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The Course of Major Depression in the Offspring of Depressed Parents: Incidence, Recurrence, and Recovery

The Course of Major Depression in the Offspring of Depressed Parents: Incidence, Recurrence, and... Abstract • The 2-year course, first onset (incidence), recurrence, and recovery of major depression in 174 offspring at high and low risk for major depression were studied. A variety of predictors of course were examined, including parental diagnosis, demographic and clinical characteristics of the family and offspring, comorbidity and social functioning in offspring, and family risk factors. The 2-year incidence rate was 8.5%. All of the incident cases of major depression occurred in offspring of depressed parents. Additional predictors of incidence were a preceding diagnosis of conduct disorder and subclinical symptoms of depression. The recurrence rate results are tentative because of the small sample. The 2-year recurrence rate was 16.1%. Predictors of recurrence were a previous comorbid diagnosis of dysthymia or problems in social functioning. By the end of 2 years, the majority of offspring (87%) had recovered. The mean number of weeks to recovery was 54 in the offspring of depressed parents and 23 in the offspring of nondepressed parents. Offspring with an onset of major depression at age 13 years or younger, who were exposed to divorce in the family or who had been exposed to more than one parental depressive episode, had significantly more protracted times to recovery. We conclude that there are different predictors of incidence of major depression, its recurrence, and time to recovery in offspring, and that parental depression has an impact on the course in offspring. References 1. Orvaschel H. Early onset psychiatric disorder in high risk children and increased familial morbidity . J Am Acad Child Adolesc Psychiatry . 1990;29: 184-188.Crossref 2. Keller MB, Beardslee W, Lavori PW, Wunder J, Drs DL, Samuelson H. Course of major depression in non-referred adolescents: a retrospective study . J Affective Disord . 1988;15:235-243.Crossref 3. Hammen C, Burge D, Burney E, Adrian C. Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder . Arch Gen Psychiatry . 1990;47:1112-1117.Crossref 4. Grigoroiu-Serbanescu M, Christodorescu D, Magureanu S, Jipescu I, Totoescu A, Marinescu E, Ardelean V, Popa S. Adolescent offspring of endogenous unipolar depressive parents and of normal parents . J Affective Disord . 1991;21:185-198.Crossref 5. Weissman MM, Gammon GD, John K, Merikangas KR, Warner V, Prusoff BA, Sholomskas D. Children of depressed parents increased psychopathology and early onset of major depression . Arch Gen Psychiatry . 1987;44: 847-853.Crossref 6. Fendrich M, Warner V, Weissman MM. Family risk factors, parental depression, and psychJarrettogy in offspring . Dev Psychol . 1990;26:40-50.Crossref 7. Frank E, Prien R, jarrett RB, Keller MB, Kupfer DJ, Lavori P, Rush AJ, Weissman MM. Conceptualization and rationale for consensus definitions of response, remission, recovery, relapse, and recurrence in major depressive disorder . Arch Gen Psychiatry . 1991;48:851-855.Crossref 8. Prien RF, Carpenter LL, Kupfer DJ. The definition and operational criteria for treatment outcome of major depressive disorder: a review of the current research literature . Arch Gen Psychiatry . 1991;48:796-800.Crossref 9. Kovacs M, Feinberg TI, Crouse-Novak MA, Paulauskas SL, Finkelstein R. Depressive disorders in childhood, I: a longitudinal prospective study of characteristics and recovery . Arch Gen Psychiatry . 1984;41:229-237.Crossref 10. Kovacs M, Feinberg TL, Crouse-Novak M, Paulauskas SL, Pollock M, Finkelstein R. Depressive disorders in childhood, II: a longitudinal study of the risk for a subsequent major depression . Arch Gen Psychiatry . 1984;41:643-649.Crossref 11. Kovacs M, Paulauskas S, Gatsonis C, Richards C. Depressive disorders in childhood, III: a longitudinal study of comorbidity with and risk for conduct disorders . J Affective Disord . 1988;15:205-217.Crossref 12. Kovacs M, Gatsonis C, Paulauskas SL, Richards C. Depressive disorders in childhood, IV: a longitudinal study of comorbidity with and risk for anxiety disorders . Arch Gen Psychiatry . 