Oregon Adolescent Depression Project Research Articles

Subthreshold Symptoms: Where Do They Lead?

Subthreshold Symptoms: Where Do They Lead?

Separation Anxiety Disorder in Childhood as a Risk Factor for Future Mental Illness

To ascertain the extent to which childhood separation anxiety disorder (SAD) confers risk for the development of psychopathology during young adulthood (ages 19-30). A subset of the participants of the Oregon Adolescent Depression Project (n = 816) was used. Subjects provided retrospective reports of lifetime mental illness (including SAD) and concurrent reports of current mental illness at age 16 and were then followed prospectively until age 30. Diagnostic assessments were conducted twice during adolescence and again at ages 24 and 30. Based on diagnosis during childhood/adolescence, the subjects were partitioned into four orthogonal groups: SAD (n = 42), other anxiety disorders (n = 88), a heterogeneous psychiatric disorders control group (n = 389), and a not mentally ill control group (n = 297). Adjusting for demographic variables that were significantly associated with group status and for comorbid disorders prior to age 19, the results were analyzed with hierarchical multiple logistic regression. SAD was a strong (78.6%) risk factor for the development of mental disorders during young adulthood. The major vulnerabilities were for panic disorder and depression. Because SAD creates a major vulnerability for mental disorders during young adulthood, clinicians should be sensitive to the presence of SAD, and children and adolescents with SAD should be treated. Future research should evaluate whether successful treatment of SAD and/or the provision of a preventive intervention during childhood/adolescence reduce the risk for future psychopathology.

Influence of Parental and Grandparental Major Depressive Disorder on Behavior Problems in Early Childhood: A Three-Generation Study

This aim of this study was to examine the influence of grandparental (G1) and parental (G2) major depressive disorder (MDD) and other forms of psychopathology on behavior problems in very young offspring (G3). Oregon Adolescent Depression Project (OADP) participants who had children over a 3-year period were invited to participate in a study of infant and child development. We attempted to collect diagnostic history from the original OADP (G2) participants, their coparents, the parents of the original OADP participants (G1), and the parents of the coparents. Child (G3) outcomes at 24 months of age were based on parent reports of behavior problems. Univariate correlations indicated that G1 and G2 familial loadings for MDD were associated with higher levels of G3 internalizing and externalizing behavior problems. Multiple regression analyses revealed a significant interaction between G1 and G2 MDD on G3 internalizing (but not externalizing) behavior problems. A higher familial loading for MDD in either the parental or grandparental generation was associated with elevated grandchild internalizing problems, but higher loadings for MDD in both generations did not convey additional risk. Parental MDD and grandparental MDD are both associated with elevated levels of internalizing problems in young grandchildren, but MDD in both the G1 and G2 generations does not confer additional risk. One important implication is that MDD in the grandparental generation is associated with increased risk to grandchildren even in the absence of parental MDD. Future studies should examine the mechanisms through which grandparental psychopathology influences behavior problems in grandchildren.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Substance Use Disorders

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Substance Use Disorders

Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence

Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUDs) and cannabis dependence. However, the temporal sequencing of these disorders has not been extensively studied to determine whether SAD serves as a specific risk factor for problematic substance use. The present study examined these relationships after controlling for theoretically-relevant variables (e.g., gender, other Axis I pathology) in a longitudinal cohort over approximately 14 years. The sample was drawn from participants in the Oregon Adolescent Depression Project. After excluding those with substance use disorders at baseline, SAD at study entry was associated with 6.5 greater odds of cannabis dependence (but not abuse) and 4.5 greater odds of alcohol dependence (but not abuse) at follow-up after controlling for relevant variables (e.g., gender, depression, conduct disorder). The relationship between SAD and alcohol and cannabis dependence remained even after controlling for other anxiety disorders. Other anxiety disorders and mood disorders were not associated with subsequent cannabis or alcohol use disorder after controlling for relevant variables. Among the internalizing disorders, SAD appears to serve as a unique risk factor for the subsequent onset of cannabis and alcohol dependence.

