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Pre-adult versus adult onset major depressive disorder in a naturalistic patient sample: the Leiden Routine Outcome Monitoring Study

Published online by Cambridge University Press:  16 November 2010

M. S. van Noorden ,
S. E. Minkenberg ,
E. J. Giltay ,
M. E. den Hollander-Gijsman ,
Y. R. van Rood ,
N. J. van der Wee  and
F. G. Zitman
M. S. van Noorden*
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
S. E. Minkenberg
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
E. J. Giltay
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
M. E. den Hollander-Gijsman
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands Rivierduinen, Mental Health Clinics, Leiden, The Netherlands
Y. R. van Rood
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
N. J. van der Wee
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands Leiden Institute for Brain and Cognition, Leiden, The Netherlands
F. G. Zitman
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands Rivierduinen, Mental Health Clinics, Leiden, The Netherlands
*
*Address for correspondence: M. S. van Noorden, M.D., Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. (Email: [email protected])
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Abstract

Background

Pre-adult onset of major depressive disorder (MDD) may predict a more severe phenotype of depression. As data from naturalistic psychiatric specialty care settings are scarce, we examined phenotypic differences between pre-adult and adult onset MDD in a large sample of consecutive out-patients.

Method

Altogether, 1552 out-patients, mean age 39.2±11.6 years, were diagnosed with current MDD on the Mini-International Neuropsychiatric Interview Plus diagnostic interview as part of the usual diagnostic procedure. A total of 1105 patients (71.2%) had complete data on all variables of interest. Pre-adult onset of MDD was defined as having experienced the signs and symptoms of a first major depressive episode before the age of 18 years. Patients were stratified according to the age at interview (20–40/40–65 years). Correlates of pre-adult onset were analysed using logistic regression models adjusted for age, age squared and gender.

Results

Univariate analyses showed that pre-adult onset of MDD had a distinct set of demographic (e.g. less frequently living alone) and clinical correlates (more co-morbid DSM-IV – Text Revision diagnoses, more social phobia, more suicidality). In the multivariate model, we found an independent association only for a history of suicide attempts [odds ratio (OR) 3.15, 95% confidence intervals (CI) 1.97–5.05] and current suicidal thoughts (OR 1.81, 95% CI 1.26–2.60) in patients with pre-adult versus adult onset MDD.

Conclusions

Pre-adult onset of MDD is associated with more suicidality than adult onset MDD. Age of onset of depression is an easy to ascertain characteristic that may help clinicians in weighing suicide risk.

Keywords

Depressiononsetroutine outcome monitoring
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 7 , July 2011 , pp. 1407 - 1417
Copyright
Copyright © Cambridge University Press 2010

