In Children with Familial Risk for Depression, Subsyndromal Symptoms Predict Risk for Major Depressive Disorder

The children of parents with depression are at increased risk of experiencing depression themselves and often experience the onset of illness earlier than children without a family history of depression. While depression may emerge during childhood or early adolescence in children with high familial risk, pediatric major depressive disorder is often missed and delays in recognition and treatment are common.  

Based on earlier studies suggesting that subsyndromal depressive symptoms in children may predict the subsequent onset of major depressive disorder (MDD), MaiUchida, MD, Director of the MGH Child Depression Program, and colleagues have evaluated the predictive utility of subsyndromal depressive symptomatology in childhood, as measured using the Child Behavior Checklist (CBCL)-Anxiety/Depression subscales, as a means of identifying children at risk for developing MDD.

The current study analyzed existing data from a separate, longitudinal study following the offspring of parents with and without major depression.  In this cohort, patients with a lifetime diagnosis of major depression or panic disorder who had young children were recruited.  A comparison group of parents with no history of mood or anxiety disorder and their children were also recruited.  Baseline assessments of the children, including the Child Behavior Checklist (CBCL)-Anxiety/Depression subscales, took place between the ages of 2 and 6 years and the children were followed for 10 years into adolescence and young adulthood. 

The analysis included data from 219 children of parents with and without depression or anxiety.  Risk for MDD was compared between three groups: 1) children with familial risk for depression who had subsyndromal scores on the CBCL-Anxiety/Depression subscale (N=30), 2) children with familial risk for depression but without subsyndromal scores (N=87), and 3) children with neither familial risk for depression nor subsyndromal scores  (N=89).  The children were assessed at 5 and 10 years of follow-up.

Among children with a familial risk for depression, subsyndromal scores on the CBCL-Anxiety/Depression subscales were at greater risk for developing MDD (odds ratio, OR=6.18) before the 10 year follow-up visit compared to children with no familial risk. Children with a familial risk who did not have subsyndromal symptoms on the CBCL had an intermediate risk for developing MDD (OR=2.74) compared to children with no familial risk. Also notable is the finding that the children with familial risk and subsyndromal symptoms developed MDD at an earlier age than the other groups.  

The CBCL is now used widely in many pediatric offices as part of well-child visits.  While typically used to screen for syndromal mental health problems, this type of screening could be used to identify children at risk for MDD in settings that are not equipped with psychiatric expertise. Those children identified with subsyndromal symptoms could be monitored more closely or may be eligible for interventions that reduce risk for developing syndromal depression.

Uchida M, Hirshfeld-Becker D, DiSalvo M, Rosenbaum J, Henin A, Green A, Biederman J.  Further Evidence that Subsyndromal Manifestations of Depression in Childhood Predict the Subsequent Development of Major Depression: A Replication Study in a 10 Year Longitudinally Assessed Sample.  J Affect Disord. 2021 May 15;287:101-106. 

Mai Uchida, MD is Director of the MGH Child Depression Program and Assistant Professor of Psychiatry at Harvard Medical School. Dr. Uchida is a child, adolescent, and adult psychiatrist and has clinical expertise in the diagnosis and treatment of children with mood disorders, anxiety disorders, and ADHD. Her research career has focused on the characteristics, longitudinal course and treatment of pediatric mood disorders.