1989;46:776-782.Crossref 13. Asarnow JR, Goldstein MJ, Carlson GA, Perdue S, Bates S, Keller J. Childhood-onset depressive disorders: a follow-up study of rates of rehospitalization and out-of-home placement among child psychiatric inpatients . J Affective Disord . 1988;15:245-253.Crossref 14. King LJ, Pittman GD. A six-year follow-up of 65 adolescent patients . Arch Gen Psychiatry . 1970;22:230-236.Crossref 15. Welner A, Welner Z, Fishman R. Psychiatric adolescent inpatients: eight- to ten-year follow-up . Arch Gen Psychiatry . 1979;36:698-700.Crossref 16. Pozanski EO, Kaahenbuhl V, Zrull LP. Childhood depression: a longitudinal perspective . J Am Acad Child Psychiatry . 1976;15:491-501.Crossref 17. Harrington R, Fudge H, Rutter M, Pickles A, Hill J. Adult outcomes of childhood and adolescent depression, I: psychiatric status . Arch Gen Psychiatry . 1990;47:465-473.Crossref 18. Garber J, Kriss MR, Koch M, Lindholm L. Recurrent depression in adolescents: a follow-up study . JAm Acad Child Adolesc Psychiatry .1988;27:49-54.Crossref 19. Eastgate J, Gilmour L. Long-term outcome of depressed children: a follow-up study . Dev Med Child Neurol . 1984;26:68-72.Crossref 20. McGee R, Williams S. A longitudinal study of depression in nine-year old children . J Am Acad Child Adolesc Psychiatry . 1988;27:342-348.Crossref 21. Chess S, Thomas A, Hassibi M. Depression in childhood and adolescence: a prospective study of six cases . J Nerv Ment Dis . 1983;171:411-420.Crossref 22. Kandel DB, Davies M. Adult sequelae of adolescent depressive symptoms . Arch Gen Psychiatry . 1986;43:255-262.Crossref 23. Reinherz HZ, Stewart-Berghauer G, Pakiz B, Frost AK, Moeykens BA, Holmes WM. The relationship of early risk and current mediators to depressive symptomatology in adolescence . J Am Acad Child Adolesc Psychiatry . 1989;28:942-947.Crossref 24. Weissman MM, Kidd KK, Prusoff BA. Variability in rates of affective disorders in relatives of depressed and normal probands . Arch Gen Psychiatry . 1982;39:1397-1403.Crossref 25. Fendrich M, Weissman MM, Warner V, Mufson L. Two-year recall of lifetime diagnoses in offspring at high and low risk for major depression: the stability of offspring reports . Arch Gen Psychiatry . 1990;47:1121-1127.Crossref 26. Leckman JF, Sholomskas D, Thompson WD, Belanger A, Weissman MM. Best estimate of lifetime psychiatric diagnosis: a methodological study . Arch Gen Psychiatry . 1982;39:879-883.Crossref 27. Weissman MM. Psychopathology in the children of depressed parents: direct interview studies . In: Dunner DL, Gershon ES, Barret J, eds. Relatives at Risk for Mental Disorders . New York, NY: Raven Press; 1988:143-159. 28. Hollingshead AB, Redlich FC. Social Class and Mental Illness . New York, NY: John Wiley & Sons Inc; 1958. 29. Weissman MM, Warner V, Wickramaratne P, Prusoff BA. Early-onset major depression in parents and their children . J Affective Disord .1988;15:269-277.Crossref 30. Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S. A children's global assessment scale (CGAS) . Arch Gen Psychiatry . 1983; 40:1228-1231.Crossref 31. Bird H, Canino G, Rubio-Stipec M, Rivera JC. Further measures of the psychometric properties of the Children's Global Assessment . Arch Gen Psychiatry . 1987;44:821-824.Crossref 32. John K, Gammon GD, Prusoff BA, Warner V. The Social Adjustment Inventory for Children and Adolescents (SAICA): testing of a new semistructured interview . J Am Acad Child Adolesc Psychiatry . 1987;26:898-911.Crossref 33. Locke HJ, Wallace KM. Short marital adjustment and prediction tests: their reliability and validity . Marriage Fam Living . 1959;21:251-255.Crossref 34. Parker G, Tupling H, Brown LB. A parental bonding instrument . Br J Med Psychol . 1979;52:1-10.Crossref 35. Olson DH, Sprenkle DH, Russell CS. Circumplex model of marital and family systems, 1: cohesion and adaptability dimensions, family types and clinical applications . Fam Process . 1979;18:3-28.Crossref 36. SAS Institute Inc. SUGI Supplemental Library User's Guide, Version 5. Cary, NC: SAS Institute Inc; 1986. 37. Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data . New York, NY: John Wiley & Sons Inc; 1980. 