Depressed adolescents grown up

被引:647
作者
Weissman, MM
Wolk, S
Goldstein, RB
Moreau, D
Adams, P
Greenwald, S
Klier, CM
Ryan, ND
Dahl, RE
Wickramaratne, P
机构
[1] Columbia Univ Coll Phys & Surg, New York State Psychiat Inst, Div Clin & Genet Epidemiol, New York, NY 10032 USA
[2] Columbia Univ, Dept Psychiat, New York, NY USA
[3] Columbia Univ, Sch Publ Hlth, New York, NY USA
[4] New York State Psychiat Inst & Hosp, New York, NY USA
[5] Virginia Commonwealth Univ, Dept Psychiat, Richmond, VA USA
[6] Univ Vienna, Dept Psychiat, A-1010 Vienna, Austria
[7] Univ Pittsburgh, Dept Psychiat, Pittsburgh, PA USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 1999年 / 281卷 / 18期
关键词
D O I
10.1001/jama.281.18.1707
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Major depressive disorder (MDD) that arises in adolescence impairs functioning and is associated with suicide risk, but little is known about its continuity into adulthood. Objective To describe the clinical course of adolescent-onset MDD into adulthood. Design and Participants Prospective case-control study. Seventy-three subjects had onset of MDD based on systematic clinical assessment during adolescence (Tanner stage III-V) and 37 controls had no evidence of past or current psychiatric disorders, and also were assessed in adolescence (assessment years: 1977-1985). Follow-up was conducted 10 to 15 years after the initial assessment by an independent team without knowledge of initial diagnosis (follow-up years: 1992-1996). Setting Cases were identified at Columbia Presbyterian Hospital, New York City, NY; controls were recruited from the community. Main Outcome Measures Suicide and suicide attempts, psychiatric diagnoses, treatment utilization, and social functioning. Results Clinical outcomes of adolescent-onset MDD into adulthood compared with control subjects without psychiatric illness include a high rate of suicide (7.7%); a 5-fold increased risk for first suicide attempt; a 2-fold increased risk of MDD, but not other psychiatric disorders; an increased occurrence of psychiatric and medical hospitalization; and impaired functioning in work, social, and family life. Thirty-seven percent of those with adolescent MDD survived without an episode of MDD in adulthood vs 69% of the control participants (relative risk, 2.2 [95% confidence interval, 1.0-4.7; P<.05]), Conclusion There is substantial continuity, specificity, morbidity, and potential mortality from suicide into adulthood in adolescent-onset MDD patients. Now that empirically based guides to their treatment are becoming available, early identification and treatment seems warranted.
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页码:1707 / 1713
页数:7
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