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Differences in Early Childhood Risk Factors for Juvenile-Onset and Adult-Onset Depression
Sara R. Jaffee, PhD;
Terrie E. Moffitt, PhD;
Avshalom Caspi, PhD;
Eric Fombonne, MD;
Richie Poulton, PhD;
Judith Martin, MA
Arch Gen Psychiatry. 2002;59:215-222.
Background Family and twin studies suggest that juvenile-onset major depressive
disorder (MDD) may be etiologically distinct from adult-onset MDD. This study
is the first to distinguish prospectively between juvenile- and adult-onset
cases of MDD in a representative birth cohort followed up from childhood into
adulthood.
Method The study followed a representative birth cohort prospectively from
birth to age 26 years. Early childhood risk factors covered the period from
birth to age 9 years. Diagnoses of MDD were made according to DSM criteria at 3 points prior to adulthood (ages 11, 13, and 15 years)
and 3 points during adulthood (ages 18, 21, and 26 years). Four groups were
defined as (1) individuals first diagnosed as having MDD in childhood, but
not in adulthood (n = 21); (2) individuals first diagnosed as having MDD in
adulthood (n = 314); (3) individuals first diagnosed in childhood whose depression
recurred in adulthood by age 26 years (n = 34); and (4) never-depressed individuals
(n = 629).
Results The 2 juvenile-onset groups had similar high-risk profiles on the childhood
measures. Compared with the adult-depressed group, the juvenile-onset groups
experienced more perinatal insults and motor skill deficits, caretaker instability,
criminality, and psychopathology in their family-of-origin, and behavioral
and socioemotional problems. The adult-onset group's risk profile was similar
to that of the never-depressed group with the exception of elevated childhood
sexual abuse.
Conclusions Heterogeneity within groups of psychiatric patients poses problems for
theory, research, and treatment. The present study illustrates that the distinction
between juvenile vs adult-onset MDD is important for understanding heterogeneity
within depression.
From the Social, Genetic, and Developmental Psychiatry Research Centre,
Institute of Psychiatry (Drs Jaffee, Moffitt, and Caspi) and Department of
Child and Adolescent Psychiatry, Institute of Psychiatry (Dr Fombonne), King's
College, London, England; Department of Psychology, University of Wisconsin,
Madison (Drs Jaffee, Moffitt, and Caspi); and Dunedin Multidisciplinary Health
and Development Research Unit (Dr Poulton) and Department of Psychological
Medicine (Ms Martin), University of Otago, Dunedin, New Zealand.
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