Preschool Depression Strong Predictor of Later MDD

Laird Harrison

April 14, 2014

Depressive syndrome in preschoolers is a stronger predictor than several other major risk factors for major depression in later childhood, a new study shows.

"These findings suggest that the preschool diagnosis is a stronger predictor of later major depression than maternal history of depression or traumatic life events," investigators, led by Joan L. Luby, MD, of Washington University School of Medicine, St. Louis, Missouri, write.

The study was published online April 4 in the American Journal of Psychiatry.

Researchers have identified preschool-onset depression as a form of depression with unique characteristics, including alterations in stress reactivity and brain function.

However, it falls short of the threshold in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association for major depressive disorder. That has raised questions about its clinical significance.

To examine the disorder further, the investigators recruited preschool children at primary care and day care sites in St. Louis.

They screened the children with the Preschool Feelings Checklist, and included a high proportion of those with depression among the 246 they followed for the next 6 years.

The mean age of the children was 4.47 years at baseline and 10.91 years at the last follow-up assessment.

The researchers found that those diagnosed with preschool-onset depression were more than 2.5 times more likely to be diagnosed with school-age depression than the control population.

Among the depressed preschoolers, 51.4% developed school-age depression, compared with 23.8% of the control population. Preschool-onset conduct disorder was also associated with school-age depression.

On the other hand, preschoolers with anxiety disorders did not appear to face an increased risk for major anxiety later in life.

Among the other findings:

  • Children from families with lower income-to-needs ratios were 1.35 times more likely to have school-age depression.

  • Children with school-age depression were 1.88 times more likely to have a mother with a history of depression.

  • Children whose primary caregivers were observed using "nonsupportive parenting strategies" were 1.08 times more likely to have school-age depression.

  • Children with preschool-onset conduct disorder were 2.7 times more likely to have school-age depression.

  • The frequency of stressful life events experienced by children was unrelated to school-age depression.

  • Children's experiences of traumatic life events were not statistically significant as a predictor of school-age depression.

  • The effect of preschool conduct disorder on school-age depression was reduced by 21% when nonsupport was accounted for in the model.

The researchers noted that their findings contradict "common clinical belief" that maternal history of depression or traumatic life events is a stronger predictive factor than preschool depression for depression later on in life.

They called for more interventions to treat depressed preschoolers.

The research was supported by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Am J Psychiatry. Published online April 4, 2014. Abstract

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