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Adolescents with Depression Grown up: Education, Intimate Relationships, Mental Health, and Personality
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Unipolar depression, estimated to be the leading contributor to burden of disease in middle- and high-income countries, often has an onset in adolescence. The disorder is associated with substantial role impairment and is highly recurrent. This raises questions about both subsequent mental health and social outcome. In order to shed light on this, a community sample of adolescents with depression and non-depressed peers was followed-up after 15 years.

In 1991-93, first-year students in upper secondary school (age 16-17) in the town of Uppsala, Sweden, were screened for depression. Adolescents with positive screening and selected peers with negative screening (n=631 in total) were assessed regarding mental health, social situation, and personality. At around age 31, the participants were followed-up in both national registers (n=609) and personal interviews (n=409). Outcome regarding social factors, mental health, and personality was assessed.

At follow-up, the former depressed adolescents had completed higher education to a lesser extent than the former non-depressed adolescents. The females with adolescent depression were also at increased risk of subsequent abortion, divorce, single parenthood, and partner violence. Characteristics associated with depression in adolescence (such as poor school performance and disruptive disorders) seemed to contribute to the poor outcome in the social domain.

Regarding adult mental health, long-term depression in adolescence was associated with a particularly poor outcome. Compared to adolescents with shorter episodes of depression, those with long-term depression were more likely to report recurrent depression, suicidal ideation, and a range of other mental disorders in adulthood.

Measures of personality traits related to neuroticism (a tendency towards negative emotionality) were elevated during ongoing depression and anxiety disorders, but were normalized with remission. However, repeated depressive episodes seemed to leave the individual more vulnerable to stress.

It is now important to assess if early treatment can alter the poor outcome depicted in this thesis. Since social adversity, educational difficulties, and interpersonal problems accompany the depressive disorder from adolescence onward, it should also be investigated if interventions aimed at such contextual factors can prevent recurrence and improve quality of life.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2010. , p. 51
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 630
Keyword [en]
Adolescent depression, Follow-up, Higher education, Childbearing, Intimate relationships, Recurrent depression, Personality development, Neuroticism, Social outcome, Community sample
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-134640ISBN: 978-91-554-7967-1 (print)OAI: oai:DiVA.org:uu-134640DiVA, id: diva2:373382
Public defence
2011-01-15, Sal IX, Universitetshuset, Övre Slottsgatan, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2010-12-22 Created: 2010-11-30 Last updated: 2011-06-21Bibliographically approved
List of papers
1. Subsequent higher education after adolescent depression: A 15-year follow-up register study
Open this publication in new window or tab >>Subsequent higher education after adolescent depression: A 15-year follow-up register study
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2010 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 25, no 7, p. 396-401Article in journal (Refereed) Published
Abstract [en]

Background: Adolescent depression has been shown to have a range of adverse outcomes. We used longitudinal data to investigate subsequent higher education in former depressed adolescents. Method: A Swedish population-based investigation of depression in 16-17-year-olds was followed up in national registers 15 years later. Adolescents with depression (n=361, 78% females) were compared to a group of non-depressed peers of the same age (n=248, 77% females). The main outcome was graduation from higher education by age 30. Results: The adolescent with depression were less likely than their non-depressed peers to have graduated from higher education by age 30, both regarding females (27.7% vs. 36.4%, p<05) and males (12.7% vs. 28.6%, p<05). After adjustment for early school performance, socioeconomic status and maternal education, the decreased likelihood of subsequent graduation from higher education remained for depressed males (OR, 0.27; 95% CI, 0.08-0.93) but not for depressed females (OR, 0.93; 95% CI, 0.58-1.49). Conclusion: Contrary to what previous research has suggested, adolescent depression and its consequences might be particularly destructive to subsequent higher education in males.

Keyword
Adolescent depression, Follow-up, Higher education
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-134635 (URN)10.1016/j.eurpsy.2010.01.016 (DOI)000284920800006 ()20541372 (PubMedID)
Available from: 2010-11-30 Created: 2010-11-30 Last updated: 2017-12-12Bibliographically approved
2. Intimate relationships and childbearing after adolescent depression: a population-based 15 year follow-up study
Open this publication in new window or tab >>Intimate relationships and childbearing after adolescent depression: a population-based 15 year follow-up study
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2011 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 46, no 8, p. 711-721Article in journal (Refereed) Published
Abstract [en]

Purpose: Adolescent depression is associated with a range of interpersonal adversities. We hypothesized that depressed adolescents are at subsequent increased risk of problems related to intimate relationships and childbearing in adulthood, and used longitudinal data to examine this.

