18 June,2019 | 1 year read
Childhood Depression or Depression in children and adolescents is a significant, persistent, and recurrent public health problem that undermines social and school functioning generates severe family stress and prompts significant use of mental health services
Major depression is a common condition that affects approximately 5% of children and adolescents.
Epidemiological studies have consistently demonstrated that females are two to three times more likely than males to develop depression. The female predominance in depression has been observed across many countries and cultures, as well as in cohorts across multiple generations.
Children usually show more symptoms of anxiety and auditory hallucinations also, children may express irritability and frustration with temper tantrums and behavioural problems instead of verbalizing feelings.
Perhaps due to their cognitive immaturity, they have fewer delusions and serious suicidal attempts. Adolescents tend to display more sleep and appetite disturbances, delusions, suicidal ideation, and impairment of functioning than younger children, but more behavioural problems and fewer neuro vegetative symptoms than adults with MDD.
In the absence of treatment, a major depressive episode lasts an average of eight months. Longer depressive episodes occur in patients who have a dysthymic disorder (a milder, but chronic and insidious form of depression) that gradually evolves into major depression. More prolonged episodes are also associated with coexisting psychiatric conditions, parental depression, and parent-child discord.
Suicide attempts and completion are among the most significant and devastating sequelae of MDD. Paralleling the increase in MDD, the adolescent suicide rate has quadrupled since 1950.
The most frequent comorbid diagnoses are dysthymia (the so-called “double depression”) and anxiety disorders (both at 30% to 80%), disruptive disorders (10% to 80%), and substance use disorders (20% to 30%). Comorbid substance abuse, conduct disorder, social phobia, and general anxiety disorder are more common in adolescents, while separation anxiety disorder is more common in children.
Biologic risk factors include possible genetic predisposition (i.e. depression runs in families). Various measures such as poor communication or family conflict, marital discord and divorce and maladaptive parenting reportedly associate with Childhood Depression.
Vulnerability to depression also arises from stressful life events. Previous depression can contribute to the risk of future depressive disorder in young people. Cognitive distortions (i.e. negative view of self, future and/or the world) and errors in thinking are psychological factors affecting depressive disorders.
Studies have shown that Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) are effective for the treatment of depressive disorders in children and adolescent. Pharmacotherapy with SSRI’s has been shown to be effective as well for the treatment of depressive disorders in children and adolescents.
There is reasonable concern about the possibility of increased suicidal behaviour in depressed youth treated with antidepressant medications (Leslie et al. 2005). Therefore, when initiating medication, careful monitoring is advised.
Overall it is seen that though depression is extremely prevalent among the adult population, recent studies are showing that it has become a concern among the younger population of children and adolescence. Simultaneously though risk factors have been identified, the aetiology is not completely clear.
Although there are rating scales available for assessing the severity of depression, studies show an in-depth interview is better able to reveal the symptoms in children. On the therapeutic front, it has been seen psychotherapies such as CBT and Interpersonal Therapy are most effective.
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