Major Depressive Disorder in Adolescence: The Role of Subthreshold Symptoms

To examine the longitudinal association between individual subthreshold symptoms and onset of major depressive disorder (MDD) in adolescence. Data for analysis come from the Oregon Adolescent Depression Project, a prospective epidemiological study of psychological disorders among adolescents, ages 14 to 18 years, from the general community. A total of 1,709 adolescents completed the initial diagnostic assessments between 1987 and 1989 (T1) and approximately 1 year later (T2), 1,507 adolescents returned for readministration of assessments (88% response). After controlling for history of depression and gender, seven of the nine DSM-III-R symptoms of depression predicted MDD incidence when tested in separate models. Endorsement of each symptom at T1 increased the likelihood of MDD incidence between T1 and T2. A summary model that included the seven DSM-III-R symptoms as predictors was significant, with sad mood contributing unique variance to the prediction of MDD onset (odds ratio = 2.01). These findings suggest that much of the variance is shared among symptom predictors and the co-occurrence of symptoms is what constitutes the greatest risk. Moreover, the presence of sad mood contributes additional unique variance to prediction and supports the centrality of depressed mood to MDD.

Sibling similarity for MDD: Evidence for shared familial factors

Background Sibling designs have the potential to identify familial factors that are shared and unshared between siblings. Unfortunately, this methodology has rarely been applied to mood disorders. Methods The current study uses the original participants from the Oregon Adolescent Depression Project (OADP) and their closest-aged sibling to investigate familial influences on sibling similarity and differences for psychopathology. Diagnostic interviews were conducted with the original participants on three occasions and with full siblings and biological parents at the time of the third assessment. Results Maternal major depressive disorder (MDD) was associated with sibling similarity for MDD and anxiety disorders, and maternal anxiety disorder was associated with sibling similarity for MDD. A number of maternal and paternal disorders were associated with sibling differences for psychopathology. The data suggest that maternal MDD and anxiety disorder have a greater influence than paternal MDD and anxiety disorder in influencing sibling similarity for MDD. Limitations Original participants were assessed on up to three occasions while their siblings were assessed only once. Conclusions Maternal MDD and anxiety disorder appear to act as shared familial risk factors with respect to sibling MDD. In addition, parental psychopathology has non-shared influences on sib-pairs. Future research should assess differential parental treatment and individual sibling characteristics as additional factors that may influence sibling similarity and differences in psychopathology.

A taxometric investigation of unipolar depression in a large community sample

The question of whether unipolar clinical depression differs categorically from limited depressive complaints has important implications for the disorder's assessment, treatment and research. This crucial issue has proven difficult to resolve, in part because many studies to date have relied on self-report measures or on clinically homogeneous samples. We therefore applied Meehl's taxometric method to a large, clinically heterogeneous sample, and examined the latent structure of depressive episodes using both self-report and structured clinical interview data. Data were derived from the Oregon Adolescent Depression Project, a large longitudinal community study. All analyses involved more than 1400 participants. MAXEIG (MAXimum EIGenvalue) and base rate estimation were performed separately for Beck Depression Inventory (BDI) items and for DSM-IV-based major depressive episode (MDE) symptoms. MAXEIG analyses of the BDI and MDE indicator sets appeared to converge on a taxonic structure for unipolar depression. Base rate estimates overall implied a latent depressive episode class that occurs more frequently than diagnosable MDEs but less frequently than persistent depressed or anhedonic mood. These findings provide tentative support for a categorical conceptualization and make it very clear that the continuity controversy regarding unipolar depression has not yet been decided in favor of dimensionality. To reconcile the conflicting reports to date, several data analytic and sampling issues need to be explored systematically.

Cigarette Smoking and Panic Attacks Among Young Adults in the Community: The Role of Parental Smoking and Anxiety Disorders

The goal of the current study is to examine the association between cigarette smoking and panic attacks and panic disorder among youth and to investigate parental anxiety disorders and parental cigarette smoking in these links. Data were drawn from the Oregon Adolescent Depression Project (OADP) (n = 1709). Cigarette smoking and panic attacks and panic disorder were assessed at three time points from adolescence to young adulthood. Daily cigarette smoking at Time 1 was associated with a significantly increased risk of panic attacks (odds ratio [OR] = 2.6 [1.3, 5.3]) and panic disorder (OR = 4.2 [2.0, 8.9]) at Time 3. After adjusting for parental anxiety disorder and parental smoking, the association between cigarette smoking and panic attack was no longer statistically significant (OR = 2.0 [.9, 4.5]), though the association between cigarette smoking and panic disorder remained (OR = 3.7 [1.6, 8.9]). The association between smoking and panic was not evident between smoking and other anxiety disorders. These findings replicate previous results showing cigarette smoking in adolescence is associated with an increased risk of panic attacks and panic disorder in early adulthood and provide initial evidence that parental anxiety and parental smoking may play a role.

