Toward effective early intervention and prevention strategies for major affective disorders: A review of antecedents and risk factors

Objective: To review critically the literature pertaining to risk factors a nd antecedent symptoms and syndromes in order to determine an empirically b ased strategy for early treatment and prevention of major mood episodes. Method: The relevant literature is summarized with particular emphasis on e arly-onset (child and adolescent) mood disorders. Results: A complex interaction between biological psychological, and sociol ogical factors contributes to the development of a major mood disorder. Hav ing a positive family history of mood disorder (bipolar and unipolar) and b eing female (unipolar) are the strongest, most reliable risk factors. There is continuity between adolescent and adult mood disorders, and subsyndroma l mood disturbance in adolescents has clinical and public health significan ce. However, more longitudinal study is required to reliably map the course and predictive importance of mood disorders in very young children. Conclusions: Substantial evidence supports the effectiveness of early inter vention and prevention efforts in children at risk for mood disorders (iden tified as having affected family members) and in adolescents manifesting si gnificant mood symptoms and syndromes (especially if associated with a posi tive family history ). However, the current level of understanding regardin g the etiological significance and mechanism of risk factors associated wit h mood disorders does not support broad community-based primary prevention strategies in unselected populations.