Journal of Affective Disorders 97 (2007) 137 144 www.elsevier.

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Research report

Predictors of future depression in early and late adolescence

Natasja D.J. van Lang a,b , Robert F. Ferdinand a,, Frank C. Verhulst a
a

Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands b Academic Center for Child and Adolescent Psychiatry, Curium, Leiden, The Netherlands Received 8 August 2005; received in revised form 7 June 2006; accepted 7 June 2006 Available online 11 July 2006

Abstract Background: This study examined whether the possibility to predict future DSM-IV depressive disorder can be increased with recurrent screening for depression in community adolescents, compared to single screening in early or in late adolescence. In addition, it examined which depressive symptoms in early and late adolescence predicted future depressive disorder most accurately. Methods: Participants from an ongoing longitudinal cohort study were assessed when they were aged between 10 and 15 (early adolescence), and between 14 and 19 (late adolescence), and were followed until they were 2025 (young adulthood). The Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) were used to screen for depression in early and late adolescence, and CIDI/DSM-IV diagnoses of depressive disorder were used as the outcome measure during follow-up. Results: Recurrent screening only slightly improved the prediction of future depression, and cognitive and physical symptoms in late adolescence predicted future depression accurately in boys. Sleeping problems in early adolescence predicted future depression in girls. Limitations: The main limitation was the retrospective recall of the age of onset of a depressive disorder. Conclusions: Recurrent screening for depression did not predict future depressive disorder better than single screening in late adolescence. However, depressive symptoms like sleeping problems predicted future depression quite accurately in adolescent boys and girls. This indicates that it may be useful to screen adolescents for the presence of such symptoms, for instance in school settings, to predict which adolescents are at risk to develop DSM-IV depressive disorder in early adulthood. 2006 Published by Elsevier B.V.
Keywords: Depressive symptoms; Adolescence; Predictive quality; General population; Gender differences

1. Introduction Many studies have shown that rates of depressive symptoms increase in early adolescence. In addition,
Corresponding author. Erasmus Medical Center Rotterdam/Sophia Children's Hospital, Department of Child and Adolescent Psychiatry, Dr. Molewaterplein 60/P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. Tel.: +31 10 4636671; fax: +31 10 4636803. E-mail address: r.f.ferdinand@erasmusmc.nl (R.F. Ferdinand). 0165-0327/$ - see front matter 2006 Published by Elsevier B.V. doi:10.1016/j.jad.2006.06.007

they showed that these symptoms are persistent and are a risk factor for future depressive disorder or suicide attempts (Cuijpers and Smit, 2004; Fergusson et al., 2005; Ge et al., 2001; Haavisto et al., 2004; Jaffee et al., 2002; Wilcox and Anthony, 2004). Good screening measures for depressive symptoms in adolescents are therefore important to enable early outreach or treatment programs in schools to prevent depressive symptoms from becoming a disorder with possible adverse effects (Beardslee and Gladstone, 2001; Kessler et al., 2001).

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To detect adolescents at risk for future depressive disorders, recurrent screening for depression from early to late adolescence may be more effective than screening only once in early or in late adolescence. So far, studies that screened for depression in general populations performed only one screening. These studies showed that such screening had a moderate diagnostic accuracy at best (Dierker et al., 2001; Kessler et al., 2001). Recurrent screening might improve this diagnostic accuracy, because it detects adolescents who have continuous depressive symptoms from early adolescence on. These adolescents might be more vulnerable to develop a depressive disorder than those who only have depressive symptoms during a limited period. Another way of screening for future depression is to assess possibly predictive symptoms. Such predictive or discriminative symptoms are important, because they may alert professionals to individuals who have these symptoms and thus are likely to develop a depressive disorder (Wilcox and Anthony, 2004). In addition, these symptoms may be useful target symptoms in intervention programs (Dierker et al., 2001). In general, studies that examined discriminative symptoms of depression showed mixed results: lack of pleasure or interest in activities in preschool children (Luby et al., 2003), crying, lack of friends, self-hate, and reduced social interests in children (Frigerio et al., 2001), persistent lack of interest and feelings of worthlessness in older children and adolescents (Wilcox and Anthony, 2004), and depressive mood, loss of appetite and suicide thoughts in older adults with ischemic stroke (Coster et al., 2005). These results suggest that different cognitive or physical symptoms are discriminative symptoms at different ages, which may be due to differences in the importance of specific developmental or psychosocial factors (Lewinsohn et al., 2003). Because adolescents undergo many developmental changes, discriminative symptoms might differ between early and late adolescence. In addition, discriminative symptoms might differ between boys and girls. Many studies have shown that the prevalence of depression is more or less the same in boys and girls during early adolescence, but differs after mid-adolescence, with girls showing a larger increase than boys (Lewinsohn et al., 1998; Roza et al., 2003). If both genders also show different discriminative symptoms of depression in early and late adolescence, different symptoms for boys and girls may be targeted in treatment programs (Kovacs et al., 2003). The present study had two goals. First, it examined whether recurrent screening for depression was more effective than single screening in early and late adolescence, with respect to the detection of individuals with a

