Studies have primarily focused on adverse life events (ALEs) as potential causes rather than as outcomes of pediatric depression. The current study prospectively examines ALEs in a sample of youth with attention-deficit/hyperactivity disorders (ADHD) to determine whether having a major depressive disorder (MDD) at baseline (T1) predicts counts of child-dependent or child-independent ALEs at a second assessment (T2) ∼8 months later.
Methods:
Subjects with ADHD 11–18 years old were drawn mostly from a tertiary mental health clinic and evaluated with semi-structured diagnostic interviews, and parent and teacher questionnaires of ADHD severity. Eighteen with and 61 without initial MDD at T1 were compared at T2 regarding counts of subsequent overall, child-dependent, and child-independent ALEs reported on life events questionnaires by the child or parent.
Results:
The group initially with MDD had higher overall ALEs (p=0.01) and child-dependent ALEs (p≤0.001) but not child-independent ALEs (p=0.12) at T2 relative to the nondepressed group, although only 3 of 18 continued to meet full criteria for MDD. The group initially with MDD also had a higher baseline ADHD severity (p=0.04) and proportion of oppositional or conduct disorders (p=0.004). In multivariate analyses, the group initially having MDD had a higher adjusted mean at T2 of child-dependent ALEs (p=0.02), but not of overall ALEs (p=0.06), after controlling for other T1 variables, including ALEs of the same type, ADHD severity, externalizing disorders, and the interaction of externalizing disorders with MDD.
Conclusions:
These findings suggest that child-dependent ALEs are potentially an important outcome after youth with ADHD have an episode of MDD. Youth with ADHD who develop comorbid MDD should be closely monitored and offered interventions to address the potential burden of child-dependent ALEs lingering after a depressive episode.
Get full access to this article
View all access options for this article.
References
1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4thText Revision (DSM-IV-TR)Washington, DC: American Psychiatric Association, 2000.
BarkleyRA, BiedermanJ. Toward a broader definition of the age-of-onset criterion for attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry, 36:1204–1210. 1997.
4.
BauermeisterJJ, ShroutPE, RamirezR, BravoM, AlegriaM, Martinez-TaboasA, ChavezL, Rubio-StipecM, GarciaP, RiberaJC, CaninoG. ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. J Abnorm Child Psychol, 35:883–898. 2007.
5.
BiedermanJ, BallSW, MonuteauxMC, MickE, SpencerTJ, McCrearyM, CoteM, FaraoneSV. New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. J Am Acad Child Adolesc Psychiatry, 47:426–434. 2008.
6.
BiedermanJ, FaraoneS, MilbergerS, CurtisS, ChenL, MarrsA, OuelletteC, MooreP, SpencerT. Predictors of persistence and remission of ADHD into adolescence: Results from a four-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry, 35:343–351. 1996.
7.
BiedermanJ, MilbergerS, FaraoneSV, KielyK, GuiteJ, MickE, AblonS, WarburtonR, ReedE. Family-environment risk factors for attention-deficit hyperactivity disorder. A test of Rutter's indicators of adversity. Arch Gen Psychiatry, 52:464–470. 1995.
8.
BirmaherB, McCaffertyJP, BellewKM, BeebeKL, ComorbidADHD. Disruptive Behavior Disorders as Predictors of Response in Adolescents Treated for Major Depression. Chicago, IL, Annual Meeting of the American Psychiatric Association, 2000(abstract).
9.
BirmaherB, RyanND, WilliamsonDE, BrentDA, KaufmanJ, DahlRE, PerelJM, NelsonB. Childhood and adolescent depression: A review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry, 35:1427–1439. 1996.
10.
BrandAH, JohnsonJH. Note on the reliability of the Life Events Checklist. Psychol Rep, 50:1274. 1882.
11.
DavissWB. A review of co-morbid depression in pediatric ADHD: Etiology, phenomenology, and treatment. J Child Adolesc Psychopharmacol, 18:565–571. 2008.
