Skip to main content

Advertisement

SpringerLink
Log in

Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders

  • ORIGINAL CONTRIBUTION
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Objective

To compare selected characteristics (age, sex, age of onset for depression, impairment, severity of depression, somatic comorbidity, and treatment status) of adolescents with currently comorbid and non-comorbid depression.

Method

A sample of 218 consecutive adolescent (13–19 years) psychiatric outpatients with depressive disorders, and 200 age- and sex-matched school-attending controls were interviewed for DSM-IV Axis I and Axis II diagnoses.

Results

Current comorbidity, most commonly with anxiety disorders, was equally frequent (>70%) in outpatients and depressed controls. Younger age (OR 0.20; 95% CI 0.08, 0.51) and male gender (OR 0.02; 95% CI 0.09, 0.55) were associated with concurrent disruptive disorders. Current comorbidity with substance use disorders (SUD) was independent of age (OR 1.13; 95% CI 0.51, 2.49) and sex (OR 0.51; 95% CI 0.22, 1.17). Personality disorders associated with older age (OR 2.06; 95% CI 1.10, 3.86). In multivariable logistic regression analysis, impairment (GAF ≤60) was associated with current comorbidity (OR 3.13; 95% CI 1.53, 6.45), while severity of depression and lifetime age of onset for depression were not.

Conclusions

Adolescent depression presents with age- and sex-dependent patterns of multiple co-occurring problem areas. While many clinical characteristics of adolescent depression are not affected by comorbidity, comorbidity associates with increased impairment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Aalto-Setälä T, Marttunen M, Tuulio-Henriksson A, Poikolainen K, Lönnqvist J (2002) Psychiatric treatment seeking and psychosocial impairment among young adults with depression. J Affect Disorders 70:35–47

    Article  PubMed  Google Scholar 

  2. Alpert JE, Fava M, Uelbacker LA, Nierenberg AA, Pava JA, Worthington JJ, Rosenbaum JF (1999) Patterns of axis I comorbidity in early-onset versus late-onset major depressive disorder. Biol Psychiatr 46:202–210

    Article  CAS  Google Scholar 

  3. Anderson JC, McGee R (1994) Comorbidity of depression in children and adolescents. In: Reynolds WM, Johnston HE (eds) Handbook of depression in children and adolescents. New York Plenium Press, pp. 581–601

    Google Scholar 

  4. Angold AA, Costello J, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatr 40:57–87

    Article  CAS  Google Scholar 

  5. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatr 4:561–571

    PubMed  CAS  Google Scholar 

  6. Bernstein DP, Cohen P, Velez N, Schwab-Stone M, Siever LJ, Shinsato L (1993) Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents. Am J Psychiatr 150:1237–1243

    PubMed  CAS  Google Scholar 

  7. Biederman J, Faraone S, Mick E, Lelon E (1995) Psychiatric comorbidity among referred juveniles with major depression: fact or artifact? J Am Acad Child Adolesc Psychiatr 34:579–590

    Article  CAS  Google Scholar 

  8. Birmaher B, Brent DA, Kolko D, Bauger M, Bridge J, Holder D, Iyengar S, Ulloa RE (2000) Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder. Arch Gen Psychiatr 57:29–36

    Article  PubMed  CAS  Google Scholar 

  9. Birmaher B, Williamson DE, Dahl RE, Axelson DA, Kaufman J, Dorn LD, Ryan ND (2004) Clinical presentation and course of depression in youth: does onset in childhood differ from onset in adolescence. J Am Acad Child Adolesc Psychiatr 43:63–70

    Article  Google Scholar 

  10. Brent DA, Kolko DJ, Birmaher B, Baugher M, Bridge J, Roth C, Holder D (1998) Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. J Am Acad Child Adolesc Psychiatr 37:906–914

    Article  CAS  Google Scholar 

  11. Brooks SJ, Kutcher S (2001) Diagnosis and measurement of adolescent depression. A review of commonly utilized instruments. J Child Adolesc Psychopharmacol 11:341–376

    Article  PubMed  CAS  Google Scholar 

  12. Cohen P, Pine DS, Must A, Kasen S, Brook J (1998) Prospective associations between somatic illness and mental illness from childhood to adulthood. Am J Epidemiol 147:232–239

