In the current issue of Archives of General Psychiatry, Joan Luby and her team at Washington University in St. Louis presented the findings of a powerful longitudinal study of depression in early childhood. In this new article, Dr. Luby examined the continuity and stability of early childhood depression. Specifically, her team wanted to explore whether preschool depression was a transient developmental phase or a more chronic condition. Surprisingly, this question has not been fully answered mostly because of the limited knowledge we have about early childhood depression.

The study included 306 preschool children (age 3 to 5) recruited from community sources in the St. Louis area. However, this is not a normative community sample, as the recruitment strategy was designed to recruit children at risk for depression and other psychiatric disorders (for example due to a family history of depression). This is a common and appropriate recruitment technique when the objective of the study is to examine the disease process rather than to provide normative or epidemiological information about the condition.  The participating children and their parents underwent a series assessments upon entry to the study (baseline) and then 12 (wave 1) and 24 (wave 2) months later.

The results

  1. At baseline 25% (N=75) children met diagnostic criteria for major depression disorder, 26% (N=79) met criteria for other psychiatric disorder, and 47% ( N= 146) did not meet criteria for any psychiatric disorder.
  2. At baseline, there was a significant difference in age among the groups, with depressed kids being more likely to be older than the kids in the other psychiatric diagnostic group. There were no gender differences between the depressed kids and the other groups.
  3. At baseline, the depressed kids were more likely to have experienced more traumatic events than the non-depressed kids.
  4. Below you can see the analysis of the longitudinal progression of MDD compared to other disorders.  Looking only at the top section of the draw, compared to kids without any psychiatric disorder at base line, kids with MDD were 11 times more likely to have MDD vs No disorder at follow up. Similarly, kids with MDD were 7 times more likely than kids with no disorder to have MDD vs. Psychiatric disorder at follow up. Finally kids with MDD were not more likely than the no disorder group to have another psychiatric disorder vs. no disorder. A Similar interpretation can be applied to the other two draws.
  5. Preschool depression

  6. The researchers also examined the predictors of depression at follow up. Four factors were significant predictors of MDD at follow up:  having MDD at baseline (increased odds of 264%), having a family history of an affective disorder, having disruptive disorder at baseline, and having family income levels below $20,000.
  7. Below you can also see the trajectory of MDD based on different severity at baseline. Severe MDD appears to follow a chronic trajectory. Those with less severe MDD follow two trajectories: a recovery, and a recovery-relapse trajectory. The authors could not identify any factors that would help us predict the  trajectories (e.g., chronic vs. recover) among kids with MDD.

Trajectories of preschool depression

There are two critical findings presented in this study. One is that MDD in preschool is highly stable and predictive of future MDD, specially when baseline MDD is severe (more than 50% of the kids with initial MDD continued to have MDD at follow up). Thus, it does not appear that MDD in preschool is a developmental transitional phase. Second, MDD appears to be a risk factor uniquely for MDD. That is, unlike more general ‘internalizing symptoms,’ which are predictive of a number of different disorders, the presence of MDD in preschool does not seem to be an indicator of future ‘general’ psychopathology, but instead it is mostly an indicator of future MDD. This suggests that the MDD diagnosis obtained at this age truly reflects a somewhat homogeneous disease process that is in place and is not simply a reflection of a non-specific dysregulation of emotion that could precede a number of conditions.

Luby, J., Si, X., Belden, A., Tandon, M., & Spitznagel, E. (2009). Preschool Depression: Homotypic Continuity and Course Over 24 Months Archives of General Psychiatry, 66 (8), 897-905 DOI: 10.1001/archgenpsychiatry.2009.97

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5 Responses to Depression in preschool – Not a transient developmental phase.

  1. Yoni says:

    Hi there,

    Thanks for the thoughtful post.

    I’m a physician with an exclusively adult population and too far away from med school to remember the answer (assuming I even ever knew it) to this quick question.

    Are the diagnostic criteria for MDD in a 3-5 year old different from that of an adult?

    How do you assess for things like anhedonia, energy, etc. in such young kids?

    • Hi Yoni, thanks for the comment. There is no specific DSM-IV criteria for pediatric depression other than a statement about differences in manifestations of some symptoms (irritability may be present instead of depressed mood). However, much recent research shows that childhood depression can actually look very similar to adult depression with some exceptions One of our papers will be published online soon in the Journal of Clinical Psychiatry (final proofs approved last week). In that paper we examined the symptom presentation across different age groups in a very large sample of children and adolescents with major depressive disorder. Our findings were not consistent with DSM-IV statement that irritability should replace depressed mood, as depressed mood was consistently found across all age groups. However, we did find that the presentation of depression became more neurovegetative as the kids got older. I will review the paper as soon as it’s published. Nestor.

  2. Nancy says:

    I wonder about the possibility of mild head injury in some of these young children. We know now that mild head injury occurs fairly frequently and can have an enduring impact on the brain’s function. Some practitioners are discovering that many ADHD youngsters, when tested with EEG, show the abnormal brainwave patterns associated with head injury. Since depressed kids often come from unhappy families, subtle injury should be considered a possibility. Fortunately, childhood depression, mild head trauma, and ADHD all respond very well to EEG neurofeedback treatment. However, I have difficulty picturing a four-year-old sitting through one neurofeedback session, let alone 20+!

  3. Wow, what a terrific article. I never realized that this was such an epidemic. Thanks for opening my eyes to this, I’d like to do more research about this as well, are there any other sites or publications that you can recommend?

  4. pooja says:


    that was a nice article.i am a student of clinical psychology and was wondering about the clinical assessment of children with depression.what are the possible ways of gathering information and preparation of case study with such children.i especially wanted to know about direct observation methods.


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