12.
DavissWB, DilerRS, BirmaherB. Associations of lifetime depression with trauma exposure, other environmental adversities, and impairment in adolescents with ADHD. J Abnorm Child Psychol, 37:857–871. 2009.
13.
DavissWB, NeryFG, OlveraRL, DilerRS, MezzomoKM, SoaresJC. Exploratory Factor Analysis of the CDRS-R in Youths with ADHD. Boston, MA, Poster, 54th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, 2007(abstract).
14.
DuggalS, Malkoff-SchwartzS, BirmaherB, AndersonBP, MattyMK, HouckPR, Bailey-OrrM, WilliamsonDE, FrankE. Assessment of life stress in adolescents: Self-report versus interview methods. J Am Acad Child Adolesc Psychiatry, 39:445–452. 2000.
15.
DuPaulGJ, PowerTJ, AnastopoulosAD, ReidR. ADHD Rating Scale-IV: Checklists, Norms, Clinical Interpretation. New York, NY: Guilford Publications, 1998.
16.
FrankoDL, Striegel-MooreRH, BrownKM, BartonBA, McMahonRP, SchreiberGB, CrawfordPB, DanielsSR. Expanding our understanding of the relationship between negative life events and depressive symptoms in black and white adolescent girls. Psychol Med, 34:1319–1330. 2004.
17.
GarrisonCZ, JacksonKL, MarstellerF, McKeownR, AddyC. A longitudinal study of depressive symptomatology in young adolescents. J Am Acad Child Adolesc Psychiatry, 29:581–585. 1990.
18.
GoodyerIM, HerbertJ, TamplinA, SecherSM, PearsonJ. Short-term outcome of major depression: II. Life events, family dysfunction, and friendship difficulties as predictors of persistent disorder. J Am Acad Child Adolesc Psychiatry, 36:474–480. 1997.
19.
HapponenM, PulkkinenL, KaprioJ, Van der MeereJ, VikenRJ, RoseRJ. The heritability of depressive symptoms: Multiple informants and multiple measures. J Child Psychol Psychiatry, 43:471–479. 2002.
20.
HarknessKL, BruceAE, LumleyMN. The role of childhood abuse and neglect in the sensitization to stressful life events in adolescent depression. J Abnorm Psychol, 115:730–741. 2006.
21.
HermanKC, OstranderR, WalkupJT, SilvaSG, MarchJS. Empirically derived subtypes of adolescent depression: Latent profile analysis of co-occurring symptoms in the Treatment for Adolescents with Depression Study (TADS)J Consult Clin Psychol, 75:716–728. 2007.
22.
HollingsheadAB. Four Factor Index of Social Status. New Haven, CT: Yale University Press, 1975.
23.
JohnstonCA, SteeleRG, HerreraEA, PhippsS. Parent and child reporting of negative life events: Discrepancy and agreement across pediatric samples. J Pediatr Psychol, 28:579–588. 2003.
24.
KaufmanJ, BirmaherB, BrentD, RaoU, FlynnC, MoreciP, WilliamsonD, RyanN. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data. J Am Acad Child Adolesc Psychiatry, 36:980–988. 1997.
25.
KesslerRC, AdlerLA, BarkleyR, BiedermanJ, ConnersCK, FaraoneSV, GreenhillLL, JaegerS, SecnikK, SpencerT, UstunTB, ZaslavskyAM. Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: Results from the national comorbidity survey replication. Biol Psychiatry, 57:1442–1451. 2005.
26.
KratochvilCJ, MayDE, SilvaSG, MadaanV, PuumalaSE, CurryJF, WalkupJ, KepleyH, VitielloB, MarchJS. Treatment response in depressed adolescents with and without co-morbid attention-deficit/hyperactivity disorder in the Treatment for Adolescents with Depression Study. J Child Adolesc Psychopharmacol, 19:519–527. 2009.
27.