later-onset DSM-IV (American Psychiatric Association, 2000) depressive disorder. Second, it examined which depressive symptoms predicted the development of a DSM-IV depressive disorder most accurately. This was done for depressive symptoms in early and late adolescence and for boys and girls separately. The DSM-IV scale Affective Problems of a parent questionnaire, the Child Behavior Checklist (CBCL), and of a self-report questionnaire, the Youth Self-Report (YSR), were used as screening measures (Achenbach et al., 2001, 2003). One of the advantages of the use of this CBCL and YSR scale as screening measures is that both questionnaires can be easily administered in school settings and the scale can thus be applied as a brief and inexpensive screening measure (Rey and Morris-Yates, 1992). In addition, the scale yields the possibility to investigate cross-informant differences, because CBCL and YSR share the majority of items. 2. Method 2.1. Participants and procedure This study is part of an ongoing longitudinal multiple cohort study in the Dutch general population. Per age and per gender, a random sample of 100 children and adolescents from age 4 to age 16, who had the Dutch nationality, was drawn from the Dutch province of ZuidHolland in 1983, using municipal registers that list all residents. Of the original sample of 2600 children and adolescents aged 4 to 16, 2447 parents were reached, and 2076 responded and provided usable data (84.8%). For details of the initial data collection, see Verhulst et al. (1985). The sample in 1983 included 1016 males and 1060 females. Respondents were interviewed at 2-year intervals until 1991, and again in 1997. At Time 1 to 5 (19831991), information about behavior and emotional problems was assessed with the CBCL and at Times 3, 4 and 5 also with the YSR. Information about DSMIV diagnoses was obtained at Time 6 (1997) for 1580 individuals (response rate = 79.1%; Roza et al., 2003). For the present study, CBCL and YSR data of each participant aged between 10 and 15 years at Time 3 (early adolescence) and aged between 14 and 19 years at Time 5 (late adolescence), with information available about DSM-IV diagnoses at Time 6 (aged between 20 and 25) were selected. This resulted in CBCL data of N = 531 participants, and YSR data of N = 381 participants. Compared to the initial cohort of Time 1, the participants with CBCL data had a higher Time 1 CBCL Total Problems score (F(1, 2074) = 4.86, p < .05), and were more often female (53%).

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2.2. Measures 2.2.1. Depressive symptoms: parent- and self-reports The DSM-IV scale Affective Problems (Achenbach et al., 2001, 2003) that can be constructed from items of the CBCL and from items of the YSR was used in this study. The DSM-IV scale of the CBCL and of the YSR assesses depressive symptoms that are more closely related to DSM-IV major depressive disorder than the original CBCL and YSR scales. 2.2.1.1. The Child Behavior Checklist (CBCL; Achenbach, 1991). The CBCL is a parent questionnaire that covers behavior and emotional problems of children aged 4 to 18 years in the past six months. It contains 120 problem items that are scored on a 3-point scale (0 = not true, 1 = somewhat or sometimes true, 2 = very or often true). The good reliability and validity of the American version of the CBCL were confirmed for the Dutch version (Verhulst et al., 1996). 2.2.1.2. The Youth Self-Report (YSR; Achenbach, 1991). The YSR is a self-report questionnaire that covers behavior and emotional problems of children aged 11 to 18 years in the past six months. It has the same response format as the CBCL. Good reliability and validity have been reported for the Dutch version (Verhulst et al., 1997). 2.2.1.3. The CBCL and YSR DSM-IV scale Affective Problems (Achenbach et al., 2001, 2003). Amongst other DSM-IV scales, this DSM-IV scale was constructed to obtain scales that are more closely related to the DSM-IV than the original CBCL and YSR scales. In a community sample (van Lang et al., 2005), scores on this scale were associated with symptoms of DSM-IV MDD. In the present study, twelve items of this scale that were similar for CBCL and YSR were used: cries a lot, harms self, doesn't eat well, feels worthless, feels too guilty, tired, sleeps less, sleeps more, thinks of suicide, trouble sleeping, lacks energy, and sad (the item enjoys little was excluded). The Crohnbach's alpha coefficients of the scale on Time 3 were comparable to the alpha coefficients of the original CBCL and YSR scales ( = .50 for CBCL, and = .55 for YSR). On Time 5, larger alpha coefficients were found ( = .61 for CBCL and = .67 for YSR). 2.2.2. Future DSM-IV depressive disorder 2.2.2.1. The Composite International Diagnostic Interview (CIDI; World Health Organization, 1997). The CIDI is a structured diagnostic interview with the

