Skip to main content

Advertisement

SpringerLink
Log in

Developmental course of anxiety and depression from adolescence to young adulthood in a prospective Norwegian clinical cohort

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Anxiety and depression are often co-occurring disorders, reflecting both homotypic and heterotypic continuity as possible developmental pathways. The present study aimed to examine homotypic and heterotypic continuities of anxiety and depression across 3 years in adolescence and young adulthood. Participants included patients presenting to psychiatric care with diagnoses of anxiety and/or depressive disorders aged 13–18 at T1 (N = 717, 44% initial participation rate) and aged 16–21 at T2 (N = 549, 80% follow-up participation rate). McNemar’s mid-p test and ordinal proportional odds logistic regression analyses were used to assess changes in prevalence within and across diagnostic categories, respectively. More adolescents had an anxiety disorder (+ 11%), whereas fewer had a depressive disorder (− 11%), at T2 compared to T1. Of adolescents with anxiety and/or depression at T1, only 25% recovered or were non-symptomatic 3 years after referral to a psychiatric clinic. Homotypic continuity was observed for anxiety disorders in general (OR = 2.33), for phobic anxiety disorders (OR = 7.45), and for depressive disorders (OR = 2.15). For heterotypic continuity, depression predicted later anxiety (OR = 1.92), more specifically social anxiety (OR = 2.14) and phobic anxiety disorders (OR = 1.83). In addition, social anxiety predicted later generalized anxiety disorder (OR = 3.11). Heterotypic continuity was thus more common than homotypic continuity. For adolescents presenting with anxiety or depression, treatment should, therefore, target broad internalizing symptom clusters, rather than individual diagnoses. This may contribute to prevent future mental illness, particularly anxiety, in clinical samples.

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
Fig. 2

Similar content being viewed by others

References

  1. Woodward LJ, Fergusson DM (2001) Life course outcomes of young people with anxiety disorders in adolescence. J Am Acad Child Adolesc Psychiatry 40:1086–1093. https://doi.org/10.1097/00004583-200109000-00018

    Article  CAS  PubMed  Google Scholar 

  2. Essau CA (2008) Comorbidity of depressive disorders among adolescents in community and clinical settings. Psychiatry Res 158:35–42

    Article  Google Scholar 

  3. Melvin GA, Dudley AL, Gordon MS, Ford S, Taffe J, Tonge BJ (2013) What happens to depressed adolescents? A follow-up study into early adulthood. J Affect Disord 151:298–305

    Article  Google Scholar 

  4. Lewinsohn PM, Rohde P, Seeley JR, Klein DN, Gotlib IH (2000) Natural course of adolescent major depressive disorder in a community sample: predictors of recurrence in young adults. Am J Psychiatry 157:1584–1591. https://doi.org/10.1176/appi.ajp.157.10.1584

    Article  CAS  PubMed  Google Scholar 

  5. Merikangas KR, Zhang H, Avenevoli S, Acharyya S, Neuenschwander M, Angst J, Zurich Cohort Study (2003) Longitudinal trajectories of depression and anxiety in a prospective community study: the Zurich Cohort Study. Arch Gen Psychiatry 60:993–1000. https://doi.org/10.1001/archpsyc.60.9.993

    Article  PubMed  Google Scholar 

  6. Patton GC, Coffey C, Romaniuk H, Mackinnon A, Carlin JB, Degenhardt L, Olsson CA, Moran P (2014) The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study. Lancet 383:1404–1411. https://doi.org/10.1016/S0140-6736(13)62116-9

    Article  PubMed  Google Scholar 

  7. Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R (2003) Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry 60:709–717. https://doi.org/10.1001/archpsyc.60.7.709

    Article  PubMed  Google Scholar 

  8. Rapee RM, Lyneham HJ, Hudson JL, Kangas M, Wuthrich VM, Schniering CA (2013) Effect of comorbidity on treatment of anxious children and adolescents: results from a large, combined sample. J Am Acad Child Adolesc Psychiatry 52:47–56. https://doi.org/10.1016/j.jaac.2012.10.002

    Article  PubMed  Google Scholar 

  9. Rutter M, Kim-Cohen J, Maughan B (2006) Continuities and discontinuities in psychopathology between childhood and adult life. J Child Psychol Psychiatry 47:276–295. https://doi.org/10.1111/j.1469-7610.2006.01614.x

