Subsyndromal depression in adolescents after a brief psychotherapy trial: course and outcome

Introduction: Subsyndromal depression has been associated with an increased risk of the development of major depressive disorder (MDD). Since treatmen t trials of adolescent MDD often result in subsyndromal depression as the o utcome, the long-term course of these youth would be useful to understand. Methods: 107 adolescents with MDD participated in a clinical psychotherapy trial, of whom 99 were followed up for two years after acute treatment. Tho se with subsyndromal depression (2-3 symptoms) at the end of acute treatmen t were compared to those who were well (less than or equal to 1 symptom) an d those who were still depressed (greater than or equal to 4 symptoms) on p resentation at intake, the end of treatment, and over the two-year follow-u p. Results: Of the 99 youth, at the end of acute treatment 26 were well, 18 were subsyndromal, and 55 were still depressed. A substantial proportion o f the subsyndromally depressed youth were functionally impaired (38%), and showed a protracted time to recovery. The risk of recurrence was similar to those who were without depression at the end of acute treatment (46% vs. 4 4%). Recurrence was predicted by depressive symptom severity and family dif ficulties at the end of acute treatment. Limitations: A large proportion of the subsyndromal groups received open treatment that may have altered thei r course. Also, this was a referred sample, lather than an epidemiological one. Conclusions: In clinical samples treated with psychotherapy, subsyndro mal depression poses a significant risk for functional impairment and protr acted recovery. Depressive recurrence may be prevented by targeting reducti on of symptom severity and of family difficulties. (C) 2001 Elsevier Scienc e B.V. All rights reserved.