were core predictors for adult psychopathology. Other studies also show that there is substantial continuity, morbidity, and potential mortality from suicide into adulthood in patients with adolescent-onset major depressive disorder. Formerly depressed adolescents are at higher risk for recurrence of major depressive disorder during young adulthood; more specifically, depressed adolescents are at 2-7 times increased odds of being depressed as adults, compared with non-depressed controls. In addition, recent studies indicate that symptoms of depression in adolescence strongly predict an episode of major depression, suicidal ideation and rates for treatment for depression in adulthood, even among adolescents without major depression. The Maudsley long-term follow-up of child and adolescent depression showed that adolescent depression carries an elevated risk of adult depression irrespective of comorbidity, and that comorbid conduct disorder in childhood is associated with raised rates of other psychiatric outcomes. Personality disorders, i.e. of dependent, antisocial, passive-aggressive, and histrionic type, may represent alternative pathways of continuity for major depressive disorder and other Axis I disorders across the child-adult transition. Bipolar disorder in childhood is often found to be associated with long delays to first treatment. Studies have shown that both childhood onset and treatment delay are associated with a persistently more adverse course of illness in adulthood. Earlier and more effective treatment of bipolar disorder in children and adolescents would result in a more benign illness and a better prognosis in adulthood. Lastly, parental depression is a strong and consistent risk factor for offspring major depression and anxiety disorder. When offspring mature into young adulthood, effects of parental depression and family discord persist. Because child and especially adolescent mood disorders are likely to continue into adulthood, early identification, assessment and treatment are warranted; capacity for treatment of children at earlier stages of risk and disorder needs to be developed in other public sectors, such as primary health care and schools. In addition, continuity of care from childhood and adolescence to adulthood is needed.