ІІІ Differing Perspectives on the Concept of Recovery
Long-Term Outcomes of Juvenile-Onset Depression. Is Recovery a Viable Concept?
This chapter addresses major depressive disorder (MDD) in clinically referred children and adolescents and has two goals. One goal is to summarize what is known about recovery from and recurrence of MDD episodes in these juvenile samples, along with information about sociodemographic and clinical predictors of recovery and recurrence. Given compelling evidence that MDD episodes in children (as well as adults) are associated with very high rates of recovery and almost as high rates of recurrence, recovery from the disorder is likely to be an elusive goal. Furthermore, although no single consistent predictor of recovery and recurrence has emerged, the strongest predictors are ones that usually cannot be modified (e.g., aspects of clinical history). In light of these factors, research should be directed toward a better understanding of how initial or subsequent episodes of MDD can be prevented, or, in the case of children, at least delayed. Such a research direction involves a focus on risk factors or risk mechanisms that precede the onset of clinical depression and/or persist subsequent to an episode of depression and serve to sensitize the affected individual to further spells of depression. Thus, the second goal of this chapter is to illustrate one such approach to risk research on juvenile-onset depressive disorders that has focused on the role of mood repair (the ability to attenuate sadness) and associated autonomic nervous system processes as playing key roles in illness course and outcome. It is argued that future research on risk factors for early-onset depression should incorporate both behavioral-psychological and physiological variables because the related systems continuously interact to render youths vulnerable or resistant to stress. By eventually integrating the results of such initiatives, successful ways to prevent or forestall juvenile-onset depression may emerge.