Psychosocial impairment in offspring of depressed parents

Offspring of depressed parents experience impairment in a number of domains of functioning. Few studies have examined the impact of both maternal and paternal depression and co-morbid psychopathology on offspring functioning. Oregon Adolescent Depression Project participants were administered diagnostic interviews and completed measures of psychosocial functioning during adolescence (mean = 16.6, S.D. = 1.19) and again during young adulthood (mean = 24.5, S.D. = 0.51). Diagnostic interviews were also conducted with the mothers and fathers of the target individual. After controlling for relevant demographic characteristics, parental co-morbid psychopathology, and offspring psychopathology, maternal depression was associated with higher levels of physical symptoms (beta = 0.14, S.E. = 0.07) during adolescence, and higher levels of minor stressors (beta = 2.52, S.E. = 1.07) and a greater risk for using mental health services (OR 1.86, 95% CI 1.14-3.03) in young adulthood. Paternal depression was associated with offspring experiencing more major stressors (beta = 0.27, S.E. = 0.07), having lower perceived social competence (beta = -0.17, S.E. = 0.08), and being more likely to attempt suicide (OR 2.65, 95% CI 1.19-5.92) during adolescence, as well as lower perceived social competence (beta = -1.21, S.E. = 0.49) in young adulthood.Conclusions. Offspring of depressed parents demonstrate impairment in a variety of domains, even after controlling for the effects of their own psychopathology. Further research on the mechanisms that lead to these impairments, as well as the role of these impairments in the subsequent development of psychopathology, is warranted.

Respiratory Symptoms and Mental Disorders Among Youth: Results From a Prospective, Longitudinal Study

To determine the relationship between respiratory symptoms and mental disorders among youth in the community, and to investigate possible mechanisms of these linkages. Data were drawn from the Oregon Adolescent Depression Project (n = 1,709), a longitudinal study of adolescents in the community. Multiple logistic regression analyses were used to examine the cross-sectional and longitudinal associations between respiratory symptoms and mental disorders at baseline, and linkages between respiratory symptoms at baseline and the onset of specific mental disorders at follow-up. Additional analyses were performed to examine the strength and specificity of the relationship between respiratory symptoms and mental disorders. The potential roles of hypochondriasis, functional impairment, and cigarette smoking in the associations between respiratory symptoms and mental disorders were investigated. Respiratory symptoms were associated with a significantly increased odds of any mental disorder (odds ratio (OR) = 1.9), specifically any depressive disorder (OR = 1.9), major depression (OR = 1.9), any substance use disorders (OR = 1.6), panic attacks (OR = 3.1), and attention deficit/hyperactivity disorder (ADHD) (OR = 5.8) at baseline. Respiratory symptoms at between 1987 and 1989 (Time 1) were associated with significantly increased risk of the onset of any mental disorder a year later (Time 2) (OR = 2.1). While demographic differences, hypochondriasis, functional impairment, and cigarette smoking contributed to the relationships between respiratory symptoms and mental disorders, these associations persisted after adjusting for these factors. The results suggest evidence of an association between respiratory symptoms and mental disorders among youth in the community. While demographic differences, hypochondriasis, functional impairment, and cigarette smoking may contribute to the linkage, these factors do not appear to completely explain the association. Future studies that can replicate these findings and include an examination of other possible mechanisms for these patterns of comorbidity, such as shared familial vulnerability or other environmental risk factors (e.g., childhood behavioral risk factors), are needed next.

The prevalence and co-morbidity of subthreshold psychiatric conditions.

