Incidence and persistence of internalizing disorders from late childhood to young adulthood: An 8-year follow-up analysis of a community-based cohort

Background : Internalizing disorders are common and impairing in youth, often continuing into adulthood. While clinical samples emphasize their persistence, non-clinical cohorts using dimensional approaches reveal diverse trajectories. However, few population-based studies have examined internalizing disorders as categorical outcomes while identifying clinically relevant predictors.

Methods : This study is part of the ongoing community-based Brazilian High-Risk Cohort Study for Mental Conditions, which includes baseline (T0, age 6 to 14 years), 3-year (T1), and 8-year (T2) evaluations (N = 2247). Participants were categorized into four non-overlapping trajectories: incident, persistent, remittent, and no internalizing disorder. Diagnoses were based on DSM-IV criteria, ascertained by clinical psychiatrists using Development and Well-Being Assessment. Baseline predictors included dimensional psychopathology, parental psychiatric disorders, environmental, and sociodemographic variables. Associations between these variables and disorder trajectories were analyzed using logistic regression models.

Results : At T0, n = 309 (13.8 %) participants met criteria for an internalizing disorder, from whom 64.4 % experienced a remittent trajectory, while 35.6 % had a persistent trajectory. Among those without baseline internalizing disorders, 25.8 % developed an incident trajectory at T1 or T2. Maternal internalizing disorders, female sex, and child-reported — rather than parent-reported — emotional symptoms at T0 were associated with both persistent and incident trajectories, whereas childhood maltreatment was associated only with the incidence of internalizing disorders.

Conclusion : Our findings suggest that these clinical factors may indicate risk for both onset and maintenance of such conditions over time, while emphasizing the need to assess children’s and young adolescents’ reports in community clinical care.