participant to assess DSM-IV mental disorders in the past year and lifetime. The CIDI contains 300 questions about DSM-IV disorders that are scored by a computer. Good reliability and validity have been reported (Andrews and Peters, 1998). Interviewers who had been trained by the Dutch World Health Organization (WHO) training center for the CIDI conducted each interview. The dependent variable in the present study was future DSM-IV depressive disorder that comprised MDD or dysthymic disorder in early adulthood. It was defined by the presence of the disorder that started at least one year after the participant's age at Time 5. Participants with a depressive disorder at Time 5 or earlier were excluded. The maximum time between the participant's age at CIDI assessment and recall of the age of onset was 6 years. 2.3. Statistical analyses First, the efficacy of recurrent screening with the Affective Problems scale of the CBCL and YSR was examined by computing cross tabulations of each scale with the presence or absence of future DSM-IV depressive disorder. This was done for adolescents with versus those without depressive symptoms at Time 3 and Time 5 separately (single screening), and for adolescents with depressive symptoms both at Time 3 and Time 5 versus those without or only with symptoms at one time (Time 3 + Time 5: recurrent screening). To perform the cross tabulations, receiver operating characteristic (ROC) analysis was applied first to obtain the best cut-off score of the Affective Problems scale for each instrument and per time. ROC analysis calculates the sensitivity and specificity of each score on the Affective Problems scale relative to the presence or absence of the disorder. The score with the most optimal ratio between sensitivity and specificity was chosen, and the area under the curve (AUC) that reflects the criterion related validity of the scale compared to the diagnosis was reported. Subsequently, the numbers of true positives, true negatives, false positives and false negatives were examined using the best cut-off scores of the Affective Problems scale per instrument and time. From these numbers, the positive predictive value (i.e., chance that positive screening indicates the presence of a disorder: PPV) and the negative predictive value (i.e., chance that negative screening indicates the absence of a disorder: NPV) were calculated. The predictive values were used to compare the efficacy of recurrent screening versus single screening. Second, discriminant analysis was conducted to determine which CBCL or YSR items of the Affective

140 Table 1 Sample characteristics Age rangea

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N Boys Girls 280 280 204 204

Mean age (SD) Boys 12 (1.5) 15 (1.5) 12 (1.2) 16 (1.1) Girls 12 (1.6) 15 (1.6) 12 (1.3) 16 (1.2)

Mean score (95% CI) on DSM-IV scale Affective Problems Boys 1.3 (1.11.5) 1.1 (.91.3) 1.8 (1.52.1) 1.9 (1.62.2) Girls 1.2 (1.01.4) 1.5 (1.31.8) b 1.5 (1.31.8) 2.9 (2.53.3) b

CBCL Time 3 Time 5 YSR Time 3 Time 5

a b

1015 1419 1115 1519

251 251 177 177

Time 3 represents early adolescence and Time 5 represents late adolescence. Girls have a significantly (p < .01) higher score on the DSM-IV scale Affective Problems than boys.

Problems scale discriminated best between the presence and absence of future depressive disorder. Separate analyses were performed for CBCL and YSR items, Time 3 and Time 5, the whole group and per gender. The discriminant functionvariable correlations were used to interpret the function that distinguished the groups. The unstandardized discriminant function coefficients were used to determine which symptoms distinguished the groups most strongly. To fulfil the minimum ratio of variable/subject of 1/20 (Stevens, 1996), items with a correlation .10 with the discriminant function were excluded from the analyses. 3. Results 3.1. Sample characteristics Table 1 presents the sample characteristics. A significant gender difference was found for the mean score of the Affective Problems scale on Time 5 for the CBCL (F(1529) = 8.52, p < .01) and YSR (F(1379) = 16.74, p < .01), indicating more depressive symptoms in girls than in boys during late adolescence.

