Lost human capital from early-onset chronic depression

Objective: Chronic depression starts at an early age for many individuals a nd could affect their accumulation of "human capital" (i.e., education, hig her amounts of which can broaden occupational choice and increase earnings potential). The authors examined the impact, by gender, of early- (before a ge 22) versus late-onset major depressive disorder on educational attainmen t. They also determined whether the efficacy and sustainability of antidepr essant treatments and psychosocial outcomes vary by age at onset and quanti fied the impact of early-versus late-onset, as well as never-occurring. maj or depressive disorder on expected lifetime earnings. Method: The authors used logistic and multivariate regression methods to an alyze data from a three-phase, multicenter, double-blind, randomized trial that compared sertraline and imipramine treatment of 531 patients with chro nic depression aged 30 years and older. These data were integrated with U.S . Census Bureau data on 1995 earnings by age, educational attainment, and g ender. Results: Early-onset major depressive disorder adversely affected the educa tional attainment of women but not of men. No significant difference in tre atment responsiveness by age at onset was observed after 12 weeks of acute treatment or, for subjects rated as having responded, after 76 weeks of mai ntenance treatment. A randomly selected 21-year-old woman with early-onset major depressive disorder in 1995 could expect future annual earnings that were 12%-18% lower than those of a randomly selected 21-year-old woman whos e onset of major depressive disorder occurred after age 21 or not at all. Conclusions: Early-onset major depressive disorder causes substantial human capital loss, particularly for women. Detection and effective treatment of early-onset major depressive disorder may have substantial economic benefi ts.