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Myrna M. Weissman, PhD; Susan Wolk, MD; Risë B. Goldstein, PhD; Donna Moreau, MD; Philip Adams, PhD; Steven Greenwald, MA; Claudia M. Klier, MD; Neal D. Ryan, MD; Ronald E. Dahl, MD; Priya Wickramaratne, PhD

JAMA. 1999;281:1707-1713.

Context  Major depressive disorder (MDD) that arises in adolescence impairs functioning and is associated with suicide risk, but little is known about its continuity into adulthood.

Objective  To describe the clinical course of adolescent-onset MDD into adulthood.

Design and Participants  Prospective case-control study. Seventy-three subjects had onset of MDD based on systematic clinical assessment during adolescence (Tanner stage III-V) and 37 controls had no evidence of past or current psychiatric disorders, and also were assessed in adolescence (assessment years: 1977-1985). Follow-up was conducted 10 to 15 years after the initial assessment by an independent team without knowledge of initial diagnosis (follow-up years: 1992-1996).

Setting  Cases were identified at Columbia Presbyterian Hospital, New York City, NY; controls were recruited from the community.

Main Outcome Measures  Suicide and suicide attempts, psychiatric diagnoses, treatment utilization, and social functioning.

Results  Clinical outcomes of adolescent-onset MDD into adulthood compared with control subjects without psychiatric illness include a high rate of suicide (7.7%); a 5-fold increased risk for first suicide attempt; a 2-fold increased risk of MDD, but not other psychiatric disorders; an increased occurrence of psychiatric and medical hospitalization; and impaired functioning in work, social, and family life. Thirty-seven percent of those with adolescent MDD survived without an episode of MDD in adulthood vs 69% of the control participants (relative risk, 2.2 [95% confidence interval, 1.0-4.7; P<.05]).

Conclusion  There is substantial continuity, specificity, morbidity, and potential mortality from suicide into adulthood in adolescent-onset MDD patients. Now that empirically based guides to their treatment are becoming available, early identification and treatment seems warranted.

Author Affiliations: Division of Clinical and Genetic Epidemiology (Dr Weissman), College of Physicians and Surgeons (Drs Weissman, Wolk, Moreau, Adams, and Wickramaratne), Department of Psychiatry (Drs Wolk, Wickramaratne, Moreau, and Adams), and School of Public Health (Dr Weissman), Columbia University (Mr Greenwald), New York, NY; New York State Psychiatric Institute, New York, NY (Drs Weissman, Wolk, Adams, Wickramaratne, and Mr Greenwald); Department of Psychiatry, Virginia Commonwealth University, Richmond (Dr Goldstein); Department of Psychiatry, University of Vienna, Vienna, Austria (Dr Klier); and Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pa (Drs Ryan and Dahl).

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