    PubMed  CAS  Google Scholar 

  13. Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatr 60:837–844

    Article  PubMed  Google Scholar 

  14. Emslie GJ, Rush AJ, Weinberg WA, Gullion CM, Rintelmann J, Hughes CW (1997) Recurrence of major depressive disorder in hospitalized children and adolescents. J Am Acad Child Adolesc Psychiatr 36:785–792

    Article  CAS  Google Scholar 

  15. 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. Am J Psychiatr 153:1308–1312

    PubMed  CAS  Google Scholar 

  16. Fava M, Farabaugh AH, Sickinger AH, Wright E, Alpert JE, Sonawalla S, Nierenberg AA, Worthington JJ III (2002) Personality disorders and depression. Psychol Med 32:1049–1057

    Article  PubMed  CAS  Google Scholar 

  17. First MB, Gibbon M, Spitzer RL, Williams JBW, Smith BL (1997) User’s guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. American Psychiatric Press, Washington, DC

    Google Scholar 

  18. Fleiss JL, Cohen J (1973) The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Measurement 33:6113–6119

    Article  Google Scholar 

  19. Frank E, Prien RF, Jarret RB, Keller MB, Kupfer DJ, Lavori PW, Rush AJ, Weissman MM (1991) Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Arch Gen Psychiatr 48:851–855

    PubMed  CAS  Google Scholar 

  20. Fyer AJ, Liebowitz MR, Klein DF (1990) Treatment trials, comorbidity, and syndromal complexity. In: Maser JD, Cloninger CR (Eds) Comoribdity of mood and anxiety disorders. American Psychiatric Press Inc., Washington DC

    Google Scholar 

  21. Giaconia RM, Reinherz HZ, Silverman AB, Pakiz N, Frost AK, Cohen E (1994) Ages of onset of psychiatric disorders in a community population of older adolescents. J Am Acad Child Adolesc Psychiatr 33:706–717

    CAS  Google Scholar 

  22. Goldberg D (1972) The detection of minor psychiatric illness by questionnaire. Oxford University Press, Oxford

    Google Scholar 

  23. Goodman SH, Lahey BB, Fielding B, Dulcan M, Narrow W, Regier D (1997) Representativeness of clinical samples of youths with mental disorders. J Abnorm Psychol 106:3–14

    Article  PubMed  CAS  Google Scholar 

  24. Goodyer IM, Herbert J, Secher SM, Pearson J (1997) Short-term outcome of major depression I. Comorbidity and severity at presentation as predictors of persistent disorder. J Am Acad Child Adolesc Psychiatr 36:179–187

    Article  CAS  Google Scholar 

  25. Hankin BL, Abramson LY, Moffitt SE, Silva PA, McGee R, Angell KE (1998) Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. J Abnorm Psychol 107:128–140

    Article  PubMed  CAS  Google Scholar 

  26. Harrington R, Fudge H, Rutter M, Pickles A, Hill J (1990) Adult outcomes of childhood and adolescent depression. I: Psychiatric status. Arch Gen Psychiatr 47:465–473

    PubMed  CAS  Google Scholar 

  27. Harrington R, Fudge H, Rutter M, Pickles A, Hill J (1991) Adult outcomes of childhood and adolescent depression: II. Links with antisocial disorders. J Am Acad Child Adolesc Psychiatr 30:434–439

    CAS  Google Scholar 

  28. Holi M, Marttunen M, Aalberg V (2003) Comparison of the GHQ-36, the GHQ-12 and the SCL-90 as psychiatric screening instruments in the Finnish population. Nordic J Psychiatr 57:233–238

    Article  Google Scholar 

  29. 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. Arch Gen Psychiatr 59:251–222

    Google Scholar 

  30. Jaffee SR, Moffitt TE, Caspi A, Fombonne E, Poulton R, Martin J (2002) Differences in early childhood risk factors for juvenile-onset and adultonset depression. Arch Gen Psychiatr 59:251–222

    PubMed  CAS  Google Scholar 

  31. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatr 36:980–988

    Article  CAS  Google Scholar 

  32. Kaufman J, Martin A King RA, Charney D (2001) Are child-, adolescent-, and adult-onset depression one and the same disorder Biol Psychiatr 49:980–1001

    Article  CAS  Google Scholar 

  33. Kessler RC, Walters EE (1998) Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey. Depression Anxiety 7:3–14

    Article  CAS  Google Scholar 

  34. Kessler RC, Avenevoli S, Merikangas RC (2001) Mood disorders in children and adolescents: an epidemiological perspective Biol Psychiatr 49:1002–1014

    Article  CAS  Google Scholar 

  35. Kovacs M, Feinberg TL, Crouse-Novak MA, Paulauskas SL, Finkelstein R (1984a) Depressive disorders in childhood. I. A longitudinal prospective study of characteristics and recovery Arch Gen Psychiatr 41:229–237

    CAS  Google Scholar 

  36. Kovacs M, Feinberg TL, Crouse-Novak M, Paulauskas SL, Finkelstein (1984b) Depressive disorders in childhood. II. A longitudinal study of the risk for a subsequent major depression. Arch Gen Psychiatr 47:465–473

    Google Scholar 

  37. Kovacs M, Gatsonis C, Paulauskas SL, Richrads C (1989) Depressive disorders in childhood. IV. A longitudinal study of comorbidity with and risk for anxiety disorders. Arch Gen Psychiatr 46:776–782

    PubMed  CAS  Google Scholar 

  38. Kovacs M, Oborsky DS, Sherrill J (2003) Developmental changes in the phenomenology of depression in girls compared to boys from childhood onward. J Affect Disorders 74:33–48

    Article  PubMed  Google Scholar 

  39. Lewinsohn PM, Rohde P, Seeley JR, Hops H (1991) Comorbidity of unipolar depression. I: major depressive disorder with dysthymia. J Abnormal Psychol 100:205–213

    Article  CAS  Google Scholar 

  40. Lewinsohn PM, Seeley JR, Hibbard J, Rohde P, Sack W (1996) Cross-sectional and prospective relationship between physical morbidity and depression in older adolescents. J Am Acad Child Adolesc Psychiatr 35:1120–1129

    Article  CAS  Google Scholar 

  41. Lewinsohn PM, Rohde P, Seeley JR, Klein DN (1997) Axis II psychopathology as a function of axis I disorders in childhood and adolescence. J Am Acad Child Adolesc Psychiatr 36:1752–1759

    Article  CAS  Google Scholar 

  42. Lewinsohn PM, Rohde P, Seeley JR, Klein DK, Gotlib IH (2000) Natural course of adolescent major depressive disorder in a community sample: predictors of recurrence in young adults. Am J Psychiatr 157:1584–1591

    Article  PubMed  CAS  Google Scholar 

  43. Levy KN, Becker DF, Grilo CM, Mattanah JJ, Garnett KE, Quinlan DM, Edell WS, McGlashan TH (1999) Concurrent and predictive validity of the personality disorder diagnosis in adolescent inpatients. Am J Psychiatr 156:1522–1528

    PubMed  CAS  Google Scholar 

  44. McCauley E, Myers K, Mitchell J, Calderon R, Scholdert K, Treder R (1993) Depression in young people: initial presentation and clinical course. J Am Acad Child Adolesc Psychiatr 32:714–722

    CAS  Google Scholar 

  45. Melartin TK, Rytsälä HJ, Leskelä US, Lestelä-Mielonen PS, Sokero P, Isometsä ET (2002) Current comorbidity of psychiatric disorders among DSEM-IV major depressive disorder patients in psychiatric care in the Vantaa Depression Study. J Clin Psychiatr 63:126–134

    Google Scholar 

  46. Myers K, Winters NC (2002) A ten-year review of rating scales: II. Scales for internalizing disorders. J Am Acad Child Adolesc Psychiatr 41:634–659

    Article  Google Scholar 

  47. Newman D, Moffitt TE, Caspi A, Magdol L, Silva PA, Stanton W (1996) Psychiatric disorders in a birth cohort of young adults: prevalence, comorbidity, clinical significance, and new case incidence from ages 11 to 21. J Consult Clin Psychol 64:552–562

    Article  PubMed  CAS  Google Scholar 

  48. Pelkonen M, Marttunen M, Laippala P, Lönnqvist J (2000) Factors associating with early drop-out from adolescent psychiatric outpatient treatment. J Am Acad Child Adolesc Psychiatr 39:329–336

    Article  CAS  Google Scholar 

  49. Rao U, Ryan ND, Birmaher B, Dahl RE, Williamson DE, Kaufman J, Rao R, Nelson B (1995) Unipolar depression in adolescents: clinical outcome in adulthood. J Am Acad Child Adolesc Psychiatr 34:566–578

