Major depressive disorder in youths with IDDM - A controlled prospective study of course and outcome

OBJECTIVE - To determine whether IDDM affects the course of major depressive disorder (MDD) in youths. RESEARCH DESIGN AND METHODS - The study samples include 24 youths with IDDM (of a group of 92) who developed MDD during a longitudinal follow-up of 10 years, on average, since onset of the medical condition, and 30 depressed psychiatric control subjects, matched on relevant variables. Both groups were repeatedly assessed by semistructured interviews and diagnosed by operational criteria. RESULTS - In diabetic subjects, median time to recovery from the first episode of MDD was 6.4 months; by 12 months from onset, 69% of the youths will have recovered. Within 2 years of recovery, 32% were at risk for a new episode; by 6.5 years, altogether 47% are estimated to have a recurrence. Only 37.5% of diabetic subjects received treatment for the first episode of depression, and 50% received treatment for the second episode. Overall rates of recovery and recurrence were indistinguishable in the diabetic and psychiatric control groups. However, young women with diabetes were at nine times greater risk for recurrent depression than their male counterparts, and diabetic subjects eventually spent more time being depressed than the control subjects. CONCLUSIONS - The course characteristics of MDD in young diabetic subjects and psychiatric control subjects appear to be similar in several regards. However, the eventual propensity of diabetic youths for more protracted depressions and the higher risk of recurrence among young diabetic women suggest that the mental health of patients with IDDM should be closely monitored. The findings confirm that depression is undertreated among patients in the primary health care sector.