Research report Course and outcome of major depressive disorder in non-referred adolescents Cecilia A. Essau School of Human and Life Sciences, Roehampton University, Whitelands College, Holybourne Avenue, London SW15 4JD, UK Received 16 June 2006; received in revised form 5 September 2006; accepted 6 September 2006 Available online 16 October 2006 Abstract Background: Although major depressive disorder (MDD) is one of the most common disorders in adolescence, little is known about its course and outcome in non-referred adolescents. Therefore, the aims of this article were to examine the course and outcome of MDD in non-referred adolescents, and to examine factors related to its stability. Methods: Five hundred and twenty-three adolescents were interviewed twice at an interval of about 15 months using the computerized Munich version of the Composite International Diagnostic Interview. Results: Of the 90 adolescents who met the diagnosis of MDD at T1, 22 (24.4%) still met the same diagnosis at T2. Sixty-eight (75.6%) of them no longer met the diagnosis of MDD at T2, and in some of these cases, their depression was replaced by several other disorders; 44 adolescents received no diagnostic criteria for any DSM-IV disorders. The factors that were significantly associated with the stability of MDD included the presence of substance use disorders and parental alcohol problems, negative life events and negative coping, past suicidal attempt, suicidal thought, and concrete suicidal plan at the T1-interview. Adolescents with “chronic” (T1 and T2) compared to “transient” (only T1) MDD and those without any disorders were significantly more impaired in various life domains. Limitations: This study was based on a small number of adolescents with a chronic MDD. Conclusions: The course and outcome of MDD in majority of the adolescents seemed to have a favourable course, whereas in some adolescents, it tended to have a heterogeneous pattern. © 2006 Elsevier B.V. All rights reserved. Keywords: Major depressive disorder; Course and outcome; Comorbidity; Adolescents 1. Introduction Major depressive disorder (MDD) is among the most common (Essau, 2000; Feehan et al., 1994; Lewinsohn et al., 1993; Reinherz et al., 1993) and chronic disorders in adolescence. In both clinical and community studies the mean length of a major depressive episode in ado- lescents was about 24–36 weeks (Kovacs et al., 1984; Lewinsohn et al., 1994; Rao et al., 1995). In a study by Kovacs et al. (1989), 21 to 41% were still depressed a year after the index interview, and at two years 8 to 10%. Relapse/recurrence appears to be high for adolescents with depression (Asarnow et al., 1988; Kovacs et al., 1984; Garber et al., 1988). Depending on the follow-up period and the settings from which the adolescents have been recruited, a relapse/recurrence rate ranging from 20 to 54% has been found (Birmaher et al., 2002). As reported by Kovacs et al. (1984), 26% of the children had a new depressive episode within one year of re- covery, and 40% after two years. In a study by Asarnow Journal of Affective Disorders 99 (2007) 191 – 201 www.elsevier.com/locate/jad E-mail address: C.Essau@roehampton.ac.uk. 0165-0327/$ - see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2006.09.010