PSYCHIATRIC COMORBIDITY AMONG REFERRED JUVENILES WITH MAJOR DEPRESSION - FACT OR ARTIFACT

Objective: The high levels of psychiatric comorbidity reported in juve niles meeting operational definitions of depressive disorders raise bo th substantive and methodological concerns about whether depression wi th comorbid disorders should be classified as two disorders or as diff erent manifestations of the same condition. Our purpose was to clarify issues of diagnostic heterogeneity and diagnostic overlap in juvenile depression. Method: The sample consisted of consecutively referred ch ildren and adolescents (N = 424) comprehensively evaluated with struct ured diagnostic interviews and psychosocial assessments. Results: A cl inical picture compatible with the diagnosis of major depression was i dentified in 40% of these referred youths. Children meeting criteria f or major depression had prototypical symptoms of the disorder, a chron ic course, and severe psychosocial dysfunction. In addition, they freq uently met criteria for attention-deficit hyperactivity disorder, cond uct disorder, and anxiety disorders. These comorbidity findings were n ot due to symptom overlap among major depression and the cc-occurring disorders. For the most part, comorbid disorders preceded the onset of major depression by several years. Conclusions: juvenile depression h as a chronic course, severe dysfunction, and high levels of psychiatri c comorbidity. Despite symptom overlap, our work suggests that major d epression and other conditions may represent different disorders.