Subsyndromal Manifestations of Depression in Children Predict the Development of Major Depression

Abstract

Objective: To evaluate the utility of assessing subsyndromal symptoms of major depressive disorder in childhood, indexed through the Child Behavior Checklist (CBCL) anxiety/depression scale, in predicting risk of developing major depressive disorder in adolescent and young adult years.

Study design: The sample consisted of 537 children, 6-17 years of age, originally ascertained for a longitudinal family genetic study of youth with and without attention-deficit hyperactivity disorder and their first-degree relatives who were followed prospectively and blindly for 10 years from childhood into young adult years. Children with full diagnosis major depressive disorder at baseline were excluded. For analysis, the sample was stratified into 4 groups based on the presence or absence of parental mood disorders and by the presence or absence of subsyndromal scores on the CBCL anxiety/depression scale at baseline assessment in childhood.

Results: Children of parents with mood disorders plus subsyndromal scores on the CBCL anxiety/depression scale at baseline (n = 22) had the highest risk for developing major depressive disorder and anxiety disorders at the 10-year follow-up when compared with the other groups. Children with either subsyndromal scores on the CBCL anxiety/depression scale at baseline alone (n = 22) or parental mood disorders alone (n = 172) had intermediate outcomes.

Conclusion: The CBCL anxiety/depression scale was useful in identifying children at high risk for the development of major depressive disorder and anxiety disorders at the 10-year prospective follow-up. Furthermore, our results emphasized the importance of familial psychiatric history in youth with subthreshold symptoms of depression. Parental mood disorder and subthreshold anxiety/depressive symptoms were predictive of developing depression.

Keywords: CBCL; Child Behavior Checklist; adolescence; anxiety; childhood; major depressive disorder.

Figure 1.

Kaplan-Meier estimates of lifetime prevalence of mood disorders (MDD and BPD-I) (N=512) and multiple (≥2) anxiety disorders (N=537).^a Compared with Normal Controls. ^b Compared with Subsyndromal MDD.^c Compared with High Risk. *P<0.05, **P<0.005, ***P<0.001.

Figure 2.

Social functioning at the 10-/11-year follow-up measured by the GAF.^a Compared with Normal Controls. ^b Compared with Subsyndromal MDD.^c Compared with High Risk. *P<0.05, **P<0.005, ***P<0.001.