3.2. Recurrent versus single screening ROC analyses showed a most optimal cut-off score 1 at Time 3 (sensitivity of .51, specificity of .44, and AUC of .51) and at Time 5 (sensitivity of .65, specificity of .49, and AUC of .61) for the CBCL Affective Problems scale. For the YSR Affective Problems scale, a cut-off score 1 was found most optimal at Time 3 (sensitivity of .68, specificity of .37, and AUC of .54), and a cut-off score 3 at Time 5 (sensitivity of .58, specificity of .64, and AUC of .64). Using the cut-off scores of the CBCL Affective Problems scale, 9% (49/ 531) had a future DSM-IV depressive disorder (of which 4% boys, and 14% girls). Using the YSR Affective Problems scale cut-off scores, 8% (31/381) had a future DSM-IV depressive disorder (of which 3% boys, and 13% girls). Table 2 presents the predictive values for the CBCL and YSR Affective Problems scale per gender, on Time 3, Time 5, and Time 3 + Time 5. It shows that the CBCL Affective Problems scale had a PPV of 9% and a NPV of 90% on Time 3, which indicates that 9% of the young adolescents with a score 1 developed a future DSM-IV

Table 2 Predictive values for the CBCL and YSR DSM-IV scale Affective Problems Cut-off score of DSM-IV scalea CBCL Time 3 Time 5 Time 3 + 5 YSR Time 3 Time 5 Time 3 + 5
a

Positive predictive value (PPV) Total (%) 9 12 10 9 13 12 Boys (%) 3 5 5 3 8 9 Girls (%) 14 17 15 14 15 14

Negative predictive value (NPV) Total (%) 90 93 91 93 95 93 Boys (%) 96 98 97 98 99 99 Girls (%) 85 89 86 89 89 88

1 1 1, 1 1 3 1, 3

CBCL and YSR cut-off scores were based on the most optimal ratio between sensitivity and specificity obtained from the ROC analyses.

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depressive disorder and 90% with a score = 0 not. In addition, the PPVand NPV increased with 23% on Time 5, but only 1% in the recurrent screening of Time 3 + Time 5. Almost the same was found for the YSR Affective Problems scale. The largest rise in PPV was found in boys on the YSR Affective Problems scale of Time 3 + Time 5 (from 3% to 9%). In general, positive predictive values were lower for boys than for girls, but negative predictive values were higher for boys than for girls. 3.3. Discriminative items 3.3.1. Overall effect For the CBCL items of the Affective Problems scale, the overall Wilks' lambda was significant at Time 5 ( = .95, 2 (10, N = 529) = 25.54, p < .01), but not at Time 3 ( = .99, 2 (8, N = 531) = 6.35, ns). For the YSR items of the Affective Problems scale, the overall Wilks' lambda did not reach significance level at Time 3 ( = .98, 2 (5, N = 374) = 9.43, p = .09) or Time 5 ( = .96, 2 (8, N = 373) = 14.06, p = .08). Table 3 presents the coefficients of the significant discriminant function of the CBCL Affective Problems scale at Time 5. It shows that the items about cognitive and physical symptoms discriminated between adolescents with and without future DSM-IV depressive disorder, of which thinks of suicide was the strongest discriminative item, followed by trouble sleeping and feels worthless. These items corresponded with a PPV of 50%, and a NPV of 92%. Separate cross tabulations between scores on these CBCL items and the presence or absence of future depression showed that thinks of suicide by itself had a PPV of 40%, trouble sleeping 22% and feels worthless 19%.
Table 3 Results of discriminant analysis of Time 5 CBCL Affective Problems item scores CBCL item no. 35 100 24 54 52 103 91 Item description Discriminant function Correlation coefficient .675 .626 .531 .453 .393 .364 .344 Unstandardized coefficient 1.118 1.306 .756 .612 .686 .001 1.623

Table 4 Significant results of discriminant analysis of Time 3 and Time 5 CBCL and YSR Affective Problems item scores per gender Item no. Item description Discriminant function Correlation coefficient .627 .602 .545 .473 .349 Unstandardized coefficient 1.038 1.567 1.119 1.165 .512

CBCL Time 5: boys 35 100 24 103 52 YSR Time 3: girls 100 54 YSR Time 5: boys 102 100 14

Feels worthless Trouble sleeping Doesn't eat well Sad Feeling guilty Trouble sleeping Feeling tired Lacks energy Trouble sleeping Cries a lot

.951 .396

1.845 .689

.571 .497 .424

1.649 1.684 3.895

Note: only correlation coefficients .30 of the discriminant function are presented.