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References

Aaronson, NK, Muller, M, Cohen, PD, Essink-Bot, ML, Fekkes, M, Sanderman, R, Sprangers, MA, te Velde, A, Verrips, E (1998). Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. Journal of Clinical Epidemiology 51, 1055–1068.CrossRefGoogle ScholarPubMed
Alpert, JE, Fava, M, Uebelacker, LA, Nierenberg, AA, Pava, JA, Worthington, JJ III, Rosenbaum, JF (1999). Patterns of axis I comorbidity in early-onset versus late-onset major depressive disorder. Biological Psychiatry 46, 202–211.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Benazzi, F (2000). Early-onset versus late-onset atypical depression: unipolar and bipolar II. Journal of Affective Disorders 61, 95–99.CrossRefGoogle ScholarPubMed
Coryell, W, Solomon, D, Leon, A, Fiedorowicz, JG, Schettler, P, Judd, L, Keller, M (2009). Does major depressive disorder change with age? Psychological Medicine 39, 1689–1695.CrossRefGoogle ScholarPubMed
de Beurs, E, den Hollander-Gijsman, ME, van Rood, YR, van der Wee, NJ, Giltay, EJ, van Noorden, MS, van der Lem, R, van Fenema, E, Zitman, FG (2010). Routine outcome monitoring in the Netherlands: practical experiences with a web-based strategy for the assessment of treatment outcome in clinical practice. Clinical Psychology and Psychotherapy Published online: 17 March 2010. doi:10.1002/cpp.696Google Scholar
de Beurs, E, Zitman, FG (2006). The Brief Symptom Inventory (BSI): reliability and validity of a practical alternative to SCL-90. Maandblad Geestelijke Volksgezondheid 61, 120–141.Google Scholar
Derogatis, LR (1977). Confirmation of the dimensional structure of the SCL-90: a study in construct validation. Journal of Clinical Psychology 33, 981.3.0.CO;2-0>CrossRefGoogle Scholar
Derogatis, LR, Melisaratos, N (1983). The Brief Symptom Inventory: an introductory report. Psychological Medicine 13, 595–605.CrossRefGoogle ScholarPubMed
Fava, M, Alpert, JE, Borus, JS, Nierenberg, AA, Pava, JA, Rosenbaum, JF (1996). Patterns of personality disorder comorbidity in early-onset versus late-onset major depression. American Journal of Psychiatry 153, 1308–1312.Google ScholarPubMed
Forman, EM, Berk, MS, Henriques, GR, Brown, GK, Beck, AT (2004). History of multiple suicide attempts as a behavioral marker of severe psychopathology. American Journal of Psychiatry 161, 437–443.CrossRefGoogle ScholarPubMed
Harrington, R, Fudge, H, Rutter, M, Pickles, A, Hill, J (1990). Adult outcomes of childhood and adolescent depression. I. Psychiatric status. Archives of General Psychiatry 47, 465–473.CrossRefGoogle ScholarPubMed
Jaffee, SR, Moffitt, TE, Caspi, A, Fombonne, E, Poulton, R, Martin, J (2002). Differences in early childhood risk factors for juvenile-onset and adult-onset depression. Archives of General Psychiatry 59, 215–222.CrossRefGoogle ScholarPubMed
Kaufman, J, Martin, A, King, RA, Charney, D (2001). Are child-, adolescent-, and adult-onset depression one and the same disorder? Biological Psychiatry 49, 980–1001.CrossRefGoogle ScholarPubMed
Kendler, KS, Gatz, M, Gardner, CO, Pedersen, NL (2005). Age at onset and familial risk for major depression in a Swedish national twin sample. Psychological Medicine 35, 1573–1579.CrossRefGoogle Scholar
Klein, DN (1999). Age of onset in chronic major depression: relation to demographic and clinical variables, family history, and treatment response. Journal of Affective Disorders 55, 149–157.CrossRefGoogle ScholarPubMed
Klein, DN, Lewinsohn, PM, Seeley, JR, Rohde, P (2001). A family study of major depressive disorder in a community sample of adolescents. Archives of General Psychiatry 58, 13–20.CrossRefGoogle Scholar
Kovacs, M, Devlin, B, Pollock, M, Richards, C, Mukerji, P (1997). A controlled family history study of childhood-onset depressive disorder. Archives of General Psychiatry 54, 613–623.CrossRefGoogle ScholarPubMed
Lecrubier, Y, Sheehan, DV, Weiller, E, Amorim, P, Bonora, I, Sheehan, K, Janavs, J, Dunbar, GC (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. European Psychiatry 12, 224–231.CrossRefGoogle Scholar
Mallinckrodt, CH, Watkin, JG, Liu, C, Wohlreich, MM, Raskin, J (2005). Duloxetine in the treatment of Major Depressive Disorder: a comparison of efficacy in patients with and without melancholic features. BMC Psychiatry 5, 1.CrossRefGoogle ScholarPubMed
