Depression and depressive symptoms in adolescence. Clinical and epidemiological studies

Abstract

Objectives: Investigate depressive symptoms and disorders in adolescence in patient and school populations as regards screening and clinical characteristics, prevalence, course, attachment relationships and reflective functioning (mentalising). Method: Depressive symptoms and suicidality were examined in 726 adolescents from high schools in Göteborg and in clinical samples of adolescent inpatients (n=207), outpatients (n=15), a community based sample of individuals with anorexia nervosa (n=51), and in age- and gender matched comparison groups. The inpatient sample was followed up after 2 to 4 years and the anorexia sample after 5 and 10 years. Depressive disorders were assessed using DSM criteria. Depressive symptoms were assessed with the Birleson Depression Self-Rating Scale (DSRS) and the Beck Depression Inventory (BDI) and with the SCID-P for DSM-III- R. Attachment relationships and reflective functioning were assessed with the Adult Attachment Interview. Social- and demographic data and on current and previous suicidality were assessed by means of a questionnaire and were collected from medical records. Results: The DSRS was found to be a valid and reliable measure. Seven percent of school adolescents had high levels of depressive symptoms according to the DSRS. Four percent had made suicide attempts (of whom almost 40% had performed repeated attempts) and 4% had current moderate-severe suicidal ideation. Depressive disorders occurred in almost 30% of the psychiatric inpatients. Suicidality in this group was often associated with depressive symptoms and disorders and with suicide ideation and suicidality in family or friends. Two to four years after hospitalisation, self-rated depressive symptoms had diminished in most adolescents, but 13%, mostly girls, still reported high levels of such symptoms. Almost 60% (girls more often than boys) had made suicide attempts (half of which were repeated). Three of the 191 inpatient adolescents had committed suicide during the follow-up period. Depressive disorders were very common among adolescents with anorexia nervosa throughout the assessments. Depression during the first and the second follow-up periods was predicted by anorexia nervosa at diagnosis, depressive disorders at first follow-up and of current eating disorder. Adolescents with a depressive disorder reported insecure attachment relationships and had characteristic limitations in reflective functioning. Conclusions: Depression can be effectively screened and diagnosed among adolescents. The rate of depressive symptoms and disorders is high in the general population, considerably higher among psychiatric inpatients, and extremely high in anorexia nervosa. Many depressed youngsters have suicidal ideation, and the rate of attempted suicide is very high. Attachment relationships appear to be dysfunctional, but it is unclear whether this is a consequence or cause of depression.