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Developmental pathway for first onset of depressive disorders in females: from adolescence to emerging adulthood

Published online by Cambridge University Press:  29 August 2023

Wenting Mu*
Department of Psychology, Tsinghua University, Beijing, China
Chuncheng Huang
Department of Psychology, Tsinghua University, Beijing, China
Nisha Yao
School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing, China
Jiaju Miao
Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
Greg Perlman
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
David Watson
Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
Daniel N. Klein
Department of Psychology, Stony Brook University, Stony Brook, NY, USA
Roman Kotov
Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA Department of Psychology, Stony Brook University, Stony Brook, NY, USA
Corresponding author: Wenting Mu; Email:;



Although risk markers for depressive disorders (DD) are dynamic, especially during adolescence, few studies have examined how change in risk levels during adolescence predict DD onset during transition to adulthood. We compared two competing hypotheses of the dynamic effects of risk. The risk escalation hypothesis posits that worsening of risk predicts DD onset beyond risk level. The chronic risk hypothesis posits that persistently elevated risk level, rather than risk change, predicts DD onset.


Our sample included 393 girls (baseline age 13.5–15.5 years) from the adolescent development of emotions and personality traits project. Participants underwent five diagnostic interviews and assessments of risk markers for DD at 9-month intervals and were re-interviewed at a 6-year follow-up. We focused on 17 well-established risk markers. For each risk marker, we examined the prospective effects of risk level and change on first DD onset at wave six, estimated by growth curve modeling using data from the first five waves.


For 13 of the 17 depression risk markers, elevated levels of risk during adolescence, but not change in risk, predicted first DD onset during transition to adulthood, supporting the chronic risk hypothesis. Minimal evidence was found for the risk escalation hypothesis.


Participants who had a first DD onset during transition to adulthood have exhibited elevated levels of risk throughout adolescence. Researchers and practitioners should administer multiple assessments and focus on persistently elevated levels of risk to identify individuals who are most likely to develop DD and to provide targeted DD prevention.

Original Article
Copyright © The Author(s), 2023. Published by Cambridge University Press

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Wenting Mu and Chuncheng Huang share first authorship of this work.


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