Impact of age at onset on the phenomenology of depression in treatment-seeking adults in the STAR*D trial

Abstract

Background: - Adolescence is characterized by biological, emotional, and behavioral changes. The onset of depression during this vulnerable time may confer specific risks. This study examined whether symptoms of depression were associated with age at onset (AAO), and whether AAO impacted depression symptom networks in adulthood.

Methods: - Data were from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. 3,184 depressed participants were included in analyses. A series of multiple regressions examined whether pretreatment differences in depression item-level symptom severity varied by AAO. Participants were divided into four groups based on AAO; GLASSO networks of depressive symptoms were estimated in each group and tests of differences between networks were performed.

Results: - Earlier AAO was associated with more severe symptom levels, with the exception of sleep-which increased with AAO, and loss of libido, psychomotor disturbance, and appetite-weight disturbance, which were invariant with AAO. In network analyses, the adolescent AAO symptom network significantly differed from the young adult and middle age AAO networks in structure and strength. In contrast, the child AAO network differed from the middle age AAO network in strength only.

Limitations: - Age at onset was recalled retrospectively and may be subject to bias. Future prospective studies should be conducted to address this limitation.

Conclusions: - Adolescence stands out as a time when onset of depression is associated with specific network characteristics. The unique severity of symptoms and network strength and structure caused by onset of depression during adolescence highlights the long-lasting impact of depression on the developing brain.

Trial registration: ClinicalTrials.gov NCT00021528.

Conflict of interest statement

COI

The authors have no conflicts of interest to report.

Copyright © 2019 Elsevier B.V. All rights reserved.

Figures

Figure 1.

Regression slopes for each symptom as a function of age at onset, controlling for current age, length of current episode, number of past episodes, and current quality of life. Standard error regions are shaded in grey. Note that sleep disturbance increases in severity as a function of AAO, whereas nearly all other symptoms decrease in severity as a function of AAO.

Figure 2.

Network Structures of Child (0–15 years), Adolescent (15–22 years), Young Adult (22–36 years), and Middle Age (36–74 years) onset groups (N= 795/group). Networks controlled for variance due to current age, length of current episode, number of past episodes, and quality of life. Green colored lines represent positive partial correlations; thicker lines indicate greater partial correlations. Figures on the left column depict networks where the distance between nodes represents how strongly related the nodes are. Figures on the right column depict networks where the layout is standardized and the distance between nodes is arbitrary. Note the centrality and connectedness of the depressed mood node in adolescent AAO compared with the other age groups (ENG=loss of energy, LIB=loss of libido, DEP=depressed mood, HYP=hypochondriasis, GLT=inappropriate guilt, SUI=thoughts of death or dying, ANH=anhedonia, PMD =psychomotor disturbance, SLP=sleep disturbance, AWD = appetite-weight disturbance, ANX = anxiety).