Major depression in the transition to adulthood: risks and impairments.

An ongoing longitudinal community study (N = 375) examined childhood risks and later adult impairments associated with 1-year Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) diagnoses of major depression during the transition to adulthood. Risks from birth to age 9 were reported by mothers, participants, and teachers. Teacher-reported hostility at age 6 predicted later depression. At age 9, self-perceptions of anxiety/depression, unpopularity, familial rejection, and abuse were potent risks. For men, neonatal and childhood health problems predicted later depression. For women, risks included family constellation, parental death, and poor academic achievement at age 9. Men and women who were depressed at age 18, age 21, or both demonstrated extensive psychosocial impairments in early adulthood, including poor overall functioning, interpersonal and behavioral problems, low self-esteem, and suicidality.

The long-term sequelae of child and adolescent abuse: a longitudinal community study.

The purpose of the present study was to examine the relationship between childhood and adolescent physical and sexual abuse before the age of 18 and psychosocial functioning in mid-adolescence (age 15) and early adulthood (age 21) in a representative community sample of young adults. Subjects were 375 participants in an ongoing 17-years longitudinal study. At age 21, nearly 11% reported physical or sexual abuse before age 18. Psychiatric disorders based on DSM-III-R criteria were assessed utilizing the NIMH Diagnostic Interview Schedule, Revised Version (DIS-III-R). Approximately 80% of the abused young adults met DSM-III-R criteria for at least one psychiatric disorder at age 21. Compared to their nonabused counterparts, abused subjects demonstrated significant impairments in functioning both at ages 15 and at 21, including more depressive symptomatology, anxiety, psychiatric disorders, emotional-behavioral problems, suicidal ideation, and suicide attempts. While abused individuals were functioning significantly more poorly overall at ages 15 and 21 than their nonabused peers, gender differences and distinct patterns of impaired functioning emerged. These deficits underscore the need for early intervention and prevention strategies to forestall or minimize the serious consequences of child abuse.

Traumas and posttraumatic stress disorder in a community population of older adolescents.

OBJECTIVE: The prevalence of DSM-III-R traumas and posttraumatic stress disorder (PTSD) and their impact on psychosocial functioning were examined in a community population of older adolescents. METHODS: Subjects were 384 adolescents participating in an ongoing longitudinal study. When subjects were aged 18 years, the NIMH Diagnostic Interview Schedule, Version IIIR, was used to identify lifetime traumatic events and diagnoses of PTSD, major depression, phobias, and substance dependence. Behavioral, emotional, and academic functioning in later adolescence was evaluated through self-report measures and school records. RESULTS: More than two fifths of adolescents experienced at least one DSM-III-R trauma by age 18 years; PTSD developed in 14.5% of these affected youths or 6.3% of the total sample. Youths with PTSD demonstrated widespread impairment at age 18, including more overall behavioral-emotional problems, interpersonal problems, academic failure, suicidal behavior, and health problems, as well as an increased risk for additional disorders. An equally striking finding was that youths who experienced traumas but did not develop PTSD also showed deficits in many of these areas when compared with their peers who had not experienced traumas. CONCLUSIONS: The substantial risk faced by youths in community settings for experiencing traumas and PTSD, along with associated impairments in later adolescence, underscores the need for programs of prompt intervention.

Early psychosocial risks for adolescent suicidal ideation and attempts.

OBJECTIVE: An ongoing, 14-year, longitudinal community study examined psychosocial risks for adolescent suicidal ideation and attempts, as well as the link between earlier suicidal behavior and later functioning. METHOD: Nearly 400 youths were followed between the ages of 5 and 18 years. Suicidal ideation was assessed at age 15 and lifetime suicide attempts were determined at age 18. Risk factors covered developmental periods from birth to age 15, and most were measured prospectively using multiple informants. Late-adolescent functioning (at age 18) was based on both self-reports and school records. RESULTS: For both genders, the early onset (by age 14) of psychiatric disorders significantly increased the risk for suicidal ideation at age 15 and suicide attempts by age 18. Early gender-specific risks for suicidal ideation included preschool behaviors that are counter to typical gender norms, such as aggressive behavior in females and dependence in males. Suicidal ideation at age 15 and suicide attempts were both associated with deficits in later adolescence (at age 18) in behavioral and social-emotional functioning. CONCLUSIONS: Suicidal ideation at age 15 was a marker of distress with long-term implications for later functioning. The early gender-specific risk factors for suicidal behavior identified in this study can aid in developing strategies for prevention and early intervention.

Ages of onset of psychiatric disorders in a community population of older adolescents.

OBJECTIVE: Ages of onset of psychiatric disorders, as well as the link between early onset and later psychosocial functioning, were examined in a community population of older adolescents. METHOD: Subjects were 386 adolescents who were participants in an ongoing 14-year longitudinal study. At age 18, lifetime diagnoses and ages of onset of major depression, phobias, post-traumatic stress disorder, and substance disorders were assessed using the NIMH Diagnostic Interview Schedule, Revised Version. Behavioral, emotional, and academic functioning in later adolescence were evaluated through self-report measures and school records. RESULTS: Almost one fourth of the adolescents met criteria for at least one disorder by age 14. Simple phobias emerged earliest (by early childhood), whereas for major depression and substance disorders the peak risk periods for onset were midadolescence. The early onset (by age 14) of disorders was associated with continued impairments in behavioral and emotional functioning in late adolescence (at age 18). Furthermore, the early onset of disorders, compared to later onset (ages 15 through 18), increased the risk for additional co-occurring disorders. CONCLUSIONS: The striking levels of early psychopathology and associated long-term deficits in functioning found in this community population underscore the need for programs of early intervention.

Psychosocial risks for major depression in late adolescence: a longitudinal community study.

OBJECTIVE: An ongoing 14-year longitudinal study examined psychosocial antecedents of major depression in late adolescence in a community population. METHOD: Subjects were 385 adolescents followed between the ages of 5 and 18 years. Early health, familial, behavior, academic, and environmental risks for major depression were identified using data collected at ages 5, 9, 15, and 18 years. At age 18, a lifetime diagnosis of major depression was assessed using the NIMH Diagnostic Interview Schedule (DIS-III-R). RESULTS: For males, neonatal health problems, dependence problems at age 5 years, perceived unpopularity and poorer perceptions of their role in the family at age 9 years, remarriage of a parent, early family discord, and anxiety at age 15 years significantly increased the risk of developing major depression. Females with major depression, compared with nondepressed females, had older parents and came from larger families, and at age 9 years had greater perceived unpopularity and anxiety, lower self-esteem, and poorer perceptions of their role in the family. Depressed females also reported more stressful life events, including death of parent and pregnancy. CONCLUSIONS: Underscoring the importance of early psychosocial factors in the later development of major depression and pointing to specific risks, our findings can aid in developing strategies for prevention and early intervention.

Pulmonary embolism after cardiac surgery.

OBJECTIVES: We examined the incidence of pulmonary embolism after cardiac surgery. BACKGROUND: Because venous thromboembolism is considered to be an uncommon complication after cardiac surgery, its incidence was documented in a consecutive series of 1,033 patients who underwent cardiac surgery over a 5-year period. METHODS: Parallel cohorts of patients in a tertiary referral center were evaluated and the incidence of pulmonary embolism was compared in subgroups of patients undergoing coronary bypass surgery, valve surgery and combined procedures. RESULTS: Pulmonary embolism developed in 33 (3.2%) of the 1,033 cardiac surgical patients, within 2 weeks of a coronary bypass operation in most; it did not develop in any patient who had isolated valve replacement surgery (p < 0.05). The diagnosis of pulmonary embolism was established by pulmonary angiography in 24 patients, ventilation/perfusion lung scan in 3, postmortem examination in 5 and clinical examination in 1 patient. Important risk factors for pulmonary embolism included prolonged postoperative recovery, obesity and hyperlipidemia. The mortality rate was 18.7% in patients with in contrast to 3.3% in those without pulmonary embolism (p < 0.01). CONCLUSIONS: Although pulmonary embolism is rare after isolated valve replacement, it is not an uncommon complication after coronary bypass surgery.

Long-term follow-up of limbs after use of intra-aortic balloon counterpulsation device.

There has been concern for the viability and function of the limb distal to the femoral artery access site after use of the intra-aortic balloon counterpulsation device (IABCD). We have studied the long-term (6 to 50 months) hemodynamic status in the lower limbs of 31 patients who received circulatory support with the IABCD. Since both limbs were classified according to the pressure changes induced by treadmill walking, comparisons with the unoperated leg could be affected. Nine of ten patients with insertion problems had satisfactory results at follow-up. One limb was lost as a result of the use of IABCD. Two patients had required femorofemoral bypass, three required use of the opposite leg because of gross femoral disease, one required thrombectomy, three lost distal pulses, and one developed groin phlebitis. All these patients (except the one requiring amputation) had satisfactory hemodynamics at follow-up. Of the 21 patients with no insertion problems, all had satisfactory hemodynamics at follow-up, and 16 of the 21 were normal. Three patients had better hemodynamic data in the balloon-access limb than in the contralateral limb at follow-up, suggesting that the surgery may have been salutary. We conclude that placement of the IABCD via the common femoral artery does not alter the long-term function of the ipsilateral limb if perioperative problems are avoided or handled appropriately.