Social and sex differences in psychiatric comorbidity and psychosocial functioning among adolescents with depression.

BACKGROUND: To determine social and sex differences in psychosocial functioning and psychiatric comorbidity among adolescents with depression. METHODS: A cohort-based study in Stockholm, Sweden. Adolescents who turned 13 years during 2001-2007, were followed in registers until they turned 18 in 2005-2011, (n = 169,262). In the current study, those with depression at age 13-17 were included (n = 6,439). RESULTS: Adolescents with parents with low (OR=1.5, CI 1.1-2.2) education were more likely to have low psychosocial functioning. Those with parents with low education and low household income were more likely to have comorbid internalizing (OR=1.3, CI 1.0-1.7/1.3, CI 1.0-1.7) and externalizing disorders (OR=2.5, CI 1.5-4.0/2.4, CI 1.4-4.2). Adolescents with parents born outside the Nordic countries were more likely to have comorbid externalizing disorders (OR=1.6, CI 1.1-2.4). No social differences were evident in relation to family receipt of unemployment benefits. Social differences were found for both girls and boys in relation to psychosocial functioning and comorbidity but the magnitude of social differences in depression with comorbidity was overall larger for boys than girls. LIMITATIONS: The findings of the current study can only be generalized to adolescents that have sought care for and been diagnosed with depression, within a setting similar to this study, e.g. with free access to care. CONCLUSION: Adolescents with depression and with more disadvantaged social circumstances in the childhood run a higher risk of psychiatric comorbidity and low psychosocial functioning, which can indicate a lengthy clinical course and poorer response to treatment. Both boys and girls follow this path but partly in different kinds of psychiatric comorbidity.

Social differences in diagnosed depression among adolescents in a Swedish population based cohort.

BACKGROUND: Population based research regarding social differences in diagnosed depression in adolescence is sparse. In this study unique material containing in-and outpatient data was used to determine if low social position in childhood increases the risk of diagnosed depression in adolescence. To further examine this association, gender differences and interactions were explored. METHODS: The study population was extracted from the Stockholm Youth Cohort (SYC), a register based cohort containing psychiatric care for all young people in Stockholm County and information about social position. For the purpose of this study, all in the SYC who turned 13 years old during 2001-2007, in total 169,262 adolescents, were followed up in 2005-2011 for diagnoses of depression until age 18. Associations were estimated with Cox regression models and presented as Hazard Ratios (HR). RESULTS: The risk of diagnosed depression was higher for adolescents with parents with low education (HR = 1.1, CI = 1.0-1.2) and medium education (HR = 1.1, CI = 1.1-1.2) compared to high as well as for those with lower household income (for example, medium low, HR = 1.2, CI = 1.1-1.3) and for those with parents who received an unemployment benefit (HR = 1.3, CI = 1.2-1.4). No differences were found for those with the lowest household income compared to those with the highest level. Adolescents with parents born outside the Nordic countries had a lower risk of diagnosed depression (HR = 0.7, CI = 0.6-0.7). An interaction effect was found between gender and parental education. CONCLUSIONS: Social differences were found but the magnitude was modest and gender differences small.

Social factors in childhood and risk of depressive symptoms among adolescents--a longitudinal study in Stockholm, Sweden.

BACKGROUND: In Sweden, self-reported depressive symptoms have increased among young people of both genders, but little is known about social differences in the risk of depressive symptoms among adolescents in welfare states, where such differences can be less pronounced. Therefore, the aim was to investigate whether multiple measures of low social status in childhood affect depressive symptoms in adolescence. A secondary aim was to explore potential gender effect modification. METHODS: Participants were recruited in 1998 for a longitudinal study named BROMS. The study population at baseline consisted of 3020 children, 11-12 years-old, from 118 schools in Stockholm County, followed up through adolescence. This study is based on 1880 adolescents answering the follow-up survey in 2004, at age 17-18 (62% of the initial cohort). Parental education, occupation, country of birth, employment status and living arrangements were reported at baseline, by parents and adolescents. Depressive symptoms were self-reported by the adolescents in 2004, using a 12-item inventory. The associations between childhood social status and depressive symptoms in adolescence are presented as Odds Ratios (OR), estimated through logistic regression. Gender interaction with social factors was estimated through Synergy Index (SI). RESULTS: Increased risk of depressive symptoms was found among adolescents whose parents had low education (OR 1.8, CI = 1.1-3.1), were unskilled workers (OR 2.1, CI = 1.2-3.7), intermediate non-manual workers (OR 1.8, CI = 1.0-3.0), or self-employed (OR 2.2, CI = 1.2-3.7), compared to parents with high education and high non-manual work. In addition, adolescents living exclusively with one adult had an increased risk compared to those living with two (OR 2.8, CI = 1.1-7.5), while having foreign-born parents was not associated with depressive symptoms. An interaction effect was seen between gender and social factors, with an increased risk for girls of low-educated parents (SI = 3.4, CI = 1.3-8.9) or living exclusively with one adult (SI = 4.9, CI = 1.4-6.8). CONCLUSIONS: The low social position in childhood may increase the risk of depressive symptoms among adolescents even in countries with small social differences and a highly developed welfare system, such as Sweden. Girls with low educated parents or living exclusively with one adult may be particularly vulnerable. This knowledge is of importance when planning preventive interventions or treatment.