Major depressive disorder in adolescents: family psychiatric history predicts severe behavioral disinhibition

BACKGROUND: Major Depressive Disorder (MDD) becomes increasingly prevalent during adolescence and is associated with substantial psychiatric comorbidity and psychosocial impairment. The marked behavioral heterogeneity evident among adolescents with MDD suggests the possibility of distinct subtypes. This study was designed to determine whether family psychiatric histories differ between groups of MDD adolescents defined by the presence or absence of severe behavioral disinhibition. METHODS: Adolescents with MDD (n = 71) completed the Buss-Durkee Hostility Inventory--Adapted, Adolescent Aggressive Incidents Interview (AAII), Measure of Aggression, Violence, and Rage in Children, Diagnostic Interview Schedule for Children, Suicidal Ideation Questionnaire-JR., Suicidal Behavior Inventory, and Reynolds Adolescent Depression Scale. Parents completed the Family Informant Schedule and Criteria, Children's Affective Liability Scale, AAII, and a partial DISC. Behavioral disinhibition (BD) measures were used to assign adolescents to MDD+BD (n = 41) and MDD-BD (n = 30) groups. RESULTS: The MDD+BD group had a higher prevalence of drug use disorders in biological fathers than the MDD-BD group. The MDD+BD group also had higher proportions of paternal second degree relatives with alcohol use disorders, drug use disorders, and psychiatric hospitalizations, and a higher proportion of maternal second degree relatives with antisocial personality disorder. LIMITATIONS: Limitations include reliance on single informants for family psychiatric histories and the failure to distinguish between child- and adolescent-onset depression. CONCLUSIONS: Family psychiatric histories differentiated MDD adolescents grouped by the presence or absence of behavioral disinhibition, suggesting possible etiologic mechanisms. Further research on subtypes or comorbid presentations may assist in the development of targeted treatment strategies.