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Phenomenology, Psychosocial Correlates, and Treatment Seeking in Major Depression and Dysthymia of Adolescence

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ABSTRACT

Objective

To compare phenomenology, psychosocial correlates, and treatment seeking in DSM-III-R major depression and dysthymia among adolescents diagnosed as cases in a community-based study.

Method

A self-report questionnaire, including psychosocial data, life events, eating behaviors, depressive symptoms, substance use, pathological behaviors, and family and school functioning was administered to a nonselected sample (N = 3,287, 93.2% of targeted population) of adolescents aged 11 to 20 years from several Haute-Marne communities in France in 1988–1989. Subgroups of subjects (n = 205, 84.7% of eligible subjects) were interviewed with a structured diagnostic schedule, and adolescents with major depression (n = 49), dysthymia (n = 21) and controls (n = 135) were compared.

Results

Nearly 30% of controls had at least one current symptom of depression. Patterns of affective symptoms were similar in major depression and dysthymia, but significant differences emerged in comorbid conditions (more anxiety disorders, suicidal behaviors, and alcohol intoxications associated with major depression) and stressor at onset (more severe in major depression). Experiences of loss during the prior 12 months were associated with both forms of affective disorder, while poor family relationships were specific correlates of dysthymia. In contrast, peer relationships and pathological behaviors did not differ between depressed subjects and controls. Although psychosocial functioning was significantly impaired in both groups of depressed adolescents, treatment seeking was limited to 34.7% for major depressive subjects and 23.8% for dysthymic subjects.

Conclusions

The results provide evidence that major depression and dysthymia in adolescence are equally severe but may have distinct patterns in associated factors. Despite free access to health care, the rate of treatment seeking for mood disorders in France is similar to that reported in U.S. studies.

Section snippets

METHOD

The study followed a two-stage design: a self-report questionnaire was first administered to a large, unselected school population; then, after subjects were designated into subgroups (based on responses to the initial questionnaire), individual clinical interviews were conducted. The entire procedure took place during two academic years (1988–1990).

Sociodemographic Characteristics of Subjects

Respondents were aged 13 to 21 years, and more than 95% had started puberty; 70% lived with both natural parents. There was an overrepresentation of girls (female-male ratio = 4:1) because of sampling design. Table 1 shows sociodemographic characteristics of subjects with lifetime diagnosis of depression or no mood disorder. Eleven subjects (16% of those with mood disorder) had double depression, as defined by Keller and Shapiro (1982); they were included in the major depression group. Fourteen

Methodology and Study Limitations

Prior to discussing results, some limitations of this study should be mentioned. First, the study design did not permit an estimate of the prevalence of affective disorders in adolescents. Individuals who received diagnoses of major depression or dysthymia at stage II appeared to be distributed across all three groups at stage I, because high scores on the Kandel Depressive Mood Inventory identify subjects with current depressive symptoms but do not screen for all current (and a fortiori past)

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  • Cited by (0)

    This study was funded by the French Ministry of Health (Direction Générale de la Santé, 16-87-13). The authors thank all interviewers: Susan Clot, Nathalie Danon, Nicolas Dantchev, Jacques Laget, Brigitte Remy, Yves Simon, and Catherine Zittoun. They also thank Denise Baillot for her help in editing the manuscript.

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