Malone, KM, Haas, GL, Sweeney, JA, Mann, JJ (1995). Major depression and the risk of attempted suicide. Journal of Affective Disorders 34, 173–185.CrossRefGoogle ScholarPubMed
Montgomery, SA (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382.CrossRefGoogle ScholarPubMed
Muller, MJ (2003). Differentiating moderate and severe depression using the Montgomery-Asberg depression rating scale (MADRS). Journal of Affective Disorders 77, 255–260.CrossRefGoogle ScholarPubMed
Neuman, RJ, Geller, B, Rice, JP, Todd, RD (1997). Increased prevalence and earlier onset of mood disorders among relatives of prepubertal versus adult probands. Journal of the American Academy of Child and Adolescent Psychiatry 36, 466–473.CrossRefGoogle ScholarPubMed
Parker, G, Roy, K, Hadzi-Pavlovic, D, Mitchell, P, Wilhelm, K (2003). Distinguishing early and late onset non-melancholic unipolar depression. Journal of Affective Disorders 74, 131–138.CrossRefGoogle ScholarPubMed
Ramklint, M, Ekselius, L (2003). Personality traits and personality disorders in early onset versus late onset major depression. Journal of Affective Disorders 75, 35–42.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV-TR and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 22–33.Google Scholar
Snaith, RP (1986). Grade scores of the Montgomery-Asberg Depression and the Clinical Anxiety Scales. The British Journal of Psychiatry 148, 599–601.CrossRefGoogle ScholarPubMed
Thompson, AH (2008). Younger onset of depression is associated with greater suicidal intent. Social Psychiatry and Psychiatric Epidemiology 43, 538–544.CrossRefGoogle ScholarPubMed
Tyrer, P, Owen, RT, Cicchetti, DV (1984). The brief scale for anxiety: a subdivision of the comprehensive psychopathological rating scale. Journal of Neurology, Neurosurgery and Psychiatry 47, 970–975.CrossRefGoogle ScholarPubMed
van Noorden, MS, Giltay, EJ, den Hollander-Gijsman, ME, der Wee, NJ, van Veen, T, Zitman, FG (2010). Gender differences in clinical characteristics in a naturalistic sample of depressive outpatients: The Leiden Routine Outcome Monitoring Study. Journal of Affective Disorders 125, 116–123.CrossRefGoogle Scholar
van Vliet, IM, de Beurs, E (2007). The MINI-International Neuropsychiatric Interview. A brief structured diagnostic psychiatric interview for DSM-IV-TR en ICD-10 psychiatric disorders. Tijdschrift voor Psychiatrie 49, 393–397.Google Scholar
Ware, Jr. JE, Sherbourne, CD (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30, 473–483.CrossRefGoogle ScholarPubMed
Weissman, MM, Wolk, S, Goldstein, RB, Moreau, D, Adams, P, Greenwald, S, Klier, CM, Ryan, ND, Dahl, RE, Wickramaratne, P (1999). Depressed adolescents grown up. Journal of the American Medical Association 281, 1707–1713.CrossRefGoogle ScholarPubMed
WHO (1990). Composite International Diagnostic Interview (CIDI). WHO: Geneva.Google Scholar
Zetin, M, Hoepner, CT (2007). Relevance of exclusion criteria in antidepressant clinical trials: a replication study. Journal of Clinical Psychopharmacology 27, 295–301.CrossRefGoogle ScholarPubMed
Zimmerman, M, Chelminski, I, Posternak, MA (2005). Generalizability of antidepressant efficacy trials: differences between depressed psychiatric outpatients who would or would not qualify for an efficacy trial. American Journal of Psychiatry 162, 1370–1372.CrossRefGoogle Scholar
Zimmerman, M, Mattia, JI, Posternak, MA (2002). Are subjects in pharmacological treatment trials of depression representative of patients in routine clinical practice? American Journal of Psychiatry 159, 469–473.CrossRefGoogle ScholarPubMed
Zisook, S, Lesser, I, Stewart, JW, Wisniewski, SR, Balasubramani, GK, Fava, M, Gilmer, WS, Dresselhaus, TR, Thase, ME, Nierenberg, AA, Trivedi, MH, Rush, AJ (2007 a). Effect of age at onset on the course of major depressive disorder. American Journal of Psychiatry 164, 1539–1546.CrossRefGoogle ScholarPubMed
Zisook, S, Rush, AJ, Albala, A, Alpert, J, Balasubramani, GK, Fava, M, Husain, M, Sackeim, H, Trivedi, M, Wisniewski, S (2004). Factors that differentiate early vs. later onset of major depression disorder. Psychiatry Research 129, 127–140.CrossRefGoogle ScholarPubMed
Zisook, S, Rush, AJ, Lesser, I, Wisniewski, SR, Trivedi, M, Husain, MM, Balasubramani, GK, Alpert, JE, Fava, M (2007 b). Pre-adult onset vs. adult onset of major depressive disorder: a replication study. Acta Psychiatrica Scandinavica 115, 196–205.CrossRefGoogle Scholar