Impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study

Abstract

Background: Little is still known about the long-term impact of childhood and adolescent persistent depression and anxiety in adulthood.

Aims: To investigate the impact of persistent anxiety, depression, and comorbid anxiety and depression across childhood and adolescence on the development of multiple adverse outcomes in young adulthood.

Method: This study used data from 8122 participants in the Avon Longitudinal Study of Parents and Children cohort. The Development and Well-Being Assessment (DAWBA) examined child anxiety and depression symptomatology. The DAWBA generalised anxiety and mood subscales at 8, 10 and 13 years were selected, and a measure of comorbid anxiety and depression symptoms was created at each time point. Further, several mental and physical health, substance misuse and education/employment problems were assessed at 24 years. Latent class growth analyses were used to detect trajectories of anxiety, depression and comorbid anxiety and depression; and logistic regression to examine how persistent anxiety, depression or both were associated with adverse outcomes at 24 years.

Results: All three classes with persistent anxiety, depression or both were significantly associated with presenting with any mental health problems and any education/employment problem. Persistent high levels of depression and high levels of comorbid anxiety and depression, but not persistent high anxiety, were significantly associated with any physical health problem. High levels of comorbid anxiety and depression was the only DAWBA domain significantly associated with substance misuse; and overall, this was the domain that exerted the greatest negative impact, as it presented the highest odd ratio values.

Conclusions: Children and adolescents with comorbid anxiety and depression are at the highest risk for having more adverse outcomes at 24 years.

Keywords: Anxiety; adverse outcome; comorbidity; depression; longitudinal cohort.

Fig. 1

Growth trajectories of anxiety, depression, and comorbid anxiety and depression symptoms across childhood and adolescence. The latent class growth analyses detected a best model fit for three classes for the three domains. x-axis represents the three time points in childhood and adolescence, and the y-axis represents the mean total score of Development and Well-Being Assessment (DAWBA). (a) Reflects the trajectories for anxiety. Class 3 (dark-blue line) is characterised by persistent (and decreasing) high levels. Class 1 (light-blue line) represents persistent (and increasing) low levels. Finally, class 2 (mid-blue line) reflects persistent intermediate levels. (b) Shows the trajectories for depression. These trajectories show a class 3 (dark-blue line) characterised by persistent (and increasing) high levels; a class 1 (light-blue line) reflecting persistent (and increasing) intermediate levels; and finally, a class 2 (mid-blue line) representing persistent (and decreasing) low levels. Finally, (c) shows the trajectories for comorbid anxiety and depression. These trajectories show a class 3 (dark-blue line) characterised by persistent (and increasing) high levels; a class 1 (light-blue line) reflecting persistent (and decreasing) low levels; and finally, a class 2 (mid-blue line) representing persistent (and decreasing) intermediate levels. Further, the three classes of this specific domain seem to equally present low levels of symptomatology at 8 years, while the discrepancies between trajectories clearly appear by the age of 10 years.