ARTICLES
Major Depression and Dysthymia in Children and Adolescents: Discriminant Validity and Differential Consequences in a Community Sample

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ABSTRACT

Objectives

To evaluate evidence, in a community sample, for discriminant validity between major depression (MDD) and dysthymia (Dy) in children and adolescents and to examine differential consequences of the 2 disorders for functioning.

Method

The National Institute of Mental Health (NIMH) Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study consists of probability samples of youths. Data for this study are derived from interviews with 1,285 complete parent-youth pairs aged 9 to 17 years from 4 geographic areas in the United States. Youths with MDD were contrasted with those with Dy and those with both (MDD-Dy) on the NIMH Diagnostic Interview Schedule for Children, Non-Clinician Children's Global Assessment Scale, Columbia Impairment Scale, and the Service Utilization and Risk Factors Module.

Results

Groups with MDD, Dy, or MDD-Dy did not differ on sociodemographic, clinical, or family and life event variables. Youths with combined MDD-Dy were significantly less competent and more impaired than youths with either disorder alone.

Conclusions

The findings do not provide support for the differentiation of MDD and Dy but strongly suggest the importance of addressing the needs of youths who meet criteria for both MDD and Dy because this combination is likely to be both serious and disruptive of normal developmental processes.

Section snippets

Participants

Data from the National Institute of Mental Health (NIMH) Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study (Lahey et al., 1996) were used to address the issues raised in this report. Data were derived from interviews with a total of 1,285 complete parent-youth pairs, approximately 300 each drawn from 4 sites: (1) the cities of Hamden, East Haven, and West Haven, Connecticut; (2) Dekalb, Rockdale, and Henry counties, Georgia; (3) Westchester County, New York; and

RESULTS

Overall, 113 children (9%) met DSM-III-R symptom and duration criteria for a depressive disorder, MDD and/or Dy, within the 6 months prior to the interview. Rates did not vary significantly by site. When impairment criteria were applied (NC-CGAS ≤ 70), the number was reduced to 93 youths (7%). Those 93 youths were classified into 1 of 3 groups: (1) Dy (n = 55, 59%), where full diagnostic criteria were met for Dy but not for MDD; (2) MDD (n = 22, 24%), in which all diagnostic criteria were met

DISCUSSION

This study examined evidence for the discriminant validity of MDD and Dy and compared these disorders with respect to degree of associated functional impairment. Youths with pure forms of MDD or Dy were compared on 4 categories of potential correlates: sociodemographics, clinical course and characteristics, family and life events, and competence/functional impairment. The diagnostic groups were not distinguished on the basis of sociodemographics or on clinical course and characteristics, with

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    Reviewed under and accepted by Michael S. Jellinek, M.D.

    The authors thank Ms. Andrya Crossman for her invaluable help in preparing this manuscript.

    The MECA Program is an epidemiological methodology study performed by 4 independent research teams in collaboration with staff of the Division of Clinical Research, which was reorganized in 1992 with components now in the Division of Epidemiology and Services Research and the Division of Clinical and Treatment Research, of the NIMH, Rockville, MD. The NIMH Principal Collaborators are Darrel A. Regier, M.D., M.P.H., Ben Z. Locke, M.S.P.H., Peter S. Jensen, M.D., William E. Narrow, M.D., M.P.H, Donald S. Rae, M.A., John E. Richters, Ph.D., Karen H. Bourdon, M.A., and Margaret T. Roper, M.S. The NIMH Project Officer was William J. Huber. The Principal Investigators and Coinvestigators from the 4 sites are as follows: Emory University, Atlanta, UO1 MH46725: Mina K. Dulcan, M.D., Benjamin B. Lahey, Ph.D., Donna J. Brogan, Ph.D., Sherryl H. Goodman, Ph.D., and Elaine W. Flagg, Ph.D.; Research Foundation for Mental Hygiene at New York State Psychiatric Institute (Columbia University), New York, UO1 MH46718: Hector R. Bird, M.D., David Shaffer, M.D., Myrna Weissman, Ph.D., Patricia Cohen, Ph.D., Denise Kandel, Ph.D., Christina Hoven, Dr.P.H., Mark Davies, M.P.H., Madelyn S. Gould, Ph.D., and Agnes Whitaker, M.D.; Yale University, New Haven, CT, UO1 MH46717: Mary Schwab-Stone, M.D., Philip J. Leaf, Ph.D., Sarah Horwitz, Ph.D., and Judith H. Lichtman, M.P.H.; University of Puerto Rico, San Juan, UO1 MH46732: Glorisa Canino, Ph.D., Maritza Rubio-Stipec, M.A., Milagros Bravo, Ph.D., Margarita Alegria, Ph.D., Julio Ribera, Ph.D., Sara Huertas, M.D., Michael Woodbury, M.D., and Jose Bauermeister, Ph.D.

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