    Article  CAS  Google Scholar 

  50. Rohde P, Lewinsohn PM, Seeley JR (1991) Comorbidity of unipolar depression: II. Comorbidity with other mental disorders in adolescents and adults. J Abnormal Psychol 100:241–222

    Google Scholar 

  51. Sanford M, Szatmari P, Spinner M, Munroe-Blum H, Jamieson E, Walsh C, Jones D (1995) Predicting the one-year course of adolescent major depression. J Am Acad Child Adolesc Psychiatr 34:1618–1628

    Article  CAS  Google Scholar 

  52. SAS Institute Inc. (1999) SAS OnlineDoc®. Version 8. SAS Institute Inc., Cary, NC

    Google Scholar 

  53. SPSS Inc. (2001) SPSS Base 11.0 for Windows User’s Guide. SPSS Inc. Chigaco, IL

    Google Scholar 

  54. 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. J Am Med Assoc 281:1707–1713

    Article  CAS  Google Scholar 

  55. Westen D, Shedler J, Durrett C, Glass S, Martens A (2003) Personality diagnoses in adolescence: DSM-IV Axis II diagnoses and an empirically derived alternative. Am J Psychiatr 160:952–966

    Article  PubMed  Google Scholar 

  56. Wittchen H-U, Nelson CB, Lachner G (1998) Prevalence of mental disorders and psychosocial impairment in adolescents and young adults. Psychol Med 28:109–126

    Article  PubMed  CAS  Google Scholar 

  57. Wu P, Hoven CW, Bird HR, Moore RE, Cohen P, Alegria M, Dulcan MK, Goodman SH, McCue HS, Lichtman JH, Narrow WE, Rae DS, Regier DA, Roper MT (1999) Depressive and disruptive disorders and mental health utilization in children and adolescents. J Am Acad Child Adolesc Psychiatr 38:1081–1090

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study has been supported by the Hospital District of University of Helsinki, the Peijas Hospital, the Yrjö Jahnsson Foundation, the Finnish Cultural Foundation, and the Finnish Psychiatric Association. We thank research assistant Mrs. Eevaliisa Orelma for her contribution in patient recruitment and data management.

Author information

Authors and Affiliations

  1. Dept. of Mental Health and Alcohol Research, The National Public Health Institute, Helsinki, Finland

    Linnea Karlsson MD, PhD, Mirjami Pelkonen Phd, Titta Ruuttu MA, Olli Kiviruusu BSocSc, Hannele Heilä MD, PhD, Matti Holi MD, PhD, Kirsi Kettunen MD, Virpi Tuisku MSocSc, Annamari Tuulio-Henriksson PhD, Johanna Törrönen MD & Mauri Marttunen MD, PhD

  2. Dept. of Psychiatry, Turku University Central Hospital, Turku, Finland

    Linnea Karlsson MD, PhD

  3. Linnea Karlsson, Lehmustie 12b, 20720, Turku, Finland

    Linnea Karlsson MD, PhD

  4. Dept. of Adolescent Psychiatry, Hospital District of University of Helsinki Peijas Hospital, Vantaa, Finland

    Mirjami Pelkonen Phd, Titta Ruuttu MA & Mauri Marttunen MD, PhD

  5. Dept. of Psychiatry, Hospital District of University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland

    Matti Holi MD, PhD

  6. Dept. of Psychiatry, Hospital District of University of Helsinki, Kellokoski Hospital, Tuusula, Finland

    Kirsi Kettunen MD

  7. Dept. of Psychiatry, University of Kuopio, Kuopio, Finland

    Mauri Marttunen MD, PhD

Authors
  1. Linnea Karlsson MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mirjami Pelkonen Phd
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Titta Ruuttu MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olli Kiviruusu BSocSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hannele Heilä MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matti Holi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kirsi Kettunen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Virpi Tuisku MSocSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Annamari Tuulio-Henriksson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Johanna Törrönen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mauri Marttunen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Linnea Karlsson MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karlsson, L., Pelkonen, M., Ruuttu, T. et al. Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders. Eur Child Adolesc Psychiatry 15, 220–231 (2006). https://doi.org/10.1007/s00787-006-0526-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-006-0526-7

Keywords

Search

Navigation