LeckmanJF, SholomskasD, ThompsonWD, BelangerA, WeissmanMM. Best estimate of lifetime psychiatric diagnosis: A methodological study. Arch Gen Psychiatry, 39:879–883. 1982.
28.
LubyJL, BeldenAC, SpitznagelE. Risk factors for preschool depression: The mediating role of early stressful life events. J Child Psychol Psychiatry, 47:1292–1298. 2006.
29.
McQuaidJR, MonroeSM, RobertsJE, KupferDJ, FrankE. A comparison of two life stress assessment approaches: Prospective prediction of treatment outcome in recurrent depression. J Abnorm Psychol, 109:787–791. 2000.
30.
NatsuakiMN, GeX, BrodyGH, SimonsRL, GibbonsFX, CutronaCE. African American children's depressive symptoms: The prospective effects of neighborhood disorder, stressful life events, and parenting. Am J Community Psychol, 39:163–176. 2007.
31.
PattonGC, CoffeyC, PosterinoM, CarlinJB, BowesG. Life events and early onset depression: Cause or consequence?Psychol Med, 33:1203–1210. 2003.
32.
PiacentiniJC, CohenP, CohenJ. Combining discrepant diagnostic information from multiple sources: Are complex algorithms better than simple ones?J Abnorm Child Psychol, 20:51–63. 1992.
33.
PineDS, CohenP, JohnsonJG, BrookJS. Adolescent life events as predictors of adult depression. J Affect Disord, 68:49–57. 2002.
34.
PliszkaSR. Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: An overview. J Clin Psychiatry, 59:50–58. 1998.
ReinherzHZ, GiaconiaRM, PakizB, SilvermanAB, FrostAK, LefkowitzES. Psychosocial risks for major depression in late adolescence: A longitudinal community study. J Am Acad Child Adolesc Psychiatry, 32:1155–1163. 1993.
37.
RiceF, HaroldGT, ThaparA. Negative life events as an account of age-related differences in the genetic aetiology of depression in childhood and adolescence. J Child Psychol Psychiatry, 44:977–987. 2003.
38.
RohdeP, ClarkeGN, LewinsohnPM, SeeleyJR, KaufmanNK. Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression. J Am Acad Child Adolesc Psychiatry, 40:795–802. 2001.
39.
RohdeP, LewinsohnPM, SeeleyJR. Are adolescents changed by an episode of major depression?J Am Acad Child Adolesc Psychiatry, 33:1289–1298. 1994.
40.
RohdeP, LewinsohnPM, SeeleyJR. Comorbidity of unipolar depression: II. Comorbidity with other mental disorders in adolescents and adults. J Abnorm Psychol, 100:214–222. 1991.
41.
RydellAM. Family factors and children's disruptive behaviour: An investigation of links between demographic characteristics, negative life events and symptoms of ODD and ADHD. Soc Psychiatry Psychiatr Epidemiol, 45:233–244. 2010.
42.
SundAM, WichstromL. Insecure attachment as a risk factor for future depressive symptoms in early adolescence. J Am Acad Child Adolesc Psychiatry, 41:1478–1485. 2002.
43.
TietQQ, BirdHR, HovenCW, MooreR, WuP, WicksJ, JensenPS, GoodmanS, CohenP. Relationship between specific adverse life events and psychiatric disorders. J Abnorm Child Psychol, 29:153–164. 2001.
44.
TillmanR, GellerB, NickelsburgMJ, BolhofnerK, CraneyJL, DelBelloMP, WighW. Life events in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls. J Child Adolesc Psychopharmacol, 13:243–251. 2003.
45.
WilliamsonDE, BirmaherB, AndersonBP, al-ShabboutM, RyanND. Stressful life events in depressed adolescents: The role of dependent events during the depressive episode. J Am Acad Child Adolesc Psychiatry, 34:591–598. 1995.
46.
WilliamsonDE, BirmaherB, DahlRE, RyanND. Stressful life events in anxious and depressed children. J Child Adolesc Psychopharmacol, 15:571–580. 2005.
