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First episode of depression in children at low and high familial risk for depression
Douglas E Williamson1, Boris Birmaher, David A Axelson
1Department of Child and Adolescent Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA. WilliamsonDE@upmc.edu
Insights
Children with high familial risk for depression have a threefold increased risk of developing major depressive disorder (MDD). Maternal anxiety and child behavioral disorders further elevate this risk, underscoring the importance of family history and early behavioral signs in pediatric depression.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Genetics of Mental Disorders
Background:
- Familial risk is a significant predictor of developing major depressive disorder (MDD) in children.
- Understanding genetic and environmental factors contributing to pediatric depression is crucial for early intervention.
- Prospective studies are essential for tracking the developmental trajectory of mental health disorders in youth.
Purpose of the Study:
- To investigate the incidence of first-onset major depressive disorder (MDD) in children with high versus low familial risk.
- To identify specific familial and child-related factors that predict the development of MDD in youth.
- To contribute to the understanding of the etiology of pediatric depression through a prospective longitudinal design.
Main Methods:
- A prospective study design followed high-risk (n=76) and low-risk (n=63) children over an average of 6 years.
- High-risk children had a history of affective disorders in first- and second-degree relatives; low-risk children had minimal family history of psychiatric disorders.
- The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version (K-SADS-E) was used for assessments.
Main Results:
- Children with high familial risk showed a threefold increased risk of developing first-onset MDD compared to low-risk children (OR=3.21).
- The average age of new-onset MDD was 14.0 years.
- Maternal anxiety disorders (OR=2.84) and child behavioral disorders (OR=3.25) significantly increased the risk for MDD, independent of familial loading.
Conclusions:
- High familial loading for affective disorders is a significant risk factor for pediatric MDD.
- Maternal anxiety and child behavioral disorders are critical predictors of first-onset MDD in children.
- These findings highlight the interplay of genetic predisposition, maternal mental health, and child behavioral patterns in the development of depression.
Objective:
To examine the development of first-onset major depressive disorder (MDD) in children at high and low familial risk for depression in a prospective study.
Method:
High-risk children (n = 76) who were free of any lifetime affective disorder and had at least one first-degree and one second-degree relative with a lifetime history of childhood-onset, recurrent, bipolar, or psychotic depression were included. Low-risk children (n = 63) were included if they were free of any lifetime psychiatric disorder and had no first-degree relatives and fewer than 20% of their second-degree relatives with a lifetime affective disorder. Children and their parents were assessed in a prospective design using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version (K-SADS-E). The average interval between follow-up interviews was 18 months, and the average follow-up period was 6 years.
Results:
High-risk children had approximately a threefold increased risk of developing first-onset MDD compared with low-risk children (odds ratio = 3.21). The average age of new-onset MDD was 14.0 +/- 2.9 years (range 9.5-19.5 years). Above and beyond the familial loading for MDD, mother's lifetime anxiety disorder (odds ratio = 2.84) and lifetime behavioral disorder (odds ratio = 3.25) in the child significantly added to the risk of developing a first-onset MDD.
Conclusions:
Having high familial loading for affective disorders, a mother with and anxiety disorder, and a behavioral disorder in the child all significantly contributed to the risk of developing depression.
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