Method: A population-based investigation of depression in 16 to 17 year olds was followed up after 15 years, at around the age of 30 years. Comparisons were made between adolescents with depression (n = 361, 78% females) and non-depressed peers (n = 248, 77% females). Data from both national registers and personal interviews were used.

Results: At follow-up, the former depressed and non-depressed adolescents had become parents to a similar extent. The former depressed females were more likely than the non-depressed females to report abortion, miscarriage, intimate partner violence and sexually transmitted disease. They also reported a higher number of intimate relationships and were more likely to have divorced and to be registered as single mothers. Depressed females with a comorbid disruptive disorder had a particularly poor outcome. In the depressed females without a disruptive disorder, only those who subsequently had recurrent depressions in adulthood were at increased risk of poor outcome. There was no indication that the formerly depressed males were at increased risk of subsequent problems related to intimate relationships.

Conclusion: Females with adolescent depression subsequently have problems related to intimate relationships and childbearing. Disruptive disorders and recurrence of depression appear to be instrumental in this association. Attention should be given to intimate relationship problems and sexual and reproductive health issues in young women with depression.

Keyword
Adolescent depression, Follow-up, Childbearing, Intimate relationships
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-134637 (URN)10.1007/s00127-010-0238-7 (DOI)000292700700006 ()
Available from: 2010-11-30 Created: 2010-11-30 Last updated: 2017-12-12Bibliographically approved
3. Mental health outcome of long-term and episodic adolescent depression: 15-year follow-up of a community  sample
Open this publication in new window or tab >>Mental health outcome of long-term and episodic adolescent depression: 15-year follow-up of a community  sample
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2011 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 130, no 3, p. 395-404Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Recent studies have highlighted the unfavourable natural course of chronic/long-term depression. We investigated the adult mental health outcome of adolescent depression, with specific focus on long-term and episodic adolescent major depression (MD). METHODS: A community sample of depressed adolescents and non-depressed peers was followed-up with a structured diagnostic interview after 15years. The participants (n=382) were divided into five groups depending on their status in adolescence: no depression (n=155); long-term MD (n=91); episodic MD (n=63); dysthymia (n=33); and subthreshold symptoms (n=40). Outcomes (age 19-31) included mood disorders, other mental disorders, suicidality, and treatment for mental disorders. RESULTS: The long-term group overall had a poorer outcome than the non-depressed group, with the episodic group in an intermediate position. The outcome of the dysthymic group was similar to that of the long-term group, while the subsyndromal group did not differ markedly from the non-depressed group. The long-term group was more likely than the episodic group to report adult anxiety disorders, multiple mental disorders, suicide attempts, and treatment; they also seemed to develop more persistent adult depressions, with a higher number of recurrent episodes and longer duration of antidepressant treatment. Even after adjustment for adolescent factors of clinical and etiological importance, the long-term group had a markedly less favourable outcome than the episodic group. LIMITATION: The participation rate at follow-up was 64.6%. CONCLUSION: Longstanding depression in adolescence is a powerful predictor of continued mental health problems in adulthood. It is now important to evaluate if early interventions can alter this severe course.

Keyword
Adolescent depression, Chronic depression, Follow-up, Mental health outcome
National Category
Neurosciences Neurology
Identifiers
urn:nbn:se:uu:diva-147878 (URN)10.1016/j.jad.2010.10.046 (DOI)000291192100005 ()21112639 (PubMedID)
Available from: 2011-03-01 Created: 2011-03-01 Last updated: 2018-01-12
4. Does depression in adolescence and early adulthood affect personality?: A 15-year follow-up of a community sample
Open this publication in new window or tab >>Does depression in adolescence and early adulthood affect personality?: A 15-year follow-up of a community sample
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(English)Manuscript (preprint) (Other academic)
Identifiers
urn:nbn:se:uu:diva-134639 (URN)
Available from: 2010-11-30 Created: 2010-11-30 Last updated: 2011-01-13

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