38. Murphy JM, Sobol AM, Olivier DC, Monson RR, Leighton AH, Pratt LA. Prodromes of depression and anxiety: the Stirling County study . Br J Psychiatry . 1989;155:490-495.Crossref 39. Horwath E, Johnson J, Klerman GL, Weissman MM. Depressive symptoms as relative and attributable risk factors for first onset major depression . Arch Gen Psychiatry . In press. 40. Weissman MM, Leaf PF, Bruce ML, Florio LP. The epidemiology of dysthymia in the community: rates, risks, comorbidity and treatment . Am J Psychiatry . 1988;145:815-819. 41. Keller MB, Lavori PW, Endicott J, Coryell W, Klerman GL. 'Double depression': two-year follow-up . Am J Psychiatry . 1983;140:689-694. 42. Sargent JK, Bruce ML, Florio LP, Weissman MM. Factors associated with 1-year outcome of major depression in the community . Arch Gen Psychiatry . 1990;47:519-526.Crossref 43. Keller MB, Shapiro RW, Lavori PW, Wolfe N. Recovery in major depressive disorder analysis with the life table and regression models . Arch Gen Psychiatry . 1982;39:905-910.Crossref 44. Keller MB, Beardslee WR, Dorer DJ, Lavori PW, Samuelson H, Klerman GR. Impact of severity and chronicity of parental affective illness on adaptive functioning and psychopathology in children . Arch Gen Psychiatry . 1986;43:930-937.Crossref 45. Puig-Antich J, Lukens E, Davies M, Goetz D, Brennen-Quattrock J, Todak G. Psychosocial functioning in prepubertal major depressive disorders, II: interpersonal relationships during the depressive episode . Arch Gen Psychiatry . 1985;42:500-507.Crossref 46. Puig-Antich J, Lukens E, Davies M, Goetz D, Brennan-Quattrock J, Todak G. Psychosocial functioning in prepubertal major depressive disorders, II: interpersonal relationships after sustained recovery from the depressive episode . Arch Gen Psychiatry . 1985;42:511-517.Crossref 47. Weissman MM, Merikangas KR, Wickramaratne PJ, Kidd KK, Prusoff BA, Leckman JF, Pauls DL. Understanding the clinical heterogeneity of major depression using family data . Arch Gen Psychiatry . 1986;43:430-434.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

The Course of Major Depression in the Offspring of Depressed Parents: Incidence, Recurrence, and Recovery

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1992.01820100039008
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Abstract

Abstract • The 2-year course, first onset (incidence), recurrence, and recovery of major depression in 174 offspring at high and low risk for major depression were studied. A variety of predictors of course were examined, including parental diagnosis, demographic and clinical characteristics of the family and offspring, comorbidity and social functioning in offspring, and family risk factors. The 2-year incidence rate was 8.5%. All of the incident cases of major depression occurred in offspring of depressed parents. Additional predictors of incidence were a preceding diagnosis of conduct disorder and subclinical symptoms of depression. The recurrence rate results are tentative because of the small sample. The 2-year recurrence rate was 16.1%. Predictors of recurrence were a previous comorbid diagnosis of dysthymia or problems in social functioning. By the end of 2 years, the majority of offspring (87%) had recovered. The mean number of weeks to recovery was 54 in the offspring of depressed parents and 23 in the offspring of nondepressed parents. Offspring with an onset of major depression at age 13 years or younger, who were exposed to divorce in the family or who had been exposed to more than one parental depressive episode, had significantly more protracted times to recovery. We conclude that there are different predictors of incidence of major depression, its recurrence, and time to recovery in offspring, and that parental depression has an impact on the course in offspring. References 1. Orvaschel H. Early onset psychiatric disorder in high risk children and increased familial morbidity . J Am Acad Child Adolesc Psychiatry . 1990;29: 184-188.Crossref 2. Keller MB, Beardslee W, Lavori PW, Wunder J, Drs DL, Samuelson H. Course of major depression in non-referred adolescents: a retrospective study . J Affective Disord . 