Longitudinal Course of Adolescent Depression: Neuroendocrine and Psychosocial Predictors

Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9101, USA.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 02/2010; 49(2):141-51. DOI: 10.1016/j.jaac.2009.09.008
Source: PubMed


The study examined whether cortisol measures are associated with the clinical course of depression in adolescents. Furthermore, the study evaluated whether the relationship between cortisol and clinical course is moderated by environmental stress and/or social support.
Fifty-five adolescents with depression (age range 13-18 years) were recruited. In addition to a systematic diagnostic assessment, information was obtained on environmental stress and social support. Urinary free cortisol measures were collected on three consecutive nights during the index episode. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period, documenting recovery from the index depressive episode and recurrent episodes. Information on environmental stress and social support also was gathered during each follow-up assessment.
Consistent with prior reports, the majority of adolescents (92.2%) recovered from the initial depressive episode. A substantial proportion of the recovered youth (42.6%) experienced a subsequent episode during the follow-up period. Higher cortisol levels were associated with a longer time to recovery from the index depressive episode. The effect of cortisol on recovery was moderated by social support. The combination of elevated cortisol and recent stressful experiences predicted recurrence, whereas a higher level of social support was protective against recurrence.
These data, in conjunction with prior literature, suggest that depression reflects an underlying neurobiological vulnerability that may predispose individuals with high vulnerability to chronic, recurrent episodes. Psychosocial factors, independently or in combination with an underlying neurobiological vulnerability, also play an important role in determining the clinical course of depression.

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    • "Factors found to predict full remission and recurrence vary across studies. Greater severity of depression at baseline (Birmaher et al., 2000; Dunn and Goodyer, 2006; Emslie et al., 1998), suicidal ideation (Rohde et al., 2006), and higher cortisol level (Rao et al., 2010) have been identified as predicting longer time to recovery. Comorbidity has also been identified as a marker of longer time to recovery including parent reported behaviour problems (Rohde et al., 2006) and number of comorbid disorders (Emslie et al., 1998). "
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