Preschool depression: homotypic continuity and course over 24 months - PubMed (original) (raw)

Comparative Study

Preschool depression: homotypic continuity and course over 24 months

Joan L Luby et al. Arch Gen Psychiatry. 2009 Aug.

Abstract

Context: Childhood depression is a serious and relapsing psychiatric disorder. However, to date studies have focused mostly on children aged 6 years and older. Validation for depression in preschool children has been provided by 2 independent study samples. While several studies have demonstrated stability and poor outcomes of internalizing symptoms in preschoolers, there has not yet been longitudinal data available to inform the course of preschool depression and whether it shows homotypic continuity into early childhood.

Objective: To examine the 24-month course of preschool depression and whether it showed homotypic vs heterotypic continuity or was a developmentally transient phenomenon.

Design: Blindly rated, prospective, 24-month, longitudinal follow-up study.

Setting: Community sites. Patients Three hundred six preschoolers aged 3 to 6 years recruited from community sites and oversampled for symptoms of depression. Main Outcome Measure Recurrence/stability of depression and predictors of course.

Results: Preschoolers with depression at baseline had the highest likelihood of subsequent depression 12 and/or 24 months later compared with preschoolers with no baseline disorder and with those who had other psychiatric disorders. Preschoolers with depression at baseline were more likely to have later depression rather than other psychiatric disorders. Findings from a logistic regression analysis indicated that when controlling for demographic variables, risk factors, and comorbid disorders, depression during the preschool period and family history of affective disorders were the most robust and significant predictors of later depression.

Conclusions: Preschool depression, similar to childhood depression, is not a developmentally transient syndrome but rather shows chronicity and/or recurrence. Homotypic continuity of preschool MDD during a 24-month period was found. These results underscore the clinical and public health importance of identification of depression as early as preschool. Further follow-up of preschoolers with depression is warranted to inform the longitudinal course throughout childhood.

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Figures

Figure 1

Figure 1

Homotypic vs heterotypic continuity of preschool depression and other psychiatric disorders. Odds ratios (ORs) are shown with 95% confidence intervals. MDD indicates major depressive disorder; NS, nonsignificant; *P < .001; †P < .05.

Figure 2

Figure 2

Rates of major depressive disorder (MDD) occurrence at follow-up in preschoolers with depression at baseline. *Excludes missing data.

Figure 3

Figure 3

Comparison of mean major depressive disorder (MDD) severity scores across study waves in 3 depression groups (chronic, recovered/recurred, and recovered), other psychiatric disorder group, and no-disorder group. The figure presents 5 waves of mean MDD severity scores for 3 depressed groups and only 3 annual waves (baseline, 12 months, and 24 months) of mean MDD severity scores for psychiatric control and no-disorders groups (owing to data collection). At 6 and 18 months, excessive data were missing from recovered and chronic groups, so MDD severity scores comparisons were only conducted for 3 annual waves.

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