Childhood Mental Health: Depression

Description

Depressive disorders, which include major depressive disorder (unipolar depression), dysthymic disorder (chronic, mild depression), and bipolar disorder (manic-depression), can have far reaching effects on the functioning and adjustment of young people. Among both children and adolescents, depressive disorders produce an increased risk for illness and interpersonal and psychosocial difficulties, that persist long after the depressive episode is resolved; in adolescents there is also an increased risk for substance abuse and suicidal behaviour.
A number of studies have reported that up to 2.5% of children and up to 8.3% of adolescents in the U.S. suffer from depression. In addition, research indicates that depression onset is occurring earlier in life today than in past decades. Depression in young people often co-occurs with other mental disorders, most commonly anxiety , disruptive behaviour, or substance abuse disorders, and with physical illnesses, such as diabetes.
In childhood, boys and girls appear to be at equal risk for depressive disorders; but during adolescence, girls are twice as likely as boys to develop depression.

Click here for a list of risk factors associated with childhood depression.

Symptoms and Signs

The diagnostic criteria and key defining features of major depressive disorder in children and adolescents are the same as they are for adults. However, recognition and diagnosis of the disorder may be more difficult in youth for several reasons. The way symptoms are expressed varies with the developmental stage of the child. In addition, children and young adolescents with depression may have difficulty in properly identifying and describing their internal emotional or mood states.
The symptoms of major depressive disorder are divided into symptoms common to adults, children and adolescents and those associated with depression in children and adolescents.

Symptoms of Major Depressive Disorder Common to Adults, Children, and Adolescents

• Persistent sad or irritable mood
• Loss of interest in activities once enjoyed
• Significant change in appetite or body weight
• Difficulty sleeping or oversleeping
• Psychomotor agitation or retardation
• Loss of energy
• Feelings of worthlessness or inappropriate guilt
• Difficulty concentrating
• Recurrent thoughts of death or suicide

Five or more of these symptoms must persist for 2 or more weeks before a diagnosis of major depression is indicated.

Signs That May Be Associated with Depression in Children and Adolescents

• Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomach-aches or tiredness
• Frequent absences from school or poor performance in school
• Talk of or efforts to run away from home
• Outbursts of shouting, complaining, unexplained irritability, or crying
• Being bored
• Lack of interest in playing with friends
• Alcohol or substance abuse
• Social isolation, poor communication
• Fear of death
• Extreme sensitivity to rejection or failure
• Increased irritability, anger, or hostility
• Reckless behaviour
• Difficulty with relationships

While the recovery rate from a single episode of major depression in children and adolescents is quite high, episodes are likely to recur. In addition, youth with dysthymic disorder are at risk for developing major depression. Prompt identification and treatment of depression can reduce its duration and severity and associated functional impairment.

Diagnosis and Treatment

There are several tools that are useful for screening children and adolescents for possible depression. They include the Children's Depression Inventory (CDI) for ages 7 to 17; and, for adolescents, the Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies Depression (CES-D) Scale. When a youngster screens positive on any of these instruments, a comprehensive diagnostic evaluation by a mental health professional is warranted. The evaluation should include interviews with the youth, parents, and when possible, other informants such as teachers and social services personnel.

Treatment for depressive disorders in children and adolescents often involves short-term psychotherapy (particularly cognitive-behavioral therapy ), antidepressant medication, or a combination of both, as well as targeted interventions involving the home or school environment. The use of medication in children and adolescents, however, has caused controversy, as, until fairly recently, little evidence was available about the safety and efficacy of these drugs in youth.

The information in this page is presented in summarised form and has been taken from the following source(s):
1. National Institute of Mental Health: http://www.nimh.nih.gov