Objective. The progression to depression in children with attention-deficit/hyperactivity disorder (ADHD) is not clearly understood. To clarify this relationship, we tested the following hypotheses in a population-based study: (1) children with ADHD have a higher risk of developing depression than children without ADHD; (2) the pathway from ADHD to depression is mediated (partly) through anxiety and disruptive behavior disorders; and (3) mediation through anxiety is more prevalent in girls, and mediation through disruptive behavior disorders is more prevalent in boys. Method. From October 2008 to September 2010, the Composite International Diagnostic Interview was used to assess ADHD, major depressive episodes, anxiety disorders, and disruptive behavior disorders in 1,584 participants from the TRacking Adolescents' Individual Lives Survey (TRAILS) cohort. Cox regression was used to model the effects of ADHD, anxiety, and disruptive behaviors on depression. Risk of and pathways to depression were studied in both children with ADHD and children with subthreshold ADHD. Results. Comorbid depression was present in 36% of children with a diagnosis of ADHD, 24% of children with subthreshold ADHD, and 14% of children with no ADHD. Anxiety and disruptive behaviors mediated 32% of depression in ADHD. Pathways through anxiety and disruptive behavior disorders were independent of gender. Disruptive behavior disorder was a stronger mediator than anxiety for both genders (all P < .01). Conclusions. These findings may help forewarn of impending depression and therefore allow opportunities for interventions when comorbid anxiety and/or disruptive behavior disorders are present in a child with ADHD.
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Gene–environment studies on adolescents’ peer contexts are important for understanding the interplay between biological and social antecedents of adolescent psychopathology. To this end, this study examined the roles of serotonin transporter (5-HTTLPR) and preadolescent and early adolescent peer rejection and acceptance, as well as the interaction between genotype and environment as predictors of antisocial behavior. Longitudinal data from TRAILS (TRacking Adolescents’ Individual Lives Survey), a Dutch cohort study into adolescent development that includes peer reports of rejection and acceptance assessed at 11.1 and 13.6 years and self-reported antisocial behavior at 19.1 years was used. The interaction between 5-HTTLPR and preadolescent peer rejection predicted antisocial behavior with arriers of the 5-HTTLPR short–short variant most strongly affected. No main or interaction effects were found for early adolescent rejection or interactions involving peer acceptance. Our results extend the gene–environment interaction literature by focusing on peer relationship experiences.
Both structural (i.e., SES, familial psychopathology, family composition) and dynamic (i.e., parental warmth and rejection) family characteristics have been associated with aggressive and depressive problem development. However, it is unclear to what extent (changes in) dynamic family characteristics have an independent effect on problem development while accounting for stable family characteristics and comorbid problem development. This issue was addressed by studying problem development in a large community sample (N = 2,230; age 10-20) of adolescents using Linear Mixed models. Paternal and maternal warmth and rejection were assessed via the Egna Minnen BetrÃ¤ffande Uppfostran for Children (EMBU-C). Aggressive and depressive problems were assessed via subscales of the Youth/Adult Self-Report. Results showed that dynamic family characteristics independently affected the development of aggressive problems. Moreover, maternal rejection in preadolescence and increases in paternal rejection were associated with aggressive problems, whereas decreases in maternal rejection were associated with decreases in depressive problems over time. Paternal and maternal warmth in preadolescence was associated with fewer depressive problems during adolescence. Moreover, increases in paternal warmth were associated with fewer depressive problems over time. Aggressive problems were a stable predictor of depressive problems over time. Finally, those who increased in depressive problems became more aggressive during adolescence, whereas those who decreased in depressive problems became also less aggressive. Besides the effect of comorbid problems, problem development is to a large extent due to dynamic family characteristics, and in particular to changes in parental rejection, which leaves much room for parenting-based interventions.