Anxiety and Depression: Adolescence to Adulthood

Source: Patton GC, Coffey C, Romaniuk H, et al. The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study. Lancet. 2014; 383(9926): 1404– 1411; doi: 10.1016/S0140-6736(13)62116-9Investigators at multiple sites in Australia and the United Kingdom followed a cohort of adolescents with anxiety or depression to ascertain predictors of their persistence into adulthood. Participants were identified by random sampling of members of a large cohort of adolescents from 44 secondary schools in Victoria, Australia. They were observed prospectively from 1992 to 2008 and were assessed for anxiety and depression at 5 different times as adolescents and 3 different times as adults. An anxiety/depression episode was defined in adolescents by a score of ≥12 on the Revised Clinical Interview Schedule (CIS-R), a psychiatric interview designed to assess symptoms of depression and anxiety in non-clinical populations. This cutoff score was deemed to be the score at which clinical intervention would be appropriate. In adults, an anxiety/depression episode was defined as a score >2 on the General Health Questionnaire and through symptom information obtained on the Composite International Diagnostic Interview. In addition to basic demographic information, data on other covariates, including parental separation or divorce, antisocial behavior, daily smoking, high-risk alcohol use, and frequent use of cannabis, were collected. Investigators estimated rates of anxiety/depression episodes in adolescence by gender, explored the persistence of episodes across study time points, and assessed the predictive associations of demographics and risk behavior covariates with this persistence.From an original sample of 2,032 cohort members, 1,943 participated at least once during the first 6 adolescent time points with 1,761 members participating at least once in the young adult phase. The final analysis included 1,750 members. Observations began and terminated at a mean age of 15.5 and 29.1 years, respectively. There were 236/821 males (29%) and 498/929 females (54%) who had at least 1 anxiety/ depression episode during adolescence. Among these, 109 (47%) males and 323 (65%) females had at least 1 further episode in young adulthood. Having prolonged initial episodes during adolescence (persisting through 2 or more time points) was the clearest predictor of persistence into adulthood (OR=3.15; 95% CI, 1.86–5.37). Additionally, female gender (OR=2.12; 95% CI, 1.29–3.48) and parental separation or divorce (OR=1.62; 95% CI, 1.03–2.53) independently predicted persistence of anxiety/depression into adulthood. Surprisingly, high-risk adolescent behaviors were not associated with persistence of anxiety/depression into adulthood.The authors conclude that nearly half of young adults with anxiety/ depression have no further episodes after adolescence, suggesting that these common mental health disorders often resolve during the transition into adulthood.Dr Wardrop has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Adolescence marks a tumultuous period emotionally and physically for many and the resultant anxiety and depression in this age group is a clinical reality for patients, families, and physicians alike.1 In the present study, depression and anxiety were seen frequently; ~41% of participants experienced at least 1 episode of these common mental health disorders as adolescents. Also notable was that ~59% of study participants with anxiety or depression in adolescence had persistence into young adulthood.What was unclear prior to this study were the factors that predicted the persistence of symptoms into young adulthood and which patients might be at most risk for this continuation of the disorder. Interestingly, cohort members who had a longer duration of initial symptoms, those of female gender, and those with a social history significant for parental divorce or separation had the greatest odds of persistence of a mental health disorder. This insight should assist clinicians in targeting their own adolescent patients with anxiety or depression for prompt treatment, in order to appropriately counsel and limit the severity and length of symptoms.Reassuringly, this study confirmed previous findings of a decrease in the prevalence of common mental disorders through young adulthood.2 While these results are compelling, their full clinical implications need further follow-up and study. Such work would lend insight into the longer-term health consequences of depression and anxiety experienced in adolescents and the outcomes of focused early interventions designed to shorten the duration of symptoms in these patients.3