Systematic Review and Meta-Analysis: Adolescent Depression and Long-Term Psychosocial Outcomes

doi:10.1016/j.jaac.2018.07.896

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 58, Issue 1, January 2019, Pages 72-79

https://doi.org/10.1016/j.jaac.2018.07.896 Get rights and content

Objective

Experiencing depression in adolescence can disrupt important developmental processes, which can have longstanding effects on socioeconomic status and relationships. The objective of this article was to systematically review the evidence examining associations between adolescent depression and adult psychosocial outcomes.

Method

Five databases (MEDLINE, Embase, PsycINFO, CINAHL, and ERIC) were searched for articles published from 1980 through March 2017. Eligible articles were peer reviewed, published in English, had prospective cohort study designs, and contrasted adult psychosocial outcomes in those with versus without adolescent depression. Outcomes with sufficient data were pooled using random-effects meta-analyses, with summary measures reported as odds ratios (ORs). A protocol for this review was registered on PROSPERO (CRD42017059662).

Results

Of the 4,988 references screened for inclusion, 31 articles comprising 136 analyses were included for review. Twenty-four cohorts were represented. Seventy-seven analyses across 10 outcomes were meta-analyzed, with remaining analyses summarized narratively. Meta-analyses suggested that adolescent depression was associated with outcomes including, but not limited to, failure to complete secondary school (OR 1.76, 95% CI 1.29–2.39), unemployment (OR 1.66, 95% CI 1.29–2.14), and pregnancy/parenthood (OR 1.38, 95% CI 1.06–1.81).

Conclusion

This review demonstrates that adolescent depression is associated with a myriad of adult psychosocial outcomes. Many are linked and can lead to the propagation of difficulties across the lifespan. These findings can have important implications for encouraging the provision of targeted mental health care early in development to improve life chances.

Section snippets

Method

Methodology and reporting for this systematic review are consistent with the PRISMA statement.⁹ A PRISMA checklist is provided in Supplement 1, available online. A protocol for this review was developed a priori and registered on PROSPERO (CRD42017059662).

Results

A PRISMA flowchart summarizing the article selection process is presented in Figure 1. In all, we screened 4,988 articles and ultimately included 31 articles in this review, comprising 24 cohorts and 136 analyses across 40 identified outcomes. Twenty-five articles comprising 77 analyses were included in 10 meta-analyses; remaining analyses were summarized narratively (Table S3, available online). A list of excluded articles, with reasons for exclusion, is presented in Table S1 (available

Discussion

The findings of this systematic review and meta-analysis demonstrate consistent associations between adolescent depression and a number of psychosocial outcomes in adulthood. Adolescent depression was associated with higher odds of experiencing outcomes including failure to complete secondary school, unemployment, and pregnancy and parenthood, and lower odds of being employed or in tertiary training and entering postsecondary education. Some analyses summarized narratively also demonstrate