In previous studies of subthreshold conditions, co-morbidity has been largely ignored. The purpose was to examine rates of co-morbidity among subthreshold disorders and between subthreshold and full-syndrome disorders for the major non-psychotic classes of disorders from DSM-IV. Participants came from the Oregon Adolescent Depression Project (mean age=16.6 years; females=52.1%). On the basis of a diagnostic interview (K-SADS), participants were assigned to eight subthreshold disorders (MDD, bipolar, eating, anxiety, alcohol use, substance use, conduct, ADHD). Of the 1704 adolescents in the analyses, 52.5% had at least one subthreshood disorder. Of those, 40.0% had also experienced a co-morbid subthreshold condition, and 29.9% of those had a second co-morbid subthreshold condition. Of those with a subthreshold, 36.4% also had a full syndrome. The subthreshold forms of externalizing disorders were co-morbid with each other. As expected, subthreshold anxiety was co-morbid with subthreshold MDD but subthreshold anxiety was also co-morbid with subthreshold alcohol, conduct, and ADHD. The pattern of co-morbidities was nearly identical for males and females. The hypotheses that externalizing disorders would be co-morbid with other externalizing disorders and that internalizing disorders would be co-morbid with other internalizing disorders was partially supported. Co-morbidities between subthreshold disorders and between subthreshold disorders and full syndrome should impact future research and clinical practice. The assessment of subthreshold disorders needs to include the assessment of other subthreshold and full-syndrome conditions.

The symptomatic expression of major depressive disorder in adolescents and young adults.

Data from the Oregon Adolescent Depression Project were used to examine the symptomatic expression of major depressive disorder (MDD) as a function of age and gender. The objective was to investigate the phenomenological nature of MDD among a cohort of adolescents as they progressed into early adulthood. The analyses were based on 564 participants who had experienced MDD in their lifetime. No systematic differences in the relative rate of occurrence of specific symptoms across episodes and only minor symptom differences between male and female participants were found. Age did not significantly influence the symptom picture. Stability of specific symptoms and episode severity across episodes was low. The results are discussed within the context of a stressor-symptom matching model.

The Core of Loneliness: Lack of Pleasurable Engagement--More So Than Painful Disconnection--Predicts Social Impairment, Depression Onset, and Recovery From Depressive Disorders Among Adolescents

Following past work, we proposed that loneliness possesses a bidimensional structure, with dimensions corresponding to lack of pleasurable engagement and painful disconnection. Moreover, we hypothesized that the distinction between lack of pleasurable engagement and painful disconnection would emerge in confirmatory factor analyses, in the pattern of relations of each facet to social impairment, in differential risk for the development of depressive disorders, and in differential rates of recovery from depressive disorders. Data from the Oregon Adolescent Depression Project were used to address these issues. Adolescents from high schools in urban and rural Oregon completed interviews and questionnaires on psychiatric status, loneliness, social functioning, and so forth, at one point in time and then again at a second session approximately a year later. Consistent with predictions, we found that the proposed bidimensional structure of loneliness represented a good fit to the covariance structure of loneliness items; the relation of lack of pleasurable engagement to social impairment exceeded that between painful disconnection and social impairment; and lack of pleasurable engagement, but not painful disconnection, was significantly related (in the expected directions) to onset of and recovery from depressive disorders. We discuss theoretical and clinical implications.

The OADP-CDS: A Brief Screener for Adolescent Conduct Disorder

To examine the ability of a very brief (6-item) self-report screener, the Oregon Adolescent Depression Project Conduct Disorder Screener (OADP-CDS), to identify adolescents with a lifetime diagnosis of conduct disorder and to examine its ability to predict antisocial personality disorder by age 24. Relevant scales from the Yough Self-Report and the Child Behavior Checklist were examined for comparison purposes. A total of 1,709 high school students completed an initial questionnaire and diagnostic interview assessment (T1); 1,507 participants returned approximately 1 year later for a second assessment (T2). A third (T3) assessment was conducted with selected T2 participants (n = 940) after they had turned 24 years of age. The OADP-CDS had good internal consistency, test-retest stability, and screening properties. Differences in the screening ability of the OADP-CDS as a function of gender and social desirability were nonsignificant. The efficacy of the measure as a screener did not differ significantly from that of longer adolescent- and parent-report measures. Perhaps most importantly, the OADP-CDS was able to identify future cases of antisocial personality disorder in young adulthood. Results suggest that self-report screening for conduct disorder with older adolescents is possible and should be explored further.

Major depressive disorder in older adolescents: Prevalence, risk factors, and clinical implications

In this article we summarize our current understanding of depression in older (14–18 years old) adolescents based on our program of research (the Oregon Adolescent Depression Project). Specifically, we address the following factors regarding adolescent depression: (a) phenomenology (e.g., occurrence of specific symptoms, gender and age effects, community versus clinic samples); (b) epidemiology (e.g., prevalence, incidence, duration, onset age); (c) comorbidity with other mental and physical disorders; (d) psychosocial characteristics associated with being, becoming, and having been depressed; (e) recommended methods of assessment and screening; and (f) the efficacy of a treatment intervention developed for adolescent depression, the Adolescent Coping With Depression course. We conclude by providing a set of summary statements and recommendations for clinicians.

Psychosocial characteristics of adolescents with a past history of dysthymic disorder: comparison with adolescents with past histories of major depressive and non-affective disorders, and never mentally ill controls

Little is known about the psychosocial functioning of persons who have recovered from dysthymic disorder. Such information might be useful in identifying trait markers for dysthymia, and for guiding continuation and maintenance treatment. We explored this issue using data from the Oregon Adolescent Depression Project, a large community-based study of the epidemiology of psychiatric disorders in a high school population. Four groups of adolescents were identified: 38 with a past history of dysthymic disorder; 217 with a past history of major depressive disorder; 142 with a past history of non-affective disorders; and 1079 with no lifetime history of psychopathology. The groups were compared on an extensive battery of psychosocial variables. The most consistent and diagnostically specific finding was that adolescents with a past history of dysthymic disorder reported having a significantly lower level of social support from friends than each of the other three groups of adolescents. Adolescents with a past history of dysthymic disorder also reported significantly higher levels of depressive, internalizing and externalizing symptoms and daily hassles than adolescents with no lifetime history of psychopathology. In addition, they reported higher levels of depressive symptoms and self-consciousness, but fewer externalizing symptoms than adolescents with a past history of non-affective disorders. These data suggest that adolescents with dysthymic disorder continue to experience significant difficulties in psychosocial functioning even after recovery.

Adolescent suicidal ideation and attempts: Prevalence, risk factors, and clinical implications.

In this article we summarize findings from our program of research (the Oregon Adolescent Depression Project) as they pertain to the suicidal behavior of older (14–18-year-old) adolescents. Specifically, we (a) present information regarding the epidemiology of suicidal ideation and suicide attempts (e.g., prevalence, incidence, onset age, methods, severity); (b) describe the psychosocial characteristics associated with past and future suicide attempts, in comparison to depression; (c) discuss issues relevant to assessment and screening, including our development of a new assessment instrument, the Life Attitudes Schedule; (d) share recommendations gained from our experience in providing treatment for depressed adolescents, approximately 40% of whom had made a suicide attempt; and (e) identify gaps in current knowledge for which more research is needed.

Continuity of Psychopathology in a Community Sample of Adolescents

To examine the continuity between the primary (first) diagnosis and secondary (second) diagnosis of those adolescents who have more than one episode of psychiatric disorder. Data were examined to determine whether the second episode "breeds true" (i.e., remains within the same diagnostic category as the first) or involves a different disorder. The sample consisted of 236 youngsters selected from the larger (n = 1,507) population of adolescents (aged 14 through 18 years) from the Oregon Adolescent Depression Project who had been assessed on two occasions, approximately 1 year apart. Results support the continuity hypothesis for the categories of disorder studied (major depression, anxiety, disruptive, substance use), with the exception of dysthymia. Primary dysthymia did not result in the diagnosis of secondary dysthymia, because most adolescents who had dysthymia had not recovered within the time frame of the study and were chronic cases, often with secondary anxiety. Also presented are data on age of onset of disorder (lowest for anxiety and highest for substance use) and information on remission intervals between episodes (well time) (lowest for substance use and highest for anxiety). The findings are interpreted as providing support for the "breed true" hypothesis, although clearly not all second episodes are identical with the first. While the psychosocial factors examined did not predict the nature of the second disorder, this clearly needs further study.