1988;15:235-243.Crossref 3. Hammen C, Burge D, Burney E, Adrian C. Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder . Arch Gen Psychiatry . 1990;47:1112-1117.Crossref 4. Grigoroiu-Serbanescu M, Christodorescu D, Magureanu S, Jipescu I, Totoescu A, Marinescu E, Ardelean V, Popa S. Adolescent offspring of endogenous unipolar depressive parents and of normal parents . J Affective Disord . 1991;21:185-198.Crossref 5. Weissman MM, Gammon GD, John K, Merikangas KR, Warner V, Prusoff BA, Sholomskas D. Children of depressed parents increased psychopathology and early onset of major depression . Arch Gen Psychiatry . 1987;44: 847-853.Crossref 6. Fendrich M, Warner V, Weissman MM. Family risk factors, parental depression, and psychJarrettogy in offspring . Dev Psychol . 1990;26:40-50.Crossref 7. Frank E, Prien R, jarrett RB, Keller MB, Kupfer DJ, Lavori P, Rush AJ, Weissman MM. Conceptualization and rationale for consensus definitions of response, remission, recovery, relapse, and recurrence in major depressive disorder . Arch Gen Psychiatry . 1991;48:851-855.Crossref 8. Prien RF, Carpenter LL, Kupfer DJ. The definition and operational criteria for treatment outcome of major depressive disorder: a review of the current research literature . Arch Gen Psychiatry . 1991;48:796-800.Crossref 9. Kovacs M, Feinberg TI, Crouse-Novak MA, Paulauskas SL, Finkelstein R. Depressive disorders in childhood, I: a longitudinal prospective study of characteristics and recovery . Arch Gen Psychiatry . 1984;41:229-237.Crossref 10. Kovacs M, Feinberg TL, Crouse-Novak M, Paulauskas SL, Pollock M, Finkelstein R. Depressive disorders in childhood, II: a longitudinal study of the risk for a subsequent major depression . Arch Gen Psychiatry . 1984;41:643-649.Crossref 11. Kovacs M, Paulauskas S, Gatsonis C, Richards C. Depressive disorders in childhood, III: a longitudinal study of comorbidity with and risk for conduct disorders . J Affective Disord . 1988;15:205-217.Crossref 12. Kovacs M, Gatsonis C, Paulauskas SL, Richards C. Depressive disorders in childhood, IV: a longitudinal study of comorbidity with and risk for anxiety disorders . Arch Gen Psychiatry . 1989;46:776-782.Crossref 13. Asarnow JR, Goldstein MJ, Carlson GA, Perdue S, Bates S, Keller J. Childhood-onset depressive disorders: a follow-up study of rates of rehospitalization and out-of-home placement among child psychiatric inpatients . J Affective Disord . 1988;15:245-253.Crossref 14. King LJ, Pittman GD. A six-year follow-up of 65 adolescent patients . Arch Gen Psychiatry . 1970;22:230-236.Crossref 15. Welner A, Welner Z, Fishman R. Psychiatric adolescent inpatients: eight- to ten-year follow-up . Arch Gen Psychiatry . 1979;36:698-700.Crossref 16. Pozanski EO, Kaahenbuhl V, Zrull LP. Childhood depression: a longitudinal perspective . J Am Acad Child Psychiatry . 1976;15:491-501.Crossref 17. Harrington R, Fudge H, Rutter M, Pickles A, Hill J. Adult outcomes of childhood and adolescent depression, I: psychiatric status . Arch Gen Psychiatry . 1990;47:465-473.Crossref 18. Garber J, Kriss MR, Koch M, Lindholm L. Recurrent depression in adolescents: a follow-up study . JAm Acad Child Adolesc Psychiatry .1988;27:49-54.Crossref 19. Eastgate J, Gilmour L. Long-term outcome of depressed children: a follow-up study . Dev Med Child Neurol . 1984;26:68-72.Crossref 20. McGee R, Williams S. A longitudinal study of depression in nine-year old children . J Am Acad Child Adolesc Psychiatry . 1988;27:342-348.Crossref 21. Chess S, Thomas A, Hassibi M. Depression in childhood and adolescence: a prospective study of six cases . J Nerv Ment Dis . 1983;171:411-420.Crossref 22. Kandel DB, Davies M. Adult sequelae of adolescent depressive symptoms . Arch Gen Psychiatry . 1986;43:255-262.Crossref 23. Reinherz HZ, Stewart-Berghauer G, Pakiz B, Frost AK, Moeykens BA, Holmes WM. The relationship of early risk and current mediators to depressive symptomatology in adolescence . J Am Acad Child Adolesc Psychiatry . 1989;28:942-947.Crossref 24. Weissman MM, Kidd KK, Prusoff BA. Variability in rates of affective disorders in relatives of depressed and normal probands . Arch Gen Psychiatry . 