Feels worthless Trouble sleeping Doesn't eat well Tired Feels too guilty Sad Thinks of suicide

3.3.2. Gender effect The only significant overall effect for the CBCL items of the Affective Problems scale was found for boys at Time 5 ( = .86, 2 (10, N = 250) = 35.56, p < .01) with items about trouble sleeping, sad, doesn't eat well and feels worthless being equally strong discriminative items (see Table 4). They had a PPV of 34%, and a NPV of 98%. For the YSR items of the Affective Problems scale, the overall Wilks' lambda at Time 3 was significant only for girls ( = .93, 2 (5, N = 197) = 12.66, p = .03), with trouble sleeping being the strongest discriminative item, with a PPV of 50% and a NPV of 89%. The overall Wilks' lambda at Time 5 for the YSR items was only significant for boys ( = .81, 2 (8, N = 173) = 35.82, p < .01), with cries a lot being the strongest discriminative item, followed by trouble sleeping and lacks energy. These items had a PPV of 43% and a NPV of 99%. 4. Discussion The present study investigated whether recurrent screening for depression across a 4-year-interval had a higher efficacy (i.e., predictive quality) than single screening in early or late adolescence with regard to a

Note: only correlation coefficients .30 of the discriminant function are presented.

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later-onset DSM-IV depressive disorder in early adulthood. In addition, the study examined which symptoms of depression in early and late adolescence predicted DSMIV depressive disorder in early adulthood most accurately. 4.1. Efficacy of screening First, the predictive values of the CBCL and YSR Affective Problems scale were consistent with those found in other studies. Higher values with respect to positive prediction were shown in girls than in boys, which confirms that more girls than boys develop a depressive disorder (Lewinsohn et al., 1998; Roza et al., 2003). In boys, higher values with respect to negative prediction were found than in girls, which means that boys without depressive symptoms will almost certainly not develop DSM-IV depressive disorder. However, boys showed the largest increase in positive predictive value from early to late adolescence. This may indicate that depression in boys starts to develop at a later age than in girls, which corroborates the results of previous studies (e.g., Cole et al., 2002; Ge et al., 2001). The predictive values of the CBCL and YSR Affective Problems scale were comparable, which is consistent with results found by Rey and Morris-Yates (1992) who showed that reports by youths themselves were not more accurate in the identification of depressive disorders than parent reports. Second, the predictive values showed that recurrent screening across a 4-year-interval was not more effective than single screening in early or late adolescence to identify of adolescents who developed a future DSM-IV depressive disorder in early adulthood. Compared to screening in early adolescence, the predictive values increased marginally with 23% with screening in late adolescence, and less with recurrent screening. This may be due to the fact that the number of false positives decreased with recurrent screening, whereas the number of false negatives increased simultaneously. This was the case for the CBCL and YSR Affective Problems scale. It can be concluded therefore that compared to a 4-year-interval of positive screening, screening in late adolescence is more effective and more efficient to identify adolescents in a general population who are at risk for DSM-IV depressive disorders in early adulthood. 4.2. Discriminative symptoms

