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Childhood Depression and Adult Personality Disorder
Alternative Pathways of Continuity
Stephanie Kasen, PhD;
Patricia Cohen, PhD;
Andrew E. Skodol, MD;
Jeffrey G. Johnson, PhD;
Elizabeth Smailes, MPhil;
Judith S. Brook, EdD
Arch Gen Psychiatry. 2001;58:231-236.
Background This study extends previous findings of the risks posed by childhood
major depressive disorder and other psychopathological features for later
personality disorder (PD) in a random sample of 551 youths.
Methods Self-reports and mother reports were used to evaluate DSM-III-R (Axes I and II) psychiatric disorders at mean ages of 12.7,
15.2, and 21.1 years. Logistic regression was used to examine the independent
effects of major depressive disorder in childhood or adolescence on 10 PDs
in young adulthood.
Results Odds of dependent, antisocial, passive-aggressive, and histrionic PDs
increased by more than 13, 10, 7, and 3 times, respectively, given prior major
depressive disorder. Those effects were independent of age, sex, disadvantaged
socioeconomic status, a history of child maltreatment, nonintact family status,
parental conflict, preexisting PD in adolescence, and other childhood or adolescent
Axis I psychopathological features, including disruptive and anxiety disorders.
In addition, odds of schizoid and narcissistic PD increased by almost 6 times
and odds of antisocial PD increased by almost 5 times given a prior disruptive
disorder, and odds of paranoid PD increased by 4 times given a prior anxiety
disorder.
Conclusion Personality disorders may represent alternative pathways of continuity
for major depressive disorder and other Axis I disorders across the child-adult
transition.
From the Department of Psychiatry (Drs Kasen, Cohen, Skodol, and Johnson)
and the School of Public Health (Dr Cohen), Columbia University, New York,
NY; the Departments of Epidemiology (Drs Kasen, Cohen, and Johnson and Ms
Smailes) and Personality Studies (Dr Skodol), New York State Psychiatric Institute,
New York; and the Department of Community and Preventive Medicine, Mount Sinai
School of Medicine, New York (Dr Brook).
Corresponding author and reprints: Stephanie Kasen, PhD, New York
State Psychiatric Institute, 1051 Riverside Dr, Unit 47, New York, NY 10032
(e-mail: sk57{at}columbia.edu).
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