    Article  PubMed  Google Scholar 

  10. Maughan B, Rutter M (2008) Development and psychopathology: a life course perspective. In: Rutter M, Bishop D, Pine D et al (eds) Rutter’s child and adolescent psychiatry, 5th edn. Blackwell Publishing Ltd., Oxford, pp 160–181

    Google Scholar 

  11. Copeland WE, Shanahan L, Costello EJ, Angold A (2009) Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Arch Gen Psychiatry 66:764–772

    Article  Google Scholar 

  12. Costello EJ, Copeland W, Angold A (2011) Trends in psychopathology across the adolescent years: what changes when children become adolescents, and when adolescents become adults? J Child Psychol Psychiatry 52:1015–1025

    Article  Google Scholar 

  13. Lewinsohn PM, Rohde P, Klein DN, Seeley JR (1999) Natural course of adolescent major depressive disorder: I. Continuity into young adulthood. J Am Acad Child Adolesc Psychiatry 38:56–63

    Article  CAS  Google Scholar 

  14. Fergusson DM, Woodward LJ (2002) Mental health, educational, and social role outcomes of adolescents with depression. Arch Gen Psychiatry 59:225–231

    Article  Google Scholar 

  15. Dunn V, Goodyer IM (2006) Longitudinal investigation into childhood-and adolescence-onset depression: psychiatric outcome in early adulthood. Br J Psychiatry 188:216–222

    Article  Google Scholar 

  16. Rao U, Hammen C, Daley SE (1999) Continuity of depression during the transition to adulthood: a 5-year longitudinal study of young women. J Am Acad Child Adolesc Psychiatry 38:908–915. https://doi.org/10.1097/00004583-199907000-00022

    Article  CAS  PubMed  Google Scholar 

  17. 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 Psychiatry 34:566–578. https://doi.org/10.1097/00004583-199505000-00009

    Article  CAS  PubMed  Google Scholar 

  18. 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. JAMA 281:1707–1713

    Article  CAS  Google Scholar 

  19. Pine DS, Cohen P, Gurley D, Brook J, Ma Y (1998) The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 55:56–64

    Article  CAS  Google Scholar 

  20. Costello EJ, Egger HL, Copeland W, Erkanli A, Angold A (2011) The developmental epidemiology of anxiety disorders: phenomenology, prevalence, and comorbidity. In: Silverman WK, Field AP (eds) Anxiety disorders in children and adolescents: research, assessment and intervention, 2nd edn. Cambridge University Press, Cambridge, pp 56–75

    Chapter  Google Scholar 

  21. Ferdinand RF, Dieleman G, Ormel J, Verhulst FC (2007) Homotypic versus heterotypic continuity of anxiety symptoms in young adolescents: evidence for distinctions between DSM-IV subtypes. J Abnorm Child Psychol 35:325–333

    Article  Google Scholar 

  22. Carballo JJ, Baca-Garcia E, Blanco C, Perez-Rodriguez MM, Arriero MAJ, Artes-Rodriguez A, Rynn M, Shaffer D, Oquendo MA, (SED) GftSoEoD (2010) Stability of childhood anxiety disorder diagnoses: a follow-up naturalistic study in psychiatric care. Eur Child Adolesc Psychiatry 19:395–403

    Article  Google Scholar 

  23. Gregory AM, Caspi A, Moffitt TE, Koenen K, Eley TC, Poulton R (2007) Juvenile mental health histories of adults with anxiety disorders. Am J Psychiatry 164:301–308. https://doi.org/10.1176/ajp.2007.164.2.301

    Article  PubMed  Google Scholar 

  24. Wittchen HU, Kessler R, Pfister H, Höfler M, Lieb R (2000) Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scand 102:14–23

    Article  Google Scholar 

  25. Moffitt TE, Harrington H, Caspi A, Kim-Cohen J, Goldberg D, Gregory AM, Poulton R (2007) Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry 64:651–660. https://doi.org/10.1001/archpsyc.64.6.651

