Background

Depression often first emerges in adolescence and, for many, is a lifelong disorder. The long-term clinical course of depression is highly variable. We aimed to examine the adult outcomes of adolescent-onset trajectories of clinically significant depressive symptoms and to identify factors differentiating trajectories that persist and desist in adulthood.

Methods

We included participants from the English population-based Avon Longitudinal Study of Parents and Children with data on depressive symptoms. Self-reported depression symptoms were assessed on ten occasions when participants were age 10·5–25 years using the short Mood and Feelings Questionnaire, and major depressive disorder episodes were assessed at age 13·0 years, 15·0 years, 17·5 years, and 25·0 years. We characterised trajectories of depression symptoms using latent class growth analysis, for which we required depression data at least once from each of three key phases: ages 10·5–13·5 years; 16·5–18·5 years; and 21–25 years. We examined adult outcomes by assessing lifetime suicidal self-harm and functional impairment at age 24·0 years, and employment, education, and the self-reported Strengths and Difficulties Questionnaire at age 25·0 years.

Findings

We studied 4234 participants: 2651 (63%) female, 1582 (37%) male, and one individual with missing sex data. The mean age was 10·6 years (SD 0·2) at baseline and 25·8 years (SD 0·5) at the final timepoint. Data on ethnicity were not available in our data set. We identified four depression trajectory classes: adolescent-persistent depression with onset early in adolescence (7%, n≈279), adolescent-limited depression with onset later in adolescence and remittance by adult life (14%, n≈592), adult-increasing depression (25%, n≈1056), and stable-low levels of depression (54%, n≈2307). The adolescent-persistent class was associated with poor adult outcomes for functional impairment (62%), suicidal self-harm (27%), mental health difficulties (25%), and not being in education, employment, or training (16%). Adolescent-limited depression was associated with transient adolescent stress, but by early adulthood functional impairment and mental health difficulties were similar to the stable-low group. Major depressive disorder polygenic score (odds ratio [OR] 1·36, 95% CI 1·04–1·79), adolescent educational attainment (OR 0·47, 0·30–0·74), and any early childhood adversity (OR 2·60, 1·42–4·78), that persisted into adulthood (OR 1·60, 1·38–1·87) distinguished the adolescent-persistent and adolescent-limited groups.

Interpretation

The future course of adolescent depression can be differentiated by age at onset during adolescence, adolescent academic attainment, early and persistent adversity, and genetic loading. A detailed social and educational history could be helpful in making clinical decisions about the intensity of interventions for young people with clinically elevated depressive symptoms who seek help.

Funding

Medical Research Council, Wolfson Centre for Young People's Mental Health, Wolfson Foundation.

中文翻译：

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持续和缓解的青少年抑郁症状轨迹的前因和结果：一项纵向的、基于人群的英语研究

背景

抑郁症通常首先出现在青春期，对许多人来说，是一种终生疾病。抑郁症的长期临床病程变化很大。我们的目的是检查具有临床意义的抑郁症状的青春期发作轨迹的成人结果，并确定区分在成年期持续存在和停止的轨迹的因素。

方法

我们纳入了来自以英语人口为基础的雅芳父母和儿童纵向研究的参与者，并提供了抑郁症状的数据。当参与者年龄为 10·5-25 岁时，使用简短的情绪和感受问卷对自我报告的抑郁症状进行了十次评估，并在 13·0 岁、15·0 岁、17·5 岁时评估了重度抑郁症发作年和 25·0 年。我们使用潜在类别增长分析来表征抑郁症症状的轨迹，为此我们至少需要三个关键阶段中每个阶段的抑郁数据一次：年龄 10·5–13·5 岁；16·5–18·5岁；和 21-25 岁。我们通过评估 24·0 岁时的终生自杀自残和功能障碍，以及 25·0 岁时的就业、教育和自我报告的优势和困难问卷来检查成人结果。

发现

我们研究了 4234 名参与者：2651 名 (63%) 女性、1582 名 (37%) 男性和一名性别数据缺失的人。平均年龄在基线时为 10·6 岁 (SD 0·2)，在最终时间点为 25·8 岁 (SD 0·5)。我们的数据集中没有关于种族的数据。我们确定了四种抑郁轨迹类别：青春期早期发作的青春期持续性抑郁症（7%，n≈279），青春期后期发作的青春期局限性抑郁症和成年后缓解的抑郁症（14%，n≈592），成人-增加抑郁症（25%，n≈1056）和稳定低水平的抑郁症（54%，n≈2307）。青少年持续班级与功能障碍 (62%)、自杀式自残 (27%)、心理健康困难 (25%) 以及未接受教育、就业或培训 (16%) 等不良成人结果相关. 青春期局限性抑郁症与短暂的青春期压力有关，但成年早期的功能障碍和心理健康困难与稳定低组相似。重度抑郁症多基因评分（比值比 [OR] 1·36，95% CI 1·04–1·79），青春期教育程度（OR 0·47，0·30–0·74），以及任何早期儿童逆境(OR 2·60, 1·42–4·78)，持续到成年期 (OR 1·60, 1·38–1·87) 区分青春期持续和青春期受限组。

解释

青少年抑郁症的未来进程可以根据青春期发病年龄、青少年学业成就、早期和持续的逆境以及遗传负荷来区分。详细的社会和教育史可能有助于对寻求帮助的临床抑郁症状加重的年轻人做出干预强度的临床决策。

资金

沃尔夫森基金会沃尔夫森青年心理健康中心医学研究委员会。