| Early onset major depressive disorder often preceded by irritability and anxiety in adolescents Adolescents at high familial risk for major depressive disorder (MDD) are more likely to be irritable, fearful, and/or anxious than sad before the onset of MDD say researchers publishing online in JAMA Psychiatry. Early-onset major depressive disorder (MDD) is common in individuals with a family risk of depression. So what signs or symptoms might precede that initial onset of MDD during adolescence among a high-risk group of children with depressed parents? A new article by Frances Rice, Ph.D., of Cardiff University, Wales, and coauthors examined data from a study that began with 337 families where a parent (315 mothers and 22 fathers) had at least two episodes of MDD and among whom there was a biologically related child from 9 to 17 years of age living with them. The authors simultaneously examined the contributions of familial and social risk factors and specific clinical symptoms to the first onset of adolescent MDD. Analyses suggest irritability and fear/anxiety were clinical antecedents associated with new-onset adolescent MDD. According to the researchers, irritability (P = 0.03) and fear and/or anxiety (P < 0.001) emerged as significant independent clinical antecedents of new adolescent-onset MDD, whereas disruptive behavior (P = 0.14) and low mood (P = 0.65) did not. Family/genetic and social risk factors also influenced the risk for new-onset MDD, according to the results. In particular, familial risk factors, such as the severity of the parent's depression and social risk factors such as poverty, also had a strong influence on new adolescent-onset MDD. The study results suggest that there are multiple routes to the first onset of MDD. The study cannot establish causality. "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 study concludes. The study had no commercial funding and the authors have disclosed no relevant financial relationships. |