Peter M. Lewinsohn

Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III—R disorders in high school students.

Data were collected on the point and lifetime prevalences, 1-year incidence, and comorbidity of depression with other disorders (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) in a randomly selected sample (n = 1,710) of high school students at point of entry and at 1-year follow-up (n = 1,508). The Schedule for Affective Disorders and Schizophrenia for School-Age Children was used to collect diagnostic information; 9.6% met criteria for a current disorder, more than 33% had experienced a disorder over their lifetimes, and 31.7% of the latter had experienced a second disorder. High relapse rates were found for all disorders, especially for unipolar depression (18.4%) and substance use (15.0%). Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.

Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications.

In this article we summarize our current understanding of depression in older (14-18 years old) adolescents based on our program of research (the Oregon Adolescent Depression Project). Specifically, we address the following factors regarding adolescent depression: (a) phenomenology (e.g., occurrence of specific symptoms, gender and age effects, community versus clinic samples); (b) epidemiology (e.g., prevalence, incidence, duration, onset age); (c) comorbidity with other mental and physical disorders; (d) psychosocial characteristics associated with being, becoming, and having been depressed; (e) recommended methods of assessment and screening; and (f) the efficacy of a treatment intervention developed for adolescent depression, the Adolescent Coping With Depression course. We conclude by providing a set of summary statements and recommendations for clinicians.

Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults

The efficacy of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screener for clinical depression was examined in a sample of 1,005 community-residing adults (age range = 50-96). Presence of a depressive disorder was determined by diagnostic interview. Analyses revealed that neither age, gender, cognitive impairment, functional impairment, physical disease, nor social desirability had a significant negative effect on the psychometric properties or screening efficacy of the CES-D. These results indicate that there was no significant degradation in the ability of the CES-D to screen for depression among community-residing elderly adults. This conclusion must be tempered by the fact that the sample did not include participants with the more disabling forms of cognitive or functional impairment and physical illness.

Sex differences and adolescent depression

This study investigates the role of certain psychosocial variables--sex, age, body image/self-esteem, self-consciousness, stressful life events, and the degree to which an individual identifies with the cultural stereotype of masculinity--as correlates and antecedents to depression in adolescents and explores possible intraindividual mediators of the stress-depression relationship in adolescents. A battery of self-report measures was administered to public high school students in Grades 9-12 in their classrooms at two different times 1 month apart. Female adolescents reported more depressive symptoms, self-consciousness, stressful recent events, feminine attributes, and negative body image and self-esteem; no age effects were obtained. Results suggest a model of adolescent depression in which body/self-esteem and stressful recent events are significant contributors.

Cognitive-behavioral treatment for depressed adolescents

The purpose of this study was to test the efficacy of two versions of a cognitive-behavioral intervention for depressed adolescents. Fifty-nine high school students, aged 14–18, meeting DSM-III and RDC criteria for a diagnosis of depression were randomly assigned to one of three conditions: Adolescent-and-Parent, Adolescent-Only, and Wait-List. The treatments were: a) an adaptation of the Coping with Depression Course (CWD), a cognitive-behavioral group intervention teaching skills for increasing pleasant activities, relaxation, controlling depressive thoughts, improving social interaction, and communication, negotation and conflict resolution skills; and b) an intervention for the parents. The results showed that, compared to the wait-list subjects, treated subjects improved significantly on the depression measures. These gains were maintained at two years posttreatment. There was a strong trend for the results to favor the Adolescent-and-Parent condition over the Adolescent-Only condition, but only one of numerous comparisons attained statistical significance.

Adolescent Psychopathology: II. Psychosocial Risk Factors for Depression

In a prospective study of adolescent depression, adolescents (N = 1,508) were assessed at Time 1 and after 1 year (Time 2) on psychosocial variables hypothesized to be associated with depression. Most psychosocial variables were associated with current (n = 45) depression. Formerly depressed adolescents (n = 217) continued to differ from never depressed controls on many of the psychosocial variables. Many of the depression-related measures also acted as risk factors for future depression (« = 112), especially past depression, current other mental disorders, past suicide attempt, internalizing behavior problems, and physical symptoms. Young women were more likely to be, to become, and to have been depressed. Controlling for the psychosocial variables eliminated the gender difference for current and future but not for past depression. This article is one in a series reporting findings from the Oregon Adolescent Depression Project (OADP). The OADP consists of a large, randomly selected cohort of high school students (aged 14-18 years) who were assessed at two time points over a period of 1 year (Time 1 [Ti] and Time 2 [T2]) using rigorous diagnostic criteria and a wide array of psychosocial measures. Previous researchers have presented data regarding the comorbidity of major depressive disorder and dysthymia (Lewinsohn, Rohde, Seeley, & Hops, 1991), the comorbidity of depression with other mental disorders (Rohde, Lewinsohn, & Seeley, 1991), and basic epidemiological characteristics of the sample, including the point and lifetime prevalence, incidence, and relapse of depression and other mental disorders (Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993). In this article we present findings of a study of the psychosocial characteristics associated with current, past, and future episodes of depression during adolescence. Clinical and empirical descriptions of adults in a depressive

Is psychopathology associated with the timing of pubertal development

OBJECTIVE This investigation tested whether the timing of pubertal development was associated with concurrent and prior experiences of psychopathology (symptoms and disorders) in adolescent boys and girls. METHOD A large (N = 1,709) community sample of high school students were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children as adapted for use in epidemiological studies. Adolescents also completed a questionnaire battery covering a range of psychosocial variables. RESULTS Analyses tested whether pubertal timing was associated with present and lifetime history of mental disorders, psychological symptoms, and psychosocial functioning. As hypothesized, early-maturing girls and late-maturing boys showed more evidence of psychopathology than other same-gender adolescents. CONCLUSIONS Early-maturing girls had the poorest current and lifetime history of adjustment problems, indicating that this pattern of pubertal development merits attention by mental health providers and researchers.

Assessment of Depression in Adolescents Using the Center for Epidemiologic Studies Depression Scale

Operating characteristics of the Center for Epidemiologic Studies Depression Scale (CES-D) were examined by using data from 4 samples of students in Grades 9-12. Although it appears that the CES-D scale may be appropriate for use with adolescents, the issues of stability of scores over time, appropriate cutoff scores, and usefulness in detecting cases of clinical depression remain unresolved

Gender differences in anxiety disorders and anxiety symptoms in adolescents

Gender differences in anxiety were examined in a large sample of adolescents that included 1,079 who had never met criteria for any disorder, 95 who had recovered from an anxiety disorder, and 47 who had a current anxiety disorder. Participants were examined on a wide array of psychosocial measures. There was a preponderance of females among current and recovered anxiety disorder cases, but not among those who had never experienced an anxiety disorder. The female preponderance emerges early in life, and retrospective data indicate that at age 6, females are already twice as likely to have experienced an anxiety disorder than are males. Psychosocial variables that were correlated with both anxiety and gender were identified. Statistically controlling for these variables did not eliminate the gender differences in prevalence or anxiety symptom means.

Epidemiology and Natural Course of Eating Disorders in Young Women From Adolescence to Young Adulthood

OBJECTIVES To describe the epidemiology of eating disorders (ED) in a community sample of adolescent girls; to compare the clinical characteristics of full-syndrome (FS) and partial-syndrome (PS) ED cases; and to provide information about the continuity between adolescent ED and young adult psychopathology. METHOD A randomly selected sample of high school girls were assessed during adolescence (n = 891) and a year later (n = 810), and a stratified subset (n = 538) was assessed during their 24th year. The assessments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children, the Longitudinal Interval Follow-up Evaluation, level of functioning, mental health treatment utilization, history of suicide attempt, and physical symptoms. RESULTS The incidence of ED was less than 2.8% by age 18, and 1.3% for ages 19 through 23. Comorbidity with other psychopathology (89.5%), but especially depression, was very high. FS- and PS-ED groups differed significantly from a no-disorder comparison group on most outcome measures, and more than 70% of the adolescent FS- and PS-ED cases met criteria for an Axis I disorder in young adulthood. CONCLUSIONS FS- and PS-ED are associated with substantial comorbidity, treatment seeking, impaired functioning, and risk for psychopathology in young adulthood.