Children with prepubertal-onset major depressive disorder and anxiety grown up

Background: The continuity in adulthood of major depressive disorder (MDD) first arising before puberty is largely unknown. This information could gui de early treatment and clarify the appropriateness of including children wi th MDD in genetic studies. Methods: Eighty-three subjects with onset of MDD, 44 subjects with anxiety disorder and no MDD, and 91 subjects with no evidence of past or current ps ychiatric disorders were assessed by two psychiatrists before puberty (Tann er stage <III) and were evaluated 10 to 15 years later as adults by an inde pendent team without knowledge of the initial diagnosis. Results: The clinical outcome of children with prepubertal-onset MDD in adu lthood includes a high risk of suicide attempts (nearly 3-fold compared wit h normal controls and 2-fold compared with children with anxiety) and bipol ar disorder. Compared with controls, both the children with MDD and those w ith anxiety went on to have increased risk of substance abuse and conduct d isorder but not other disorders, increased use of longterm psychiatric and medical services, and overall impaired functioning. Children with prepubert al-onset MDD with a recurrence of MDD during follow-up had higher rates of MDD in their first-degree relatives. Conclusions: There is high morbidity in clinically referred children with p repubertal-onset MDD and anxiety, but continuity and specificity of MDD or anxiety disorder in adulthood is less clear. Caution is warranted in select ing clinically referred children with prepubertalonset MDD for inclusion in genetic studies unless they have a family history of MDD and recurrence of MDD over time.