ARTICLES
Recurrence of Major Depressive Disorder in Hospitalized Children and Adolescents

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ABSTRACT

Objective

To evaluate the outcome of a sample of children and adolescents hospitalized with major depressive disorder (MDD) and to assess different duration and severity criteria to define recovery and recurrence.

Method

Fifty-nine of 70 children and adolescents were reevaluated 1 to 5 years later, and the intervening course of depression and other disorders was assessed using the Kiddie-Longitudinal Interval Follow-up Evaluation (K-LIFE).

Results

Ninety-eight percent of subjects had recovered from their index MDD episode within 1 year of their initial evaluation, but 61% had at least one recurrence during the follow-up period. Of those with recurrences, 47.2% had a recurrence within 1 year and 69.4% by 2 years from the offset of the index episode. Changing the criteria for recovery by increasing the length of time required to define recovery resulted in decreases in the number of episodes of recurrence reported.

Conclusion

MDD in children and adolescents is often an episodic disorder. Differences in definitions of recovery and recurrence affect the data reported. Consistent definitions of remission, recovery, relapse, and recurrence are needed. These data suggest that recovery may be defined after two consecutive months without symptoms and that episodes of MDD may be briefer, but more frequent, in children and adolescents than in adults.

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    This work was supported by grants from the NIMH (MH 39188, Dr. Emslie; MH41115, the Mental Health Clinical Research Center), the McArthur Depression Network, Caleb C. and Julia W. Dula Education and Charitable Foundation, Mr. and Mrs. Woody Hunt, Mr. and Mrs. Morton Meyerson, and the Azoulay Family (Dr. Weinberg). The authors acknowledge the administrative support of Kenneth Z. Altshuler, M.D., Stanton Sharp Distinguished Chair, Professor, and Chairman, Department of Psychiatry; statistical consultation from Tom Carmody, Ph.D.; the clinical assistance of the staff of the Child and Adolescent Psychiatry Unit, Children's Medical Center of Dallas; and the secretarial support of Melody Brummett.

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