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Predictors of Recovery and Recurrence

Given the functional impairment and societal costs associated with depression episodes, which includes impaired academic performance among youths,5 there has been ongoing interest in identifying predictors of course and outcome. Studies of depression in adults and youths have typically examined identical clinical (e.g., age at onset of a given episode, episode severity) and demographic (e.g., sex) predictors, but with developmental differences in how some key constructs have been indexed. For example, family intactness and stability of caregivers are indicators of psychosocial resources when studying youth, whereas marital status occupies a similar role when studying adults. As another example, a key index of functioning in youth is school and academic performance, whereas employment status or other role-specific performance provides similar information about adults.

Predictors of the course of depression in youth can be broadly classified as (a) demographic characteristics, including sex, socioeconomic status (SES), ethnicity, and presence of an intact family; (b) clinical characteristics, including age at episode onset, number of prior episodes, depression severity, psychiatric comorbidity; (c) interventions received for depression; (d) family history, including depression and mood disorders in first-degree relatives; and (e) psychosocial features, such as personality or cognitive traits, family environment, coping skills, and stress events. There is also a more recent, smaller body of literature on physiological (e.g., neuroendocrine and neural) predictors of depression course and outcome in youth.29 This chapter focuses primarily on the most commonly examined demographic and clinical predictors of depression course (age, sex, SES, age at episode onset), as well as on treatment and family history.

A notable aspect of the literature on depression is that the predictive value of some variables appears to differ as a function of the phase of clinical course under consideration.3,5 For example, being female increases the risk of depression onset starting in adolescence but has no consistent impact on risk of recurrence; lower SES likewise appears to increase the risk of first onset but does not measurably affect recurrence.3 Thus, the present overview examines onset and recovery separately and seeks to specify the episode number, if possible.

 
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