Fear and anxiety, economic disadvantage, and recent psychosocial adversity contribute significantly to the onset of major depressive disorder in children and adolescents with a strong family history of the condition.

A 4-year longitudinal study followed the offspring of 279 families in which one parent had experienced at least two episodes of major depressive disorder (MDD) and in which there was a biologically related child living with that index parent.

Fear and anxiety showed a strong and significant association with new-onset major depressive disorder, as did irritability. Furthermore, the association between the two symptoms was low but significant, suggesting that they do not often co-occur (JAMA Psychiatry. 2016 Dec 7. doi: 10.1001/jamapsychiatry.2016.3140).

“The results suggested that generalized anxiety symptoms were driving the predictive effect of fear/anxiety on new-onset MDD and that fear/anxiety (and not irritability) predicted an especially early MDD onset,” wrote Frances Rice, PhD, of the division of psychological medicine and clinical neurosciences at Cardiff University, Wales, and coauthors.

Recent psychosocial adversity – stressful events such as the death of a friend, illness, bullying, or parents fighting – also showed a strong association with new-onset major depressive disorder, while economic disadvantage had a lesser but still significant contribution. Both of these also were associated with fear and anxiety, and irritability.

Greater family history and more severe parental depression also contributed significantly to the emergence of depression in the offspring, although those factors were not associated with the clinical antecedents such as fear and anxiety.

“Therefore, the indicators of social risk predicted MDD independent of correlated familial risk, parental depression severity, and clinical antecedents in the child,” the authors wrote. “This result has important implications for treatment and prevention and highlights the need to resolve not only clinical phenomena in the child but also wider contextual difficulties.”

The study also suggested that neither disruptive behavior nor low mood were significantly associated with new-onset MDD in children and adolescents.

The children and adolescents in the study had a mean of 1.85 DSM-IV major depressive disorder symptoms at follow-up, and 20 of them – six males and 14 females – had new-onset MDD, with a mean age of onset of 14.4 years.

“Our findings suggest that primary prevention methods for depression in groups with high familial risk will need to include effective treatment of parental depression, irritability, and fear/anxiety in the child and consider social risk factors,” Dr. Rice and her coauthors wrote.

The research and researchers were supported by the Sir Jules Thorn Charitable Trust, the Medical Research Council, the Economic and Social Research Council, the British Academy, and the British Medical Association. No conflicts of interest were declared.


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