| 1. |
- Alaie, Iman
(författare)
-
Adulthood Outcomes of Child and Adolescent Depression : From Mental Health to Social Functioning
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression is a common mental disorder affecting people across the lifespan, with first onset frequently occurring in the teenage years. The disorder is costly to society and constitutes one of the leading causes of disability in youths and adults worldwide. Research demonstrates that depression in childhood or adolescence is linked to adverse adult consequences, including mental health problems, physical health issues, various social difficulties, and economic hardships. While the specific factors and mechanisms associated with these long-term adversities are not well understood, previous studies point to the relevance of considering the heterogeneity in early-life depression.The overarching aim of this doctoral thesis was to shed more light on long-term outcomes of childhood and adolescent depression across multiple life domains. This work made use of extensive follow-up data gathered in Sweden and USA, as part of two community-based longitudinal cohort studies of depressed and nondepressed youths prospectively followed into adulthood. In the Uppsala Longitudinal Adolescent Depression Study, participants were interviewed around age 16 (n=631) and age 31 (n=409). Using linkage to nationwide population-based registries, participants were followed up around age 40 (n=576). In the Great Smoky Mountains Study, participants were interviewed at repeated occasions in childhood and adolescence (n=1,420), and at further follow-ups in adulthood extending up to age 30 (n=1,336).Findings from this work suggest that childhood/adolescent depression can have long-lasting associations with a broad spectrum of adverse outcomes. First, the risk of adult depression is known to be elevated among those exposed to depression in early life; however, depressed youths experiencing major conflicts with parents may be at an additionally increased risk of subsequent depression recurrence. Second, early-life depression was found to be associated with higher levels of adult psychiatric disorders, and also with worse health, criminal, and social functioning, even when accounting for a multitude of potential confounders. Third, early-life depression was predictive of poor labor market outcomes, especially for those with persistent depression. This link was partially mediated by the course of depression. Fourth, the welfare burden associated with early depression amounted to considerable public expenditures in adulthood, particularly for those with persistent depression or comorbid psychiatric conditions such as anxiety and disruptive behavior disorders.The adverse long-term consequences in the wake of early-life depression underscore the importance of prevention and treatment approaches that are both efficacious and cost-effective. Such targeted efforts may have the potential to avert later ill-health, impairment, and possibly also economic disadvantage.
|
|
| 2. |
- Jonsson, Ulf, 1974-
(författare)
-
Adolescents with Depression Grown up : Education, Intimate Relationships, Mental Health, and Personality
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Unipolar depression, estimated to be the leading contributor to burden of disease in middle- and high-income countries, often has an onset in adolescence. The disorder is associated with substantial role impairment and is highly recurrent. This raises questions about both subsequent mental health and social outcome. In order to shed light on this, a community sample of adolescents with depression and non-depressed peers was followed-up after 15 years. In 1991-93, first-year students in upper secondary school (age 16-17) in the town of Uppsala, Sweden, were screened for depression. Adolescents with positive screening and selected peers with negative screening (n=631 in total) were assessed regarding mental health, social situation, and personality. At around age 31, the participants were followed-up in both national registers (n=609) and personal interviews (n=409). Outcome regarding social factors, mental health, and personality was assessed. At follow-up, the former depressed adolescents had completed higher education to a lesser extent than the former non-depressed adolescents. The females with adolescent depression were also at increased risk of subsequent abortion, divorce, single parenthood, and partner violence. Characteristics associated with depression in adolescence (such as poor school performance and disruptive disorders) seemed to contribute to the poor outcome in the social domain. Regarding adult mental health, long-term depression in adolescence was associated with a particularly poor outcome. Compared to adolescents with shorter episodes of depression, those with long-term depression were more likely to report recurrent depression, suicidal ideation, and a range of other mental disorders in adulthood. Measures of personality traits related to neuroticism (a tendency towards negative emotionality) were elevated during ongoing depression and anxiety disorders, but were normalized with remission. However, repeated depressive episodes seemed to leave the individual more vulnerable to stress. It is now important to assess if early treatment can alter the poor outcome depicted in this thesis. Since social adversity, educational difficulties, and interpersonal problems accompany the depressive disorder from adolescence onward, it should also be investigated if interventions aimed at such contextual factors can prevent recurrence and improve quality of life.
|
|
| 3. |
- Ssegonja, Richard
(författare)
-
Effectiveness and cost-effectiveness of indicated preventive interventions for depression in adolescents : An application of health economics methods
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Unipolar depressive disorders are commonly encountered conditions in clinical practice with about 25% reporting their first episode during adolescence. Longitudinal studies show adolescent depression to be associated with an increased risk of mental illness in adulthood, healthcare usage, poor educational outcomes, unemployment, and dependency on welfare recipiency. Therefore, adolescent depression contributes a high disease burden and impinges a considerable financial strain on society’s limited resources.Several preventive interventions have been developed to prevent adolescent depression. Of these interventions, group-based cognitive behavioural therapy (GB-CBT) indicated preventive interventions for depression are well studied and accepted. However, evaluations of their effectiveness and cost effectiveness have yielded conflicting and incomplete results mainly due to methodological limitations.Therefore, the overarching aim of this thesis was to investigate the effectiveness and cost-effectiveness of GB-CBT indicated preventive interventions for depression in children and adolescents, and estimate the additional healthcare costs and welfare burden in early to mid-adulthood associated with adolescent depression.In study I, GB-CBT indicated preventive interventions for depression in children and adolescents were protective against developing a depressive disorder and also reduced depressive symptoms. The intervention relative effect was noted to decay over time. Study II revealed that adolescent depression was associated with considerable increased healthcare consumption in mid-adulthood compared to the non-depressed peers at a population level. This finding was more pronounced in females with persistent depressive disorder (PDD). Study III showed adolescent depression to be associated with all the forms of social transfer payments (welfare) especially in individuals with PDD and those with early comorbid psychopathologies.Study IV demonstrated that GB-CBT indicated preventive interventions for adolescent depression are not only effective but also have the potential to be cost-effective compared to leaving adolescents with subsyndromal depression unattended.Findings from studies II and III, emphasized the large financial burden to society in terms of additional healthcare costs and welfare expenditure associated with adolescent depression. Whereas, study I and IV bring forward the message that it is possible to change the course of subsyndromal depression by offering GB-CBT indicated preventive interventions to adolescents with subsyndromal depression. Such an initiative was not only cost-effective compared to not intervening, but also largely cost-saving. Therefore, GB-CBT indicated preventive interventions could be used as part of a stepped care program linking into more specialized care services. The results of this thesis will be useful in decision-making concerning the resource allocation related to adoption and implementation of such preventive measures.
|
|
