Emergence of Depressive Symptoms from Kindergarten to Sixth Grade

This study documents the emergence of symptoms of anxiety and depression in a community sample of school-age children and describes the temporal progression of symptoms leading to depressive episodes. Caregivers of 468 seventh graders reported retrospectively the manifestation of 14 symptoms of depression and anxiety in their children from kindergarten through sixth grade. The sample was balanced by sex and reflected the racial and economic diversity of the urban school district. Childhood period prevalence was calculated for each symptom, and discrete time survival analyses compared likelihoods of early symptom emergence in children who did and did not meet diagnostic criteria for major depressive disorder (MDD) by ninth grade. Symptom prevalence ranged between 20% (excessive guilt) and 50% (concentration problems) during the elementary school years. The 4-year period prevalence of MDD was 8.9%, 95% confidence interval [6.5%, 12.1%]. Low energy, excessive worry, excessive guilt, anhedonia, social withdrawal, and sadness or depressed mood were each associated with a significantly higher likelihood of onset of MDD. Compared to girls, boys were more likely to exhibit sad mood, fatigue, and trouble concentrating. Children who later met criteria for MDD demonstrated a significantly higher likelihood of showing core features of depressive and anxiety disorders during their elementary school years. The findings underscore the importance of recognizing early signs and developing interventions to help children manage early symptoms and prevent later psychiatric illness.