    Article  PubMed  Google Scholar 

  26. Benjamin CL, Harrison JP, Settipani CA, Brodman DM, Kendall PC (2013) Anxiety and related outcomes in young adults 7 to 19 years after receiving treatment for child anxiety. J Consult Clin Psychol 81:865–876. https://doi.org/10.1037/a0033048

    Article  PubMed  Google Scholar 

  27. Coplan JD, Aaronson CJ, Panthangi V, Kim Y (2015) Treating comorbid anxiety and depression: psychosocial and pharmacological approaches. World J Psychiatry 5:366–378. https://doi.org/10.5498/wjp.v5.i4.366

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lewinsohn PM, Zinbarg R, Seeley JR, Lewinsohn M, Sack WH (1997) Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents. J Anxiety Disord 11:377–394

    Article  CAS  Google Scholar 

  29. Castagnini AC, Foldager L, Caffo E, Thomsen PH (2016) Early-adult outcome of child and adolescent mental disorders as evidenced by a national-based case register survey. Eur Psychiatry 38:45–50

    Article  CAS  Google Scholar 

  30. Sareen J, Henriksen CA, Stein MB, Afifi TO, Lix LM, Enns MW (2013) Common mental disorder diagnosis and need for treatment are not the same: findings from a population-based longitudinal survey. Psychol Med 43:1941–1951

    Article  CAS  Google Scholar 

  31. World Health Organization (WHO) (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization (WHO), Geneva

    Google Scholar 

  32. 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 Psychiatry 36:980–988. https://doi.org/10.1097/00004583-199707000-00021

    Article  CAS  Google Scholar 

  33. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision: DSM-IV-TR. American Psychiatric Association, Washington, D.C.

    Book  Google Scholar 

  34. de Vet HC, Mokkink LB, Terwee CB, Hoekstra OS, Knol DL (2013) Clinicians are right not to like Cohen’s κ. BMJ 346:f2125

    Article  Google Scholar 

  35. Fagerland MW, Lydersen S, Laake P (2017) Statistical analysis of contingency tables. Chapman and Hall/CRC, Boca Raton

    Book  Google Scholar 

  36. Liebowitz MR, Heimberg RG, Fresco DM, Travers J, Stein MB (2000) Social phobia or social anxiety disorder: what’s in a name? Arch Gen Psychiatry 57:191–192

    Article  CAS  Google Scholar 

  37. Bryant TN (2000) CIA Software

  38. Ranøyen I, Jozefiak T, Wallander J, Lydersen S, Indredavik MS (2014) Self-reported social anxiety symptoms and correlates in a clinical (CAP) and a community (Young-HUNT) adolescent sample. Soc Psychiatry Psychiatr Epidemiol 49:1937–1949. https://doi.org/10.1007/s00127-014-0888-y

    Article  PubMed  Google Scholar 

  39. Den Boer JA, Dunner DL (1999) Physician attitudes concerning diagnosis and treatment of social anxiety disorder in Europe and North America. Int J Psychiatry Clin Pract 3:S13–S19

    Google Scholar 

  40. Kessler RC, Zhao S, Blazer DG, Swartz M (1997) Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. J Affect Disord 45:19–30

    Article  CAS  Google Scholar 

  41. Richards D (2011) Prevalence and clinical course of depression: a review. Clin Psychol Rev 31:1117–1125. https://doi.org/10.1016/j.cpr.2011.07.004

    Article  PubMed  Google Scholar 

  42. Kouros CD, Quasem S, Garber J (2013) Dynamic temporal relations between anxious and depressive symptoms across adolescence. Dev Psychopathol 25:683–697

    Article  Google Scholar 

  43. Axelson DA, Birmaher B (2001) Relation between anxiety and depressive disorders in childhood and adolescence. Depress Anxiety 14:67–78

    Article  CAS  Google Scholar 

  44. Beesdo K, Knappe S, Pine DS (2009) Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin N Am 32:483–524. https://doi.org/10.1016/j.psc.2009.06.002

    Article  Google Scholar 

  45. Lewinsohn PM, Clarke GN, Seeley JR, Rohde P (1994) Major depression in community adolescents: age at onset, episode duration, and time to recurrence. J Am Acad Child Adolesc Psychiatry 33:809–818

