Subthreshold depressive disorder in adolescents: predictors of escalation to full-syndrome depressive disorders.
OBJECTIVE
Subthreshold depressive disorder is one of the best established risk factors for the onset of full-syndrome depressive disorders. However, many youths with subthreshold depressive disorder do not develop full-syndrome depression. We examined predictors of escalation to full-syndrome depressive disorders in a community sample of 225 adolescents with subthreshold depressive disorder.


METHODS
Criteria for subthreshold depressive disorder were an episode of depressed mood or loss of interest or pleasure lasting at least 1 week and at least two of the seven other DSM-IV-associated symptoms for major depression. Participants were assessed four times from mid-adolescence to age 30 years using semistructured diagnostic interviews.


RESULTS
The estimated risk for escalation to full-syndrome depressive disorders was 67%. Five variables accounted for unique variance in predicting escalation: severity of depressive symptoms, medical conditions/symptoms, history of suicidal ideation, history of anxiety disorder, and familial loading for depression. Adolescents with three or more risk factors had an estimated 90% chance of escalating to full-syndrome depressive disorder, compared with 47% of adolescents with fewer than three risk factors.


CONCLUSIONS
These data may be useful in identifying a subgroup of youths with subthreshold depressive disorder who are at especially high risk for escalating to full-syndrome depressive disorders.
Klein
Daniel N
DN
Dr. Klein is with State University of New York-Stony Brook; Dr. Shankman is with the University of Illinois; and Drs. Lewinsohn and Seeley are with the Oregon Research Institute. Electronic address: daniel.klein@stonybrook.edu.
Shankman
Stewart A
SA
Dr. Klein is with State University of New York-Stony Brook; Dr. Shankman is with the University of Illinois; and Drs. Lewinsohn and Seeley are with the Oregon Research Institute.
Lewinsohn
Peter M
PM
Dr. Klein is with State University of New York-Stony Brook; Dr. Shankman is with the University of Illinois; and Drs. Lewinsohn and Seeley are with the Oregon Research Institute.
Seeley
John R
JR
Dr. Klein is with State University of New York-Stony Brook; Dr. Shankman is with the University of Illinois; and Drs. Lewinsohn and Seeley are with the Oregon Research Institute.
D000293:Adolescent; D000328:Adult; D000339:Affect; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics / Q000523:psychology; D006306:Health Surveys; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009922:Oregon; D010552:Personality Assessment / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011594:Psychometrics; D012306:Risk; D055815:Young Adult