Do childhood externalizing disorders predict adult depression? A meta-analysis

Abstract

Childhood externalizing disorders have been linked to adult affective disorders, although some studies fail to substantiate this finding. Multiple longitudinal cohort studies identifying childhood psychopathology and their association with adult psychiatric illness have been published. To examine the association between childhood externalizing symptoms or disorders and the development of adult depression across cohorts, a meta-analysis was performed. Potential studies were identified using a PubMed search through November 2013. All published, prospective, longitudinal, community-sampled cohort studies of children (≤ 13 years) with externalizing symptoms or disorders (aggression, conduct problems, oppositional defiant disorder, conduct disorder), reassessed in adulthood (≥ 18 years) for depressive disorders (major depressive disorder, depressive disorder NOS, or dysthymic disorder) were included. A random effects model was used to summarize the pooled effect sizes. Ancillary analyses considered covariates that could account for variance among studies. Ten studies representing eight cohorts of children initially assessed at age 13 or younger (N = 17,712) were included in the meta-analysis. Childhood externalizing behavior was associated with adult depressive disorders (OR = 1.52, 95% confidence interval = 1.27-1.80, p < 0.0001). Utilizing Orwin's Fail-safe N approach, 263 studies with a mean odds ratio of 1.0 would have to be added to the analysis before the cumulative effect would become trivial. Externalizing psychopathology in childhood is associated with the development of unipolar depressive disorders in adulthood.

Figure 1

Review and selection of articles describing longitudinal studies.

Figure 2

Childhood externalizing symptoms as predictors of adult depressive disorders. Boxes reflect weights of individual predictors. Effect sizes were combined within cohorts; combined effect sizes are in bold and represented by diamonds. NCDS = National Child Development Study, CNUS = Community in Northeast US, FBM = Finnish Boy to Man, GSM = Great Smoky Mountains, SSDP = Seattle Social Development Project, ZHLS = Zuid-Holland Longitudinal Study, CCLS = Columbia County Longitudinal Study, CHDS = Christchurch Health and Development Study, aggr. = aggression, CI = confidence interval, CP = conduct problems, OD = oppositional defiant symptoms.