    Article  CAS  Google Scholar 

  46. Kasper S (2006) Anxiety disorders: under-diagnosed and insufficiently treated. Int J Psychiatry Clin Pract 10(Suppl 1):3–9. https://doi.org/10.1080/13651500600552297

    Article  PubMed  Google Scholar 

  47. Schneier FR, Johnson J, Hornig CD, Liebowitz MR, Weissman MM (1992) Social phobia. Comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry 49:282–288

    Article  CAS  Google Scholar 

  48. Garber J, Weersing VR (2010) Comorbidity of anxiety and depression in youth: implications for treatment and prevention. Clin Psychol (New York) 17:293–306. https://doi.org/10.1111/j.1468-2850.2010.01221.x

    Article  Google Scholar 

  49. Wittchen HU, Hoyer J (2001) Generalized anxiety disorder: nature and course. J Clin Psychiatry 62(Suppl 11):15–19

    PubMed  Google Scholar 

  50. Rogers MP, Warshaw MG, Goisman RM, Goldenberg I, Rodriguez-Villa F, Mallya G, Freeman SA, Keller MB (1999) Comparing primary and secondary generalized anxiety disorder in a long-term naturalistic study of anxiety disorders. Depress Anxiety 10:1–7

    Article  CAS  Google Scholar 

  51. Vanable PA, Carey MP, Carey KB, Maisto SA (2002) Predictors of participation and attrition in a health promotion study involving psychiatric outpatients. J Consult Clin Psychol 70:362–368

    Article  Google Scholar 

  52. Sørensen MJ, Mors O, Thomsen PH (2005) DSM-IV or ICD-10-DCR diagnoses in child and adolescent psychiatry: does it matter? Eur Child Adolesc Psychiatry 14:335–340. https://doi.org/10.1007/s00787-005-0482-7

    Article  PubMed  Google Scholar 

  53. Andrews G, Slade T, Peters L (1999) Classification in psychiatry: ICD-10 versus DSM-IV. Br J Psychiatry 174:3–5

    Article  CAS  Google Scholar 

  54. Davis KA, Sudlow CL, Hotopf M (2016) Can mental health diagnoses in administrative data be used for research? A systematic review of the accuracy of routinely collected diagnoses. BMC Psychiatry 16:263. https://doi.org/10.1186/s12888-016-0963-x

    Article  PubMed  PubMed Central  Google Scholar 

  55. Compton SN, March JS, Brent D, Albano AM, Weersing R, Curry J (2004) Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review. J Am Acad Child Adolesc Psychiatry 43:930–959

    Article  Google Scholar 

Download references

Acknowledgements

This study was financed by a Grant awarded to the first author by The Liaison Committee for education, research and innovation in Central Norway. The St. Olav CAP Study is a product of the collaboration between St. Olav’s University Hospital and Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU; it is also funded by Unimed Innovation at St. Olav’s University Hospital and The Liaison Committee for education, research and innovation in Central Norway.

Author information

Authors and Affiliations

  1. Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    Ingunn Ranøyen, Stian Lydersen, Tricia L. Larose, Bernhard Weidle, Norbert Skokauskas, Jan Wallander & Marit S. Indredavik

  2. Division of Mental Health Care, Department of Children and Youth, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Ingunn Ranøyen, Bernhard Weidle & Marit S. Indredavik

  3. Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, K.G. Jebsen Centre for Genetic Epidemiology, NTNU, Trondheim, Norway

    Tricia L. Larose

  4. Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark

    Per Hove Thomsen

  5. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Per Hove Thomsen

  6. Psychological Sciences and Health Sciences Research Institute, University of California, Merced, USA

    Jan Wallander

Authors
  1. Ingunn Ranøyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stian Lydersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tricia L. Larose
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernhard Weidle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Norbert Skokauskas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Per Hove Thomsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jan Wallander
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marit S. Indredavik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ingunn Ranøyen.

Ethics declarations

Ethical standards

This study has been approved by the appropriate ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 48 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ranøyen, I., Lydersen, S., Larose, T.L. et al. Developmental course of anxiety and depression from adolescence to young adulthood in a prospective Norwegian clinical cohort. Eur Child Adolesc Psychiatry 27, 1413–1423 (2018). https://doi.org/10.1007/s00787-018-1139-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-018-1139-7

Keywords

Search

Navigation