Follow-up of childhood depression: Historical factors

The study by Fombonne et al (2001), following adolescents with diagnoses of major depressive disorder into adulthood, raises some questions pertaining to the era when they were diagnosed (1970-1983).

First, it was only in the early 1980s that child abuse began to come into the awareness of professionals and, a few years later, the general public. Therefore, it is possible that some of the young people identified with depressive disorders may have had a history of sexual abuse which was not disclosed or enquired about. This raises the question of what would have been the outcome in those young people who had been sexually abused had they made disclosures and had appropriate therapeutic intervention for this. It is well known that childhood sexual abuse is a significant factor in the histories of some adults presenting with depressive syndromes.

Second, this period was also a time when attention-deficit hyperactivity disorder (ADHD) was not recognised and hyperkinetic disorder was only rarely diagnosed. Some of the young people, especially those in the comorbid conduct disorder/major depressive disorder group, may have had undiagnosed and untreated ADHD. Certainly this was long before the use of psychostimulants on a wider basis in the UK and it is possible that some of these young people untreated may have been more vulnerable to development of depressive syndromes because of untreated attentional and other behavioural problems impacting on their self-esteem.

Third, although antidepressants were in use by child and adolescent psychiatrists when the diagnosis was major depressive disorder, they may not always have been used in young people with major depressive disorder with comorbid conduct disorder because of the risks of overdose in such a population. Tricyclic antidepressants were the predominant antidepressants used at that time in this population. With the advent of selective serotonin reuptake inhibitors, child and adolescent psychiatrists probably began prescribing more anti-depressants in the comorbid conduct disorder/major depressive group because of the lower risk of serious harm in overdose. This raises the possibility that more effective treatment of these young people might also have an impact on their outcomes in adult life.