Irritability, Anxiety Precede Depression in Children

Megan Brooks

December 12, 2016

Adolescents at high familial risk for major depressive disorder (MDD) are more apt to be irritable, fearful, and/or anxious than sad before the onset of MDD, new research shows.

The findings also show that familial risk factors such as the severity of the parent's depression and social risk factors such as poverty have a strong influence on new adolescent-onset MDD.

"Our findings suggest that primary prevention methods for depression in groups with high familial risk will need to include effective treatment of parental depression, irritability, and fear/anxiety in the child and consider social risk factors," investigators, led by Francis Rice, PhD, from Cardiff University, Wales, write.

The study was published online December 7 in JAMA Psychiatry.

Early-onset MDD is common in individuals with a family risk for depression. Dr Rice and colleagues examined the contributions of familial and social risk factors and specific clinical symptoms with respect to the time of first onset of adolescent MDD.

They recruited families in which the mother or father had experienced at least two episodes of MDD and in which there was a biologically related child aged 9 to 17 years living in the home.

Altogether, 279 of 304 families (92%) were followed for 4 years. During this time, 20 adolescents (6 boys and 14 girls) had new-onset MDD. The mean age of onset was 14.4 years (range, 10 to 18 years).

According to the researchers, irritability (β = 0.12, P = .03) and fear and/or anxiety (β = 0.38, P < .001) emerged as significant independent clinical antecedents of new adolescent-onset MDD, whereas disruptive behavior (β = -0.08, P = .14) and low mood (β = -0.03, P = .65) did not.

In addition, they note that all of the measured familial/genetic indicators (family history of depression and severe parental depression) and the social risk indicators (economic disadvantage and recent psychosocial adversity) contributed significantly and directly to first adolescent-onset MDD.

"Primary depression prevention or early intervention strategies may need to not only target clinical features in the high-risk child and the parent but also incorporate public health and community strategies to help overcome social risks, most notably poverty and psychosocial adversity," the investigators write.

Better Prevention Targets

This study will "potentially pave the way for better prevention targets in high-risk youth," write Anne Glowinski, MD, and Max Rosen, MD, of the Division of Child and Adolescent Psychiatry, Washington University School of Medicine, in St. Louis, Missouri, in a linked commentary.

"It is critical to pause and reflect on the fact that this study also strengthens previous findings that exposure to parental depression and low socioeconomic status are significant and independent risk factors for youth depression," they add.

"Taken together, these findings represent an urgent call. Prevention studies on youth depression in the United States are needed that carefully examine effects on high-risk individuals and the general population," the investigators conclude.

This study is "very interesting indeed," Edward D. Barker, PhD, Department of Psychology, King's College London and Institute of Psychiatry, Psychology and Neuroscience, United Kingdom, told Medscape Medical News.

On the one hand, he said, it supports a study (Whelan et al) he worked on that was published in 2015. That study found that both child irritability and symptoms of anxiety were associated with increased symptoms of depression in adolescents.

"The studies do differ though in that Rice et al focused on symptoms of depression for individuals who experienced these symptoms for the first time," said Dr Barker.

"They additionally examined the degree to which family history might also influence first-time depression symptoms, which it did. This is an important potential source of confounding in that depression may run in families, hence have heritable or genetic influences," he noted.

"The interesting finding here is that irritability and anxiety increased first-time depression symptoms above and beyond parent and family history of depression," Dr Barker said.

"Hence, this study, like Whelan et al, suggests that irritability and anxiety in children are an important target for prevention of subsequent depression," he concluded.

The study had no commercial funding. The authors have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online December 7, 2016. Full text, Editorial


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