1982;39:1397-1403.Crossref 25. Fendrich M, Weissman MM, Warner V, Mufson L. Two-year recall of lifetime diagnoses in offspring at high and low risk for major depression: the stability of offspring reports . Arch Gen Psychiatry . 1990;47:1121-1127.Crossref 26. Leckman JF, Sholomskas D, Thompson WD, Belanger A, Weissman MM. Best estimate of lifetime psychiatric diagnosis: a methodological study . Arch Gen Psychiatry . 1982;39:879-883.Crossref 27. Weissman MM. Psychopathology in the children of depressed parents: direct interview studies . In: Dunner DL, Gershon ES, Barret J, eds. Relatives at Risk for Mental Disorders . New York, NY: Raven Press; 1988:143-159. 28. Hollingshead AB, Redlich FC. Social Class and Mental Illness . New York, NY: John Wiley & Sons Inc; 1958. 29. Weissman MM, Warner V, Wickramaratne P, Prusoff BA. Early-onset major depression in parents and their children . J Affective Disord .1988;15:269-277.Crossref 30. Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S. A children's global assessment scale (CGAS) . Arch Gen Psychiatry . 1983; 40:1228-1231.Crossref 31. Bird H, Canino G, Rubio-Stipec M, Rivera JC. Further measures of the psychometric properties of the Children's Global Assessment . Arch Gen Psychiatry . 1987;44:821-824.Crossref 32. John K, Gammon GD, Prusoff BA, Warner V. The Social Adjustment Inventory for Children and Adolescents (SAICA): testing of a new semistructured interview . J Am Acad Child Adolesc Psychiatry . 1987;26:898-911.Crossref 33. Locke HJ, Wallace KM. Short marital adjustment and prediction tests: their reliability and validity . Marriage Fam Living . 1959;21:251-255.Crossref 34. Parker G, Tupling H, Brown LB. A parental bonding instrument . Br J Med Psychol . 1979;52:1-10.Crossref 35. Olson DH, Sprenkle DH, Russell CS. Circumplex model of marital and family systems, 1: cohesion and adaptability dimensions, family types and clinical applications . Fam Process . 1979;18:3-28.Crossref 36. SAS Institute Inc. SUGI Supplemental Library User's Guide, Version 5. Cary, NC: SAS Institute Inc; 1986. 37. Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data . New York, NY: John Wiley & Sons Inc; 1980. 38. Murphy JM, Sobol AM, Olivier DC, Monson RR, Leighton AH, Pratt LA. Prodromes of depression and anxiety: the Stirling County study . Br J Psychiatry . 1989;155:490-495.Crossref 39. Horwath E, Johnson J, Klerman GL, Weissman MM. Depressive symptoms as relative and attributable risk factors for first onset major depression . Arch Gen Psychiatry . In press. 40. Weissman MM, Leaf PF, Bruce ML, Florio LP. The epidemiology of dysthymia in the community: rates, risks, comorbidity and treatment . Am J Psychiatry . 1988;145:815-819. 41. Keller MB, Lavori PW, Endicott J, Coryell W, Klerman GL. 'Double depression': two-year follow-up . Am J Psychiatry . 1983;140:689-694. 42. Sargent JK, Bruce ML, Florio LP, Weissman MM. Factors associated with 1-year outcome of major depression in the community . Arch Gen Psychiatry . 1990;47:519-526.Crossref 43. Keller MB, Shapiro RW, Lavori PW, Wolfe N. Recovery in major depressive disorder analysis with the life table and regression models . Arch Gen Psychiatry . 1982;39:905-910.Crossref 44. Keller MB, Beardslee WR, Dorer DJ, Lavori PW, Samuelson H, Klerman GR. Impact of severity and chronicity of parental affective illness on adaptive functioning and psychopathology in children . Arch Gen Psychiatry . 1986;43:930-937.Crossref 45. Puig-Antich J, Lukens E, Davies M, Goetz D, Brennen-Quattrock J, Todak G. Psychosocial functioning in prepubertal major depressive disorders, II: interpersonal relationships during the depressive episode . Arch Gen Psychiatry . 1985;42:500-507.Crossref 46. Puig-Antich J, Lukens E, Davies M, Goetz D, Brennan-Quattrock J, Todak G. Psychosocial functioning in prepubertal major depressive disorders, II: interpersonal relationships after sustained recovery from the depressive episode . Arch Gen Psychiatry . 1985;42:511-517.Crossref 47. Weissman MM, Merikangas KR, Wickramaratne PJ, Kidd KK, Prusoff BA, Leckman JF, Pauls DL. Understanding the clinical heterogeneity of major depression using family data . Arch Gen Psychiatry . 1986;43:430-434.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Oct 1, 1992

References