PATTERNS OF PERSONALITY-DISORDER COMORBIDITY IN EARLY-ONSET VERSUS LATE-ONSET MAJOR DEPRESSION

Objective: This study tested the hypothesis that in a population of ad ult outpatients with major depression, those with an early onset of de pression would have a greater prevalence of personality disorders than those with a late onset of depression. Method: The 404 subjects weve patients participating in depression treatment studies at the Massachu setts General Hospital. They were administered the Structured Clinical Interview for DSM-III-R-Patient Version to assess the current presenc e of major depression and the age at onset of the initial depressive e pisode. The subjects were then divided into two groups: those with ear ly onset (before 18 years of age) and those with late onset (at age 18 or later). The prevalence of personality disorders was determined thr ough use of the physician-rated Structured Clinical Interview for DSM- III-R Personality Disorders (SCID-II) and the patient-rated Personalit y Diagnostic Questionnaire-Revised (PDQ-R). Results: The patients with early onset of major depression had a significantly higher prevalence of avoidant, histrionic, narcissistic, and borderline personality dis orders according to the SCID-II. The PDQ-R scores indicated that avoid ant, dependent, passive-aggressive, histrionic, narcissistic, borderli ne, and antisocial personality disorders were significantly more preva lent among the patients with early onset of major depression. Conclusi ons: Overall, the results are consistent with the view that early-onse t depressive illness is distinguished from late-onset major depression by more frequent association with persistent disturbances in behavior s and attitudes.