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Problematic substance use in depressed adolescents: Prevalence and clinical correlates
2024, Addictive Behaviors Reports
Substance use among adolescents is common and associated with significant consequences, including depression. Adolescents can experience myriad problems related to early onset substance use and depression, making further understanding of this comorbidity necessary.
Participants were a subset from a large-scale performance improvement project and consisted of adolescents aged 12–18 who screened positive for depression during their routine medical or psychiatric appointment and who then completed the substance use assessment Car, Relax, Alone, Forget, Friends, Trouble Version 2.1 (CRAFFT). Participants with problematic substance use had a CRAFFT score ≥2.
A total of 621 participants were included in this study, and 105 (16.9%) reported problematic substance use. Compared with participants without problematic substance use, those with problematic use were more likely to have moderate to severe depression and anxiety, as well as significantly higher irritability, impulsivity, suicidal propensity, and suicidal thoughts scores. Controlling for age at screening, sex, race, and ethnicity, problematic substance use remained a significant predictor of depression severity, impulsivity, suicidal propensity, and suicidal thoughts.
Participants were from a large, metropolitan area of the Southwest United States who must have screened positive for depression, so results may not generalize. Because all participants were underage, they may have been wary in responding to the substance use assessment accurately.
By using a large, diverse sample in a real-world clinical setting, findings strengthen the association between problematic substance use and depression and depression-associated symptoms among adolescents, highlighting the need for early detection and universal depression screening.
Global, regional, and national incidence trends of depressive disorder, 1990–2019: An age-period-cohort analysis based on the Global Burden of Disease 2019 study
2024, General Hospital Psychiatry
Depressive disorder is a severe global public health problem. It is crucial to evaluate the global incidence trends of depressive disorder.
The incidence data were drawn from the Global Burden of Disease Study (GBD) 2019. Estimates were presented by global and sociodemographic index (SDI) quintiles, and the age-period-cohort (APC) model was used to estimate the incidence trends.
APC analysis indicated a decline in depressive disorder incidence globally (net drift = −0.24%, 95%CI: −0.29, −0.18), except for an increase in SDI regions (net drift = 0.07, 95%CI:0, 0.14). In high SDI regions, depressive disorder incidence increased among the younger and declined among the elder population, whereas the opposite trend was observed in middle and low-middle SDI regions. The depressive disorder incidence increased significantly among people aged 15 to 24 years after adjusting for age effects, decreased since 2000 after adjusting for period effects and increased rapidly in the birth cohort after 1990 in high SDI by adjusting for cohort effects.
Globally, there was a declining trend of depressive disorder incidence in 1990–2019. Specifically, the incidence was declining globally in younger populations, while increasing in older populations. However, this trend differed depending on the SDI of the region.
When money and mental health problems pile up: The reciprocal relationship between income and psychological distress
2024, SSM - Population Health
Longitudinal studies suggest that socioeconomic status (SES) and mental health have a bidirectional relationship such that SES declines lead to a deterioration of mental health (social causation), while worsening mental health leads to SES declines (social drift). However, the dynamic relationship between income and psychological distress has not been sufficiently studied.
We use cross-lagged panel models with unit fixed effects (FE-CLPM) and data from a five-wave representative panel (n = 3103) of working-age (18–64) New York City adults. Yearly measures include individual earnings, family income (income-to-needs), and psychological distress. We also examine effects by age, gender, education, and racial/ethnic identification.
We find significant bidirectional effects between earnings and distress. Increases in past-year individual earnings decrease past-month psychological distress (social causation effect [SCE], standardized β= −0.07) and increases in psychological distress reduce next-year individual earnings (social drift effect [SDE], β= −0.03). Family income and distress only have a unidirectional relationship from past-year family income to distress (SCE, β= -.03). Strongest evidence of bidirectional effects between earnings and distress is for prime working-age individuals (SCE, β= −0.1; SDE, β= −0.03), those with less than bachelor's degrees (SCE, β= −0.08; SDE, β= −0.05), and Hispanics (SCE, β= −0.06; SDE, β= −0.08). We also find evidence of reciprocal effects between family income and distress for women (SCE, β= −0.03; SDE, β= −0.05), and Hispanics (SDE, β= −0.04; SDE, β= −0.08).
Individual earnings, which are labor market indicators, may be stronger social determinants of mental health than family income. However, important differences in social causation and social drift effects exist across groups by age, education, gender, and racial/ethnic identities. Future research should examine the types of policies that may buffer the mental health impact of negative income shocks and the declines in income associated with worsening mental health, especially among the most vulnerable.
Protocol for teen inflammation glutamate emotion research (TIGER): Toward predictors of treatment response and clinical course in depressed adolescents
2024, Brain, Behavior, and Immunity - Health
Adolescent-onset depression is a prevalent and debilitating condition commonly associated with treatment refractory depression and non-response to first-line antidepressants. There are, however, no objective tests to determine who may or may not respond to antidepressants. As depressed adolescents are especially vulnerable to the lifelong consequences of ineffectively-treated depression, it is critical to identify neurobiological predictors of treatment non-response in this population. Here, we describe the scientific rationale and protocol for the Teen Inflammation Glutamate Emotion Research (TIGER) study, a prospective 18-month investigation of 160 depressed adolescents who will be assessed before and after treatment with selective serotonin reuptake inhibitors. TIGER will be using ultra-high field imaging to test the effects of acute stress and antidepressant treatment on inflammatory and glutamatergic processes hypothesized to underlie depression maintenance. Results from this work will motivate future studies testing alternative therapeutics for depressed adolescents at risk for treatment resistant depression. ClinicalTrials.gov Identifier: NCT05329441.
Cognitive functioning in children and adolescents with depression: A systematic review and meta-analysis
2024, European Neuropsychopharmacology
Although cognitive dysfunction is associated with depression in adults, the link in children and adolescents is unclear. This systematic review and meta-analysis quantifies the association between depression and cognitive function in children and adolescents. Systematic searches were conducted in six databases: Child Development and Adolescent Studies, Ovid MEDLINE, Ovid Embase, Ovid APA PsycINFO, EBSCO CINAHL Plus, Scopus (last search: April 2023). Studies including measures of cognitive outcomes (memory, attention, executive function, processing speed, language) among children (≤18 years) with depression were included. The Joanna Briggs Institute Critical Appraisal Tools were used to determine study risk of bias. Random-effects meta-analyses of study outcomes were performed. Seventeen studies were included (15 were cross-sectional, 1 prospective, 1 randomized control trial). Participants (N = 13,567) were 10 to 17 years old (mean 13.8 ± 2.2 years; 60 % female). Compared with healthy controls, depressed participants had lower performance on tests of working memory (g = -0.40; 95 % CI: -0.67, -0.13), long-term memory (g = -0.48; 95 % CI: -0.72, -0.25), attention (g = -0.15; 95 % CI: -0.26, -0.04), executive function (g = -0.16; 95 % CI: -0.24, -0.08), and language (g = -0.23; 95 % CI: -0.36, -0.09). No performance differences were observed on tests of short-term memory or processing speed. Children and adolescents with depression demonstrated lower performance on tests of working and long-term memory, attention, executive function and language. These findings emphasize the importance of considering cognitive functioning among children with depression, and greater understanding of the effect of treatment on these outcomes. PROSPERO (CRD42022332064).
Global, regional, and national burden of depressive disorders among young people aged 10–24 years, 2010–2019
2024, Journal of Psychiatric Research
To describe the latest disease burden, temporal trends, and risk factors of depressive disorders among young people.
Data from the Global Burden of Disease Study 2019 was utilized to analyze depressive disorders among individuals aged 10–24 years. The study focused on describing the incidence, prevalence, disability-adjusted life years (DALYs), and their attributable risk factors across 204 countries and territories from 2010 to 2019. The estimated annual percentage change (EAPC) was calculated to quantify the temporal trends.
Globally, the incidence, prevalence, and DALYs rate of depressive disorders per 100 000 young people increased from 3003.01, 2445.69, and 448.61 in 2010 to 3035.26, 2470.67, and 452.58 in 2019, indicating a slight upward trend (EAPC = 0.11 for incidence and prevalence; EAPC = 0.09 for DALYs rate). Notably, the percentage of DALYs of depressive disorders among young people increased substantially from 3.24% in 2010 to 3.66% in 2019, an increase of 13.06% (EAPC = 1.26, 95%CI: 1.08–1.44), and the burden of depressive disorders among young people rose from fouth to second in females, and from tenth to fifth in males. Social demographic index (SDI) and other indicators were positively correlated with the percentage of DALYs of depressive disorder and negatively correlated with the EAPC of DALYs.
The global burden of depressive disorders among young people is on the rise. The regional differences in depressive disorders among young people suggest the need for enhanced screening efforts in low-SDI areas, along with the adoption of more effective prevention and control measures.