symptoms assessed with the YSR. Symptoms like suicide thoughts, trouble sleeping, and feeling worthless discriminated adolescents who did or did not develop a DSM-IV depressive disorder. This was not the case for depressive symptoms in early adolescence, assessed with either CBCL or YSR. In addition, gender differences were found. For boys, cognitive and physical symptoms in late adolescence, such as sadness and feeling worthless and trouble sleeping and not eating well, assessed with the CBCL, distinguished those who did or did not develop a depressive disorder. With the YSR, only physical symptoms in late adolescence distinguished adolescent boys. For girls, sleeping problems in early adolescence, assessed with the YSR, was the only symptom that distinguished young adolescent girls. Wilcox and Anthony (2004) found that self-reported feelings of persistent lack of interest and pleasure, and feelings of worthlessness, had the strongest prognostic value in childhood and adolescence for adult-onset depression, particularly in girls. The present study showed that self-reported physical symptoms like trouble sleeping predicted future depression more accurately than cognitive symptoms, both in boys and in girls. It is noteworthy that only parent-reported cognitive symptoms like suicide thoughts were predictive, whereas self-reports were not. It may be that selfreported physical symptoms reflect more inner distress than cognitive symptoms, but it may also be that some parents have experienced depressive symptoms themselves and therefore were more aware of such cognitive symptoms in their children. It was found that the discriminative symptoms had a predictive value of 3450%. Wilcox and Anthony (2004) found that persistent lack of interest and feeling worthless had a higher predictive value of 60%, which may be due to the fact that they assessed a broader range of clinical features in children and adolescents than the symptoms assessed with the Affective Problems scale. Because the item enjoys little was excluded from the Affective Problems scale, we cannot compare the predictive quality of this symptom. However, the results of both parent- and self-reports in this study underscore the importance of also physical symptoms of depression in adolescents, and indicate that the presence of such symptoms may help to predict depressive disorders in early adulthood. 4.3. Implications

Depressive symptoms in late adolescence that were assessed with the CBCL predicted DSM-IV depressive disorder in early adulthood far more accurately than

The classification accuracy of future depression as indicated by the AUC was low for the CBCL and YSR

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Affective Problems scale, and it can be questioned whether this scale is a valuable measure to identify community individuals who are at risk for developing a depressive disorder in early adulthood. However, other community studies also showed low to moderate AUC values with for instance the Center for Epidemiologic Studies-Depression Scale (CES-D; in Dierker et al., 2001). In addition, 3450% of the adolescents who had the discriminative symptoms in the present study developed a DSM-IV depressive disorder. This implies that the CBCL and YSR Affective Problems scale may be useful to screen for depression in a general population, not primarily by looking at scale scores but by taking account of separate item scores. Both the CBCL and YSR are frequently used in school settings, and it could be useful if teachers or other professionals would pay extra attention to adolescents who score on the items about physical symptoms. Although not all adolescents with scores on these items will develop a DSM-IV depressive disorder, they might benefit from depression intervention programs nonetheless (Kessler et al., 2001), with gender specific target symptoms (Kovacs et al., 2003). 4.4. Limitations Four limitations need to be addressed. First, the presence or absence of future DSM-IV depressive disorder was defined by the participants' recall of the age of onset of depression when they were adults. This is a clear limitation of the study and prospective research with repeated measures of DSM diagnoses will certainly provide more reliable data about the age of onset than retrospective recall. However, the time of the participant's recall of the age of onset in this study was confined to a maximum of 6 years, which may have restricted the inaccuracy of the recall. Second, the CBCL and YSR Affective Problems scale did not include the item enjoys little in this study, because the CBCL and YSR versions used did not encompass this item. Therefore, the discriminative power of this symptom could not be examined, which limited the comparison of our results with those of Frigerio et al. (2001) and Wilcox and Anthony (2004), who showed, amongst others, that lack of enjoyment or interest (anhedonia) was specific for depression. Third, like other studies (e.g., Dierker et al., 2001; Wilcox and Anthony, 2004), our study was restricted by the small number of boys who developed a depressive disorder. Fourth, to increase the predictive quality of screening measures for depression in a general population, it would have been useful to also assess other risk factors that could predict DSM-IV depressive disorders, like peer rejection and family history of depression (Reinherz et al., 2003). In addition, information about the presence of life

events that were stressful for the adolescents during the screening period might have been helpful to explain why some of the adolescents with depressive symptoms developed a depressive disorder in early adulthood, and others with the same depressive symptoms did not. 4.5. Conclusions This study showed that recurrent screening for future DSM-IV depressive disorders in community adolescents, across a 4-year-interval, did not influence screening efficacy. Screening in late adolescence was the most efficient method to detect individuals from a general population who are at risk to develop a depressive disorder in early adulthood. According to parents, cognitive and physical symptoms in late adolescence predicted such a future depressive disorder most accurately, particularly in boys. With self-reports, physical symptoms in late adolescence predicted future depressive disorder accurately for boys, whereas sleeping problems in early adolescence predicted future depressive disorder accurately for girls. These findings indicate that it may be useful to screen adolescents for the presence of predictive symptoms, since 3450% of the adolescents with these symptoms developed a depressive disorder in early adulthood. Acknowledgement The study was supported by the Sophia Foundation for Scientific Research (SSWO: Endowed chair grant). References
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