Depression in childhood and adolescence

, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.
Depression in childhood and adolescence is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or behavioral discontrol instead of the more common sad, empty, or hopeless feelings that are seen with adults. Children who are under stress, experiencing loss or grief, or have other underlying disorders are at a higher risk for depression. Depression in young people is often comorbid with mental disorders outside of other mood disorders, most commonly anxiety disorders, especially social anxiety disorder, and conduct disorder. Highlighting the pivotal role of adolescence and young adulthood, the National Alliance on Mental Illness reports that 75 percent of mental health disorders commence by age 24, emphasizing the urgency of addressing youth mental health challenges. Depression also tends to run in families. In a 2016 Cochrane review, cognitive behavior therapy, third-wave CBT and interpersonal therapy demonstrated small positive benefits in the prevention of depression. Psychologists have developed different treatments to assist children and adolescents suffering from depression, though the legitimacy of the diagnosis of childhood depression as a psychiatric disorder, as well as the efficacy of various methods of assessment and treatment, remains controversial.

Base rates and prevalence

About 8% of children and adolescents suffer from depression. In 2016, 51% of students who visited a counseling center reported having anxiety, followed by depression, relationship concerns and suicidal ideation. Many students reported experiencing multiple conditions at once. Research suggests that the prevalence of children with major depressive disorder in Western cultures ranges from 1.9% to 3.4% among primary school children. Among teenagers, up to 9% meet criteria for depression at a given moment and approximately 20% experience depression sometime during adolescence. Studies have also found that among children diagnosed with a depressive episode, there is a 70% rate of recurrence within five years. Furthermore, 50% of children with depression will have a recurrence at least once during their adulthood. While there is no gender difference in depression rates up in those under 15 after that age the rate among women doubles compared to men. However, in terms of recurrence rates and symptom severity, there is no gender difference. In an attempt to explain these findings, one theory asserts that preadolescent women on average have more risk factors for depression when compared to men. These risk factors then combine with the typical stresses and challenges of adolescent development to trigger the onset of depression. Depression in youth and adolescence is associated with a wide array of outcomes that can come later in life for the affected individual. Some of these outcomes include poor physical and mental health, trouble functioning socially, and suicide.

Suicidal intent

Like their adult counterparts, children and adolescents suffering from depression are at an increased risk of attempting or committing suicide. Suicide is the fourth leading cause of death among 15- to 19-year-olds. Adolescent males may be at an even higher risk of suicidal behaviour when also presenting with a conduct disorder. In the 1990s, the National Institute of Mental Health found that up to 7% of adolescents who develop major depressive disorder may commit suicide as young adults. Such statistics demonstrate the importance of interventions by family and friends