Graduation Year


Document Type




Degree Granting Department


Major Professor

Jonathan Rottenberg, Ph.D.

Committee Member

Tiina Ojanen, Ph.D.

Committee Member

Ellis Gesten, Ph.D.


major depression, depression recurrence, early onset MDD, childhood depression, first MDD episode


Early onset depression is associated with high recurrence rates later in life. Recurrent depressive episodes during childhood may be particularly problematic, if additional episodes have a scarring effect that hinders healthy development. Distinguishing between first onsets and recurrences has been useful in understanding adult depression. This distinction has seldom been examined in pediatric depression, in part because it is difficult to enroll adequate samples of children with recurrent depression. We conducted archival analyses of carefully-diagnosed pediatric probands with depression first onset between ages of 4 and 12. Probands who reported one depressive episode (N = 435) were compared with probands who reported two depression episodes (N = 115) on clinical (treatment, comorbidities), psychosocial (negative life events (NLEs), parental psychopathology) and emotion regulation measures. Based on previous findings in older adolescents and adults, we hypothesized that probands with two MDEs will have higher comorbidity, parental psychopathology, more NLEs, and higher maladaptive emotion regulation scale scores than probands with one MDE. Surprisingly, probands with one and two MDEs were indistinguishable on psychological and pharmacological treatment variables. As expected, probands with two MDEs had lower age of first onset, higher maladaptive emotion regulation scores, higher rates of comorbid anxiety and reported more NLEs than probands with one MDE. Probands with two MDEs also spent a longer total time in episode; group differences remained after controlling for time spent depressed. Distinguishing between first onsets and recurrences is meaningful in pediatric depression.