Predictors of depressive symptom emergence and recurrence in youth at risk of mood disorders: Findings from the T-RAD study.

BACKGROUND: The prevalence of Major Depressive Disorder (MDD) among adolescents has increased substantially, underscoring the need to identify predictors of onset. We investigated the associations between mood-related factors, resilience factors, and quality-of-life domains and emergence of elevated depressive symptoms in adolescents and young adults at risk for depression. METHODS: Participants enrolled in the RAD arm of the Texas Resilience Against Depression (T-RAD) study (longitudinal, observational) were included in the current analysis. Depressive symptom emergence was defined as the first occurrence of a categorical score of mild, moderate, severe, or very severe depression as reported using the Inventory of Depressive Symptomatology - Self Report (IDS-SR), Quick Inventory of Depressive Symptomatology Clinician Report (QIDS-C), and Patient Health Questionnaire-9 (PHQ-9). Cox proportional hazards models were used to assess associations between clinical assessments and the time to elevated symptom emergence. RESULTS: Among RAD study participants (n = 111), 44.1% (n = 49) reported elevated depressive symptoms in at least one visit in up to 7.7 years of study participation, with average time to symptom emergence of 0.78 years and a mean age at symptom emergence of 19.7 years. Among those who reported elevated depressive symptoms, 69.4% (n = 34) reported additional occurrence of elevated symptoms, with significantly lower baseline psychological quality-of-life scores (p = .02). Baseline anxiety, childhood emotional abuse, poor family connectedness, and low psychological health, were significantly associated with increased risk of experiencing elevated depressive symptoms (p < .05). CONCLUSION: Our preliminary findings highlight family connectedness and psychological well-being as prevention targets among at-risk youth. CLINICAL TRIALS REGISTRATION: The RAD study was registered in ClinicalTrials.gov (NCT03458936).