View all citing articles on Scopus

: Ms. Clayborne is supported by a Master’s Award from the Canadian Institutes of Health Research. Dr. Colman is supported by the Canada Research Chairs Program. The sources of funding had no role in the study design, collection, analysis, and interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication.

: The authors gratefully acknowledge Lindsey Sikora, MIS, of University of Ottawa, for her help in developing the search strategy used in this article.

: Disclosure: Dr. Colman, Ms. Clayborne, and Ms. Varin report no biomedical financial interests or potential conflicts of interest.

View full text

ReviewSystematic Review and Meta-Analysis: Adolescent Depression and Long-Term Psychosocial Outcomes

Objective

Method

Results

Conclusion

Section snippets

Method

Results

Discussion

J Adolesc Heal

J Am Acad Child Adolesc Psychiatry

J Pediatr Adolesc Gynecol

J Am Acad Child Adolesc Psychiatry

Eur Psychiatry

Clin Psychol Rev

Compr Psychiatry

J Affect Disord

Res Soc Stratif Mobil

Lancet

Major depression among adolescents

The Maudsley long-term follow-up of child and adolescent depression

Br J Psychiatry

Emerging adulthood. A theory of development from the late teens through the twenties

Am Psychol

Conceptions of the transition to adulthood: perspectives from adolescence through midlife

J Adult Dev

Depression and risk for onset of type II diabetes. A prospective population-based study

Diabetes Care

A prospective study of the role of depression in the development and persistence of adolescent obesity

Pediatrics

Mental health, educational, and social role outcomes of adolescents with depression

Arch Gen Psychiatry

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

PLoS Med

Adolescent development

Diagnostic and Statistical Manual of Mental Disorders

The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses

A coefficient of agreement for nominal scales

Educ Psychol Meas

Review
Systematic Review and Meta-Analysis: Adolescent Depression and Long-Term Psychosocial Outcomes