Abstract
Childhood externalizing disorders have been linked to adult affective disorders, although some studies fail to substantiate this finding. Multiple longitudinal cohort studies identifying childhood psychopathology and their association with adult psychiatric illness have been published. To examine the association between childhood externalizing symptoms or disorders and the development of adult depression across cohorts, a meta-analysis was performed. Potential studies were identified using a PubMed search through November 2013. All published, prospective, longitudinal, community-sampled cohort studies of children (≤ 13 years) with externalizing symptoms or disorders (aggression, conduct problems, oppositional defiant disorder, conduct disorder), reassessed in adulthood (≥ 18 years) for depressive disorders (major depressive disorder, depressive disorder NOS, or dysthymic disorder) were included. A random effects model was used to summarize the pooled effect sizes. Ancillary analyses considered covariates that could account for variance among studies. Ten studies representing eight cohorts of children initially assessed at age 13 or younger (N = 17,712) were included in the meta-analysis. Childhood externalizing behavior was associated with adult depressive disorders (OR = 1.52, 95 % confidence interval = 1.27–1.80, p < 0.0001). Utilizing Orwin’s Fail-safe N approach, 263 studies with a mean odds ratio of 1.0 would have to be added to the analysis before the cumulative effect would become trivial. Externalizing psychopathology in childhood is associated with the development of unipolar depressive disorders in adulthood.
Similar content being viewed by others
References
Althoff, R. R., Verhulst, F. C., Rettew, D. C., Hudziak, J. J., & van der Ende, J. (2010). Adult outcomes of childhood dysregulation: a 14-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 1105–1116.
Angold, A., Costello, E. J., & Erkanli, A. (1999a). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.
Angold, A., Costello, E. J., Farmer, E. M., Burns, B. J., & Erkanli, A. (1999b). Impaired but undiagnosed. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 129–137.
Bank, L., Duncan, T., Patterson, G. R., & Reid, J. (1993). Parent and teacher ratings in the assessment and prediction of antisocial and delinquent behaviors. Journal of Personality, 61, 693–709.
Beardslee, W. R., Gladstone, T. R., & O'Connor, E. E. (2012). Developmental risk of depression: experience matters. Child and Adolescent Psychiatric Clinics of North America, 21, 261–278. vii.
Biederman, J., Petty, C. R., Dolan, C., Hughes, S., Mick, E., Monuteaux, M. C., et al. (2008). The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study. Psychological Medicine, 38, 1027–1036.
Borenstein, M., Hedges, L. V., Higgisn, J. P. T., & Rothestein, H. R. (2009). Introduction to meta-analysis. Chichester: Wiley.
Brotman, M. A., Schmajuk, M., Rich, B. A., Dickstein, D. P., Guyer, A. E., Costello, E. J., et al. (2006). Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biological Psychiatry, 60, 991–997.
Burke, J. D., Loeber, R., Lahey, B. B., & Rathouz, P. J. (2005). Developmental transitions among affective and behavioral disorders in adolescent boys. Journal of Child Psychology and Psychiatry, 46, 1200–1210.
Capaldi, D. M. (1992). Cooccurrence of conduct problems and depressive symptoms in early adolescent boys. A 2-year follow-up at grade-8. Development and Psychopathology, 4, 125–144.
Capaldi, D. M., & Stoolmiller, M. (1999). Co-occurrence of conduct problems and depressive symptoms in early adolescent boys: III. Prediction to young-adult adjustment. Development and Psychopathology, 11, 59–84.
Clark, C., Rodgers, B., Caldwell, T., Power, C., & Stansfeld, S. (2007). Childhood and adulthood psychological ill health as predictors of midlife affective and anxiety disorders: the 1958 British Birth Cohort. Archives of General Psychiatry, 64, 668–678.
Colman, I., Murray, J., Abbott, R. A., Maughan, B., Kuh, D., Croudace, T. J., et al. (2009). Outcomes of conduct problems in adolescence: 40 Year follow-up of national cohort. British Medical Journal, 338, a2981.
Connell, A. M., & Dishion, T. J. (2008). Reducing depression among at-risk early adolescents: three-year effects of a family-centered intervention embedded within schools. Journal of Family Psychology: Journal of the Division of Family Psychology of the American Psychological Association, 22, 574–585.
Connor, D. F., Ford, J. D., Albert, D. B., & Doerfler, L. A. (2007). Conduct disorder subtype and comorbidity. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 19, 161–168.
Copeland, W. E., Shanahan, L., Costello, E. J., & Angold, A. (2009). Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Archives of General Psychiatry, 66, 764–772.
Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844.
DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science: The Official Journal of the Society for Prevention Research, 5, 73–89.
Drabick, D. A. (2009). Can a developmental psychopathology perspective facilitate a paradigm shift toward a mixed categorical-dimensional classification system? Clinical Psychology: A Publication of the Division of Clinical Psychology of the American Psychological Association, 16(1), 41–49.
Drabick, D. A., Gadow, K. D., & Sprafkin, J. (2006). Co-occurrence of conduct disorder and depression in a clinic-based sample of boys with ADHD. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47, 766–774.
Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2007). Recurrence of major depression in adolescence and early adulthood, and later mental health, educational and economic outcomes. British Journal of Psychiatry, 191, 335–342.
Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2013). Childhood self-control and adult outcomes: results from a 30-year longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 52(709–717), e701.
Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, K. (2002). Young adult follow-up of hyperactive children: self-reported psychiatric disorders, comorbidity, and the role of childhood conduct problems and teen CD. Journal of Abnormal Child Psychology, 30, 463–475.
Frick, P. J., & Viding, E. (2009). Antisocial behavior from a developmental psychopathology perspective. Developmental Psychopathology, 21, 1111–1131.
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analysis. British Medical Journal, 327, 557–560.
Hofstra, M. B., van der Ende, J., & Verhulst, F. C. (2002). Child and adolescent problems predict DSM-IV disorders in adulthood: a 14-year follow-up of a Dutch epidemiological sample. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 182–189.
Huesmann, L. R., Dubow, E. F., & Boxer, P. (2009). Continuity of aggression from childhood to early adulthood as a predictor of life outcomes: implications for the adolescent-limited and life-course-persistent models. Aggressive Behavior, 35, 136–149.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 289, 3095–3105.
Loeber, R., & Farrington, D. P. (1994). Problems and solutions in longitudinal and experimental treatment studies of child psychopathology and delinquency. Journal of Consulting and Clinical Psychology, 62, 887–900.
Mason, W. A., Kosterman, R., Hawkins, J. D., Herrenkohl, T. I., Lengua, L. J., & McCauley, E. (2004). Predicting depression, social phobia, and violence in early adulthood from childhood behavior problems. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 307–315.
Moffitt, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychological Review, 100, 674–701.
Moffitt, T. E., & Caspi, A. (2001). Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females. Developmental Psychopathology, 13, 355–375.
Moffitt, T. E., Caspi, A., Harrington, H., & Milne, B. J. (2002). Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years. Developmental Psychopathology, 14, 179–207.
Moffitt, T. E., Harrington, H., Caspi, A., Kim-Cohen, J., Goldberg, D., Gregory, A. M., et al. (2007). Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry, 64, 651–660.
Patterson, G. R., & Capaldi, D. M. (1990). Risk and protective factors in the development of psychopathology. New York: Cambridge University Press.
Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55, 56–64.
Reinherz, H. Z., Giaconia, R. M., Hauf, A. M., Wasserman, M. S., & Silverman, A. B. (1999). Major depression in the transition to adulthood: risks and impairments. Journal of Abnormal Psychology, 108, 500–510.
Reinherz, H. Z., Paradis, A. D., Giaconia, R. M., Stashwick, C. K., & Fitzmaurice, G. (2003). Childhood and adolescent predictors of major depression in the transition to adulthood. The American Journal of Psychiatry, 160, 2141–2147.
Rowe, R., Costello, E. J., Angold, A., Copeland, W. E., & Maughan, B. (2010). Developmental pathways in oppositional defiant disorder and conduct disorder. Journal of Abnormal Psychology, 119, 726–738.
Roza, S. J., Hofstra, M. B., van der Ende, J., & Verhulst, F. C. (2003). Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: a 14-year follow-up during childhood, adolescence, and young adulthood. American Journal of Psychiatry, 160, 2116–2121.
Sourander, A., & Helstela, L. (2005). Childhood predictors of externalizing and internalizing problems in adolescence. A prospective follow-up study from age 8 to 16. European Child and Adolescent Psychiatry, 14, 415–423.
Sourander, A., Jensen, P., Davies, M., Niemela, S., Elonheimo, H., Ristkari, T., et al. (2007). Who is at greatest risk of adverse long-term outcomes? The Finnish From a Boy to a Man study. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1148–1161.
Stormshak, E. A., Fosco, G. M., & Dishion, T. J. (2010). Implementing interventions with families in schools to increase youth school engagement: the family check-up model. School Mental Health, 2, 82–92.
Stringaris, A., & Goodman, R. (2009). Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 404–412.
Stringaris, A., Cohen, P., Pine, D. S., & Leibenluft, E. (2009). Adult outcomes of youth irritability: a 20-year prospective community-based study. American Journal of Psychiatry, 166, 1048–1054.
Stringaris, A., Zavos, H., Leibenluft, E., Maughan, B., & Eley, T. C. (2012). Adolescent irritability: phenotypic associations and genetic links with depressed mood. American Journal of Psychiatry, 169, 47–54.
Woodward, L. J., & Fergusson, D. M. (1999). Childhood peer relationship problems and psychosocial adjustment in late adolescence. Journal of Abnormal Child and Adolescent Psychology, 27, 87–104.
Zoccolillo, M. (1992). Co-occurrence of conduct disorder and its adult outcomes with depressive and anxiety disorders: a review. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 547–556.
Acknowledgments
This research was partially supported by grants from the National Institute of Mental Health (K01MH0737 to DD; Intramural Research Program to EL) and the National Institutes of Drug Abuse (K12 DA000357 for LH’s effort). The authors would like to thank Mr. Michael Tonzi for administrative assistance and Dr. Michael Borenstein for statistical consultation.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary Table 1
(DOCX 22 kb)
Supplementary Table 2
(DOCX 22 kb)
Rights and permissions
About this article
Cite this article
Loth, A.K., Drabick, D.A.G., Leibenluft, E. et al. Do Childhood Externalizing Disorders Predict Adult Depression? A Meta-Analysis. J Abnorm Child Psychol 42, 1103–1113 (2014). https://doi.org/10.1007/s10802-014-9867-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-014-9867-8