Children With Prepubertal-Onset Major Depressive Disorder and Anxiety Grown Up

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Abstract
NUMEROUS studies now show that the rate of major depressive disorder (MDD) begins to rise in adolescents with the onset of puberty,1 particularly in girls.2 While prepubertal-onset MDD does occur, the rates are low and the sex ratios are equal.3-5 The few follow-up studies examining adolescent-onset MDD in young adulthood show that MDD is continuous, specific, and associated with high morbidity and potential mortality through suicide.6-10 With the exception of the study by Harrington et al,8 the continuity of prepubertal-onset MDD in adulthood is unknown. Even the important longitudinal studies of children with MDD by Kovacs et al11-13 have not yet evaluated the children beyond adolescence. Harrington et al,8 using a longitudinal design to assess the adult psychiatric status of depressed subjects compared with matched controls with other psychiatric disorders, found strong continuity and specificity of adolescent-onset MDD, but not prepubertal-onset MDD in adulthood. The childhood diagnoses were made retrospectively from medical records. Pubertal status was not determined by Tanner staging and only 18 subjects were studied. Information on continuity in adulthood is important to guide early treatment and to clarify the appropriateness of including children with MDD in genetic studies. We describe the continuity in adulthood of subjects first studied as children with prepubertal-onset MDD, anxiety disorder without MDD, and normal controls. All subjects were ascertained in the same period, studied using identical methods, and assessed in adulthood without knowledge of the original childhood diagnosis.

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