Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Depression and Suicide in Children and Adolescents
Course and Natural History
Most children with depression experience a recurrence. Twenty to 40 percent of
depressed children relapse within 2 years, and 70 percent will do so by
adulthood (Garber et al., 1988; Velez et al., 1989; Harrington et al., 1990;
Fleming et al., 1993; Kovacs et al., 1994; Lewinsohn et al., 1994a; Garrison et
al., 1997). The reasons for relapse are not known, but there is some evidence
that experiencing a depression leaves behind psychological“scars” that may
increase vulnerability throughout early life (see below).
The age of first onset of depression appears to play a role in its course.
Children who first become depressed before puberty are at risk for some form of
mental disorder in adulthood, while teenagers who first become depressed after
puberty are most likely to experience another episode of depression (Harrington
et al., 1990; McCracken, 1992a; Lewinsohn et al., 1994a, 1994b; Rao et al.,
1995). These differences in outcome suggest that different mechanisms may lead
to superficially similar but inherently different clinical conditions. Factors
that worsen the prognosis for depressed children and adolescents include
depression occurring in the context of conduct disorder (Harrington et al.,
1990; Asarnow et al., 1994) and living in conflict-ridden families (Asarnow et
al., 1994). Children and particularly adolescents who suffer from depression are
at much greater risk of committing suicide than are children without depression
(Shaffer et al., 1996b).
The prognosis for dysthymia (Klein et al., 1997a) is unfavorable, with most
patients continuing to feel depressed and to have social difficulties even after
they have apparently recovered. The prognosis for double depressives (major
depressive disorder plus dysthymia) is worse than that for either condition
alone (Kovacs et al., 1994).
Twenty to 40 percent of adolescents with depression eventually develop bipolar
disorder. Factors that predict later bipolar disorder include young age at the
time of the first depressive episode, psychotic features in the initial
depression, a family history of bipolar illness, and symptoms of hypomania
developing during treatment with antidepressant drugs (Garber et al., 1988;
Strober et al., 1993).
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