Outcome of depressive mood disorder among adolescent outpatients in an eight-year follow-up
Open accessAbstract
OBJECTIVES: This study investigated the eight-year course and outcomes of depressive mood disorders and the key outcome predictors among adolescent outpatients. METHODS: Depressive adolescent outpatients (N = 148) in a naturalistic clinical setting were assessed at baseline, six months, 12 months and eight years using diagnostic and self-report instruments. Baseline predictors covered selected sociodemographic, clinical and treatment-related characteristics. The outcomes were time to recovery, recurrence, time spent being ill and longitudinal latent profiles of depressive symptoms. RESULTS: The recovery rate from any depressive mood disorder was 73% at two years, 91% at five years and 94% by the end of the eight-year follow-up. Two thirds (67%) of the subjects presented at least one recurrence and 57% of them were depressed for 25% or more of the follow-up period. At the eight-year follow-up, 36% had a mood disorder, 48% suffered from anxiety and 26% had a personality disorder. Less severe depression at baseline predicted a shorter time to recovery, whereas recurrence was predicted by a younger age. A latent profile with initially moderate-level depressive symptoms but a poor distal outcome was associated with being female and borderline personality disorder. LIMITATIONS: The female preponderance in the sample warrants caution when interpreting sex differences in the findings. CONCLUSIONS: Although the depression outcome for some adolescents making the transition to young adulthood is promising, many of them experience long, even chronic episodes, and recurrences are common. Personality-disorder characteristics appeared to be significant outcome predictors in this adolescent population.
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Young people with both depressive problems and BPD, compared to those without BPD, had up to four times higher likelihood of experiencing recurrent depressive episodes.
“These young people, compared to those without BPD, had up to four times higher likelihood of experiencing recurrent depressive episodes [16].”
From The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial (2024) · cites this paper as [16]
Table 2 reports lower, not fourfold higher, estimated odds of any recurrent episode for adolescents with borderline personality disorder versus those without a personality disorder (OR 0.58; 95% CI 0.20–1.70). Section 3.2 says younger age was the only significant predictor of recurrent episodes. The approximately fourfold odds reported elsewhere in the paper concern severe depressive-symptom profiles, not recurrent episodes. (LLM, conf=0.94)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn a prospective follow-up study of young people receiving CBT for depression, the subgroup of females with both depressive problems and BPD showed poor distal outcomes.
“in a prospective follow-up study of young people receiving cognitive behavioural therapy (CBT) for depression, the subgroup of females with both depressive problems and BPD showed poor distal outcomes.”
From The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial (2024) · cites this paper as [16]
The Methods describe a naturalistic follow-up of adolescent outpatients with depressive mood disorders, and §3.5 reports that female sex and borderline personality disorder each predicted membership in the poor-distal-outcome profile. The paper does not identify this as a subgroup of females with both conditions, and §2.2 records treatment contacts and antidepressant use without establishing that participants received CBT. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBrief psychosocial treatments that are common in primary care seem to be less effective for young people with BPD.
“Brief psychosocial treatments that are common in primary care seem to be less effective for young people with BPD.”
From The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial (2024) · cites this paper as [16]
The Discussion (page unavailable) reports that borderline personality disorder predicted a poorer long-term depressive-symptom profile among adolescent outpatients. It does not assess brief psychosocial treatments in primary care or show that those treatments are less effective for young people with BPD. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAround two-thirds of young people who recover from their first episode of MDD will experience a relapse.
“While most young people recover from their first episode of MDD, around two-thirds will experience a relapse.9”
From A mindfulness-based, cognitive, social, digital relapse-prevention intervention for youth with depression in Australia: study protocol for a randomised controlled trial of Rebound (2024) · cites this paper as [9]
The Discussion reports that 91% recovered within five years and 66.9% had at least one recurrent episode. But the 66.9% figure covers adolescent outpatients with depressive mood disorders, not specifically young people recovering from a first episode of MDD; the study also calls these episodes recurrences rather than relapses. The Results table includes patients with dysthymia and minor depression alongside those with MDD. (LLM, conf=0.88)
Experimental — accuracy not yet measuredYoung people with BPD are up to four times more likely to have recurrent depressive episodes than those without BPD, and about 40-50% disengage from treatment prematurely.
“These young people are up to four times more likely to have recurrent depressive episodes than those without BPD (62). One important reason for this non-response might be the high dropout rate from these treatments, with about 40–50% of young people with BPD disengaging from treatment prematurely, despite their high levels of distress and suffering (63).”
From The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence (2023) · cites this paper as [62]
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“These young people are up to four times more likely to have recurrent depressive episodes than those without BPD (62).”
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“These young people, compared to those without BPD, had up to four times higher likelihood of experiencing recurrent depressive episodes [16].”
Background
- Authors
- Kiviruusu, O., Strandholm, T., Karlsson, L., & Marttunen, M.
- Affiliations
- University of Helsinki (FI)
- Finnish Institute for Health and Welfare (FI)
- Corresponding author
- Kiviruusu, Olli
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 266
- Pages
- 520-527
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W3003674568
- Cited by
- 34
- References
- 43
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 9 · 2023: 6 · 2022: 5 · 2021: 1 · 2020: 3
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- WOS
- Funders
- Academy of Finland
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- adolescent depression, long-term outcomes, recurrence, recovery, chronic depression, borderline personality disorder, anxiety, personality disorders, prognostic factors, sex differences, transition to young adulthood
- MeSH terms
- Adolescent, Adult, Depression, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Outpatients, Recurrence, Mood Disorders, Young Adult
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