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Adolescent depression, adult mental health and psychosocial outcomes at 30 and 35 years

  • G. F. H. McLeod (a1), L. J. Horwood (a1) and D. M. Fergusson (a1)



There is limited information on long-term outcomes of adolescent depression. This study examines the associations between severity of depression in adolescence and a broad array of adult functional outcomes.


Data were gathered as part of the Christchurch Health and Development Study, a 35-year longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand in 1977. Severity of depression at age 14–16 years was classified into three levels according to DSM symptom criteria for major depression (no depression/sub-threshold symptoms/major depression). This classification was related to adult functional outcomes assessed at ages 30 and 35 years using a generalized estimating equation modeling approach. Outcome measures spanned domains of mental disorder, education/economic circumstances, family circumstances and partner relationships.


There were modest but statistically significant bivariate associations between adolescent depression severity and most outcomes. After covariate adjustment there remained weak but significant (p < 0.05) associations with rates of major depression, anxiety disorder, illicit substance abuse/dependence, any mental health problem and intimate partner violence (IPV) victimization. Estimates of attributable risk for these outcomes ranged from 3.8% to 7.8%. For two outcomes there were significant (p < 0.006) gender interactions such that depression severity was significantly related to increased rates of unplanned pregnancy and IPV victimization for females but not for males.


The findings reinforce the importance of the individual/family context in which adolescent depression occurs. When contextual factors and probable maturational effects are taken into account the direct effects of adolescent depression on functioning in mature adulthood appear to be very modest.


Corresponding author

* Address for correspondence: Research Associate Professor L. J. Horwood, Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand. (Email:


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Aalto-Setälä, T, Marttunen, M, Tuulio-Henriksson, A, Poikolainen, K, Lönnqvist, J (2014). Depressive symptoms in adolescence as predictors of early adulthood depressive disorders and maladjustment. American Journal of Psychiatry 159, 12351237.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.
Bertha, EA, Balázs, J (2013). Subthreshold depression in adolescence: a systematic review. European Child and Adolescent Psychiatry 22, 589603.
Bhatia, SK, Bhatia, SC (2007). Childhood and adolescent depression. American Family Physician 75, 7380.
Braiker, H, Kelley, H (1979). Conflict in the development of close relationships. In Social Exchange and Developing Relationships (ed. Burgess, R. and Huston, T.), pp. 127154. Academic Press: New York.
Carlin, JB, Wolfe, R, Coffey, C, Patton, GC (1999). Tutorial in biostatistics. Analysis of binary outcomes in longitudinal studies using weighted estimating equations and discrete-time survival methods: prevalence and incidence of smoking in an adolescent cohort. Statistics in Medicine 18, 26552679.
Costello, A, Edelbrock, C, Kalas, R, Kessler, M, Klaric, SA (1982). The National Institute of Mental Health Diagnostic Interview Schedule for Children (DISC). National Institute of Mental Health: Rockville, MD.
Costello, EJ, Maughan, B (2015). Annual research review: optimal outcomes of child and adolescent mental illness. Journal of Child Psychology and Psychiatry 56, 324341.
Devries, KM, Mak, J, Bacchus, LJ, Child, JC, Falder, G, Petzold, M, Astbury, J, Watts, CH (2013). Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Medicine 10, e1001439.
Dunn, V, Goodyer, IM (2006). Longitudinal investigation into childhood and adolescence-onset depression: psychiatric outcome in early adulthood. British Journal of Psychiatry 188, 216222.
Fergusson, DM, Boden, JM, Horwood, LJ (2008). Exposure to childhood sexual and physical abuse and adjustment in early adulthood. Child Abuse and Neglect 32, 607619.
Fergusson, DM, Horwood, LJ (2001). The Christchurch health and development study: review of findings on child and adolescent mental health. Australian and New Zealand Journal of Psychiatry 35, 287296.
Fergusson, DM, Horwood, LJ (2013). The Christchurch health and development study. In The Christchurch Experience: 40 Years of Research and Teaching (ed. Joyce, P., Nicholls, G., Thomas, K. and Wilkinson, T.), pp. 7987. University of Otago: Christchurch.
Fergusson, DM, Horwood, LJ, Lynskey, MT (1993). The prevalence and comorbidity of DSM-III-R diagnoses in a birth cohort of 15 year olds. Journal of the American Academy of Child and Adolescent Psychiatry 32, 11271134.
Fergusson, DM, Horwood, LJ, Lynskey, MT (1995). Maternal depressive symptoms and depressive symptoms in adolescents. Journal of Child Psychology and Psychiatry and Allied Disciplines 36, 11611178.
Fergusson, DM, Horwood, LJ, Ridder, EM, Beautrais, AL (2005). Sub-threshold depression in adolescence and mental health outcomes in adulthood. Archives of General Psychiatry 62, 6672.
Fergusson, DM, Woodward, LJ (2002). Mental health, educational and social role outcomes of adolescents with depression. Archives of General Psychiatry 59, 225231.
Fombonne, E, Wostear, G, Cooper, V, Harrington, R, Rutter, M (2001). The Maudsley long-term follow-up of child and adolescent depression 1. Psychiatric outcomes in adulthood. British Journal of Psychiatry 179, 210217.
Goodman, A, Joyce, R, Smith, JP (2011). The long shadow cast by childhood physical and mental problems on adult life. Proceedings of the National Academy of Sciences USA 108, 60326037.
Hammen, C, Brennan, PA, Le Brocque, R (2013). Youth depression and early childrearing: stress generation and intergenerational transmission of depression. Journal of Consulting and Clinical Psychology 79, 353363.
Keenan-Miller, D, Hammen, CL, Brennan, PA (2007). Health outcomes related to early adolescent depression. Journal of Adolescent Health 41, 256262.
Kessler, RC (1997). The effects of stressful life events on depression. Annual Review of Psychology 48, 191214.
Kessler, RC, Berglund, PA, Foster, CL, Saunders, WB, Stang, PE, Walters, EE (1997). Social consequences of psychiatric disorders, II: Teenage parenthood. American Journal of Psychiatry 154, 14051411.
Lehrer, JA, Shrier, LA, Gortmaker, S, Buka, S (2006). Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students. Pediatrics 118, 189200.
Lewinsohn, PM, Rohde, P, Seeley, JR, Klein, DN, Gotlib, IH (2003). Psychosocial functioning of young adults who have experienced and recovered from major depressive disorder during adolescence. Journal of Abnormal Psychology 112, 353363.
Lewinsohn, PM, Solomon, A, Seeley, JR, Zeiss, A (2000). Clinical implications of ‘subthreshold’ depressive symptoms. Journal of Abnormal Psychology 109, 345351.
Lynch, FL, Clarke, GN (2006). Estimating the economic burden of depression in children and adolescents. American Journal of Preventive Medicine 31, S143S151.
Marmorstein, NR (2009). Longitudinal associations between alcohol problems and depressive symptoms: early adolescence through early adulthood. Alcoholism: Clinical and Experimental Research 33, 4959.
Nduna, M, Jewkes, RK, Dunkle, KL, Jama Shai, NP, Colman, I (2010). Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. Journal of the International AIDS Society 13, 44.
Organisation for Economic Co-operation and Development (OECD) (2007). Purchasing Power Parities (PPPs) for OECD Countries since 1980 (
Pine, DS, Cohen, E, Cohen, P, Brook, J (1999). Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder? American Journal of Psychiatry 156, 133135.
Prager, LM (2009). Depression and suicide in children and adolescents. Pediatrics in Review 30, 199206.
SAS Institute Inc. (2012). SAS 9.3 TS1M1. SAS Institute Inc.: Cary, NC.
Smith, JP, Smith, GC (2010). Long-term economic costs of psychological problems during childhood. Social Science and Medicine 71, 110115.
StataCorp (2011). Stata Statistical Software: Release 12.0. Stata Corporation: College Station, TX.
Straus, MA, Hamby, SL, Boney-McCoy, S, Sugarman, DB (1996). The revised Conflict Tactics Scales (CTS2). Development and preliminary psychometric data. Journal of Family Issues 17, 283316.
Thapar, A, Collishaw, S, Pine, DS, Thapar, AK (2012). Depression in adolescence. Lancet 379, 10561067.
Tuisku, V, Kiviruusu, O, Pelkonen, M, Karlsson, L, Strandholm, T, Marttunen, M (2014). Depressed adolescents as young adults – Predictors of suicide attempt and non-suicidal self-injury during an 8-year follow-up. Journal of Affective Disorders 152–154, 313319.
Weissman, MM, Wolk, S, Goldstein, RB, Moreau, D, Adams, P, Greenwald, S, Klier, CM, Ryan, ND, Dahl, RE, Wickramaratne, P (1999 a). Depressed adolescents grown up. Journal of the American Medical Association 281, 17071713.
Weissman, MM, Wolk, S, Wickramaratne, P, Goldstein, RB, Adams, P, Greenwald, S, Ryan, ND, Dahl, RE, Steinberg, D (1999 b). Children with prepubertal-onset major depressive disorder and anxiety grown up. Archives of General Psychiatry 56, 794801.
WHO (1993). Composite International Diagnostic Interview (CIDI). World Health Organization: Geneva, Switzerland.
Zeger, SL, Liang, K-Y (1986). Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42, 121130.


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