Prevalence, 20-month incidence and outcome of unipolar depressive disorders in a community sample of adolescents.
BACKGROUND
This article presents prospective longitudinal findings on prevalence, incidence, patterns of change and stability of depressive disorders in a community sample of 1228 adolescents.


METHODS
Data were collected at baseline and follow-up (20 months later) in a representative population sample of 1228 adolescents, aged 14-17 at baseline. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI).


RESULTS
The overall cumulative lifetime incidence of any depressive condition was 20.0% (major depressive disorder (MDD), 12.2%; dysthymia, 3-5%; subthreshold MDD, 6.3%), of which about one-third were incident depressions in the period between baseline and follow-up. Depressive disorders rarely started before the age of 13. Females were about twice as likely as males to develop a depressive disorder. Overall, the 20-month outcome of baseline depression was unfavourable. Dysthymia had the poorest outcome of all, with a complete remission rate of only 33% versus 43% for MDD and 54% for subthreshold MDD. Dysthymia also had the highest number of depressive episodes, and most psychosocial impairment and suicidal behavioural during follow-up. Treatment rates were low (8-23%). Subthreshold MDD associated with considerable impairment had an almost identical course and outcome as threshold MDD.


CONCLUSIONS
DSM-IV MDD and dysthymia are rare before the age of 13, but frequent during adolescence, with an estimated lifetime cumulative incidence of 14%. Only a minority of these disorders in adolescence is treated, and more than half of them persist or remit only partly.
Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology Unit, Munich, Germany.
A J
AJ
Oldehinkel
H U
HU
Wittchen
P
P
Schuster
D000293:Adolescent; D017668:Age of Onset; D003156:Community Mental Health Services; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013997:Time Factors