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One-Year Course and Predictors of Outcome of Adolescent Depression: A Case-Control Study in Finland

Linnea Karlsson, M.D., Ph.D.; Olli Kiviruusu, B.Soc.Sc.; Jouko Miettunen, Ph.D.; Hannele Heilä, M.D., Ph.D.; Matti Holi, M.D., Ph.D.; Titta Ruuttu, M.A.; Virpi Tuisku, M.Soc.Sc.; Mirjami Pelkonen, Ph.D.; and Mauri Marttunen, M.D., Ph.D.

Background: Clinical studies on the outcome of adolescent depression beyond treatment trials are scarce.

Objective: To investigate the impact of characteristics of the depressive episode and current comorbidity on the 1-year outcome of depression.

Method: A sample of 174 consecutive adolescent psychiatric outpatients (aged 13 through 19 years) and 17 school-derived matched controls, all with unipolar depressive disorders at baseline, were reinterviewed for DSM-IV Axis I and Axis II disorders at 12 months. The study was conducted between January 1998 and May 2002.

Results: The outpatients had equal recovery rate and episode duration but shorter time to recurrence than the controls. Among the outpatients, Axis II comorbidity predicted shorter time to recurrence (p = .02). Longer time to recovery was predicted by earlier lifetime age at onset for depression (p = .02), poor psychosocial functioning (p = .003), depressive disorder diagnosis (p <= .05), and longer episode duration by study entry (p = .001), with an interaction between episode duration and depressive disorder diagnosis (p = .04).

Conclusions: Characteristics of depression generally predicted the outcome better than comorbidity. Axis II comorbidity has prognostic value in adolescent depression.


(J Clin Psychiatry 2008;69:844-853. Online Ahead of Print April 8, 2008.)

Received April 19, 2007; accepted Nov. 27, 2007. From the Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki (Drs. Karlsson, Heilä, Holi, Pelkonen, and Marttunen, Mr. Kiviruusu, and Mss. Ruuttu and Tuisku); Department of Psychiatry, Turku University Central Hospital, Turku (Dr. Karlsson); Department of Psychiatry, University of Oulu, Oulu (Dr. Miettunen); The Social Insurance Institution of Finland, Helsinki (Dr. Heilä); Department of Psychiatry, Kellokoski Hospital, Hospital District of University of Helsinki, Helsinki (Dr. Holi); Department of Adolescent Psychiatry, Peijas Hospital, Hospital District of University of Helsinki, Vantaa (Ms. Ruuttu and Drs. Pelkonen and Marttunen); and Department of Psychiatry, University of Kuopio, Kuopio (Dr. Marttunen), Finland.

This study was supported by the Hospital District of the University of Helsinki, the Peijas Hospital, the Yrjö Jahnsson Foundation, the Finnish Medical Foundation, the Foundation of Jalmari and Rauha Ahokas, and the Finnish Academy.

Parts of this article were presented in the Nordic Congress of Psychiatry, August 16-19, 2006, Tampere, Finland, and in the congress of European Child and Adolescent Psychiatry, August 25-29, 2007, Florence, Italy.

Acknowledgments appear at the end of this article.

The authors report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Linnea Karlsson, M.D., Ph.D., Lehmustie 12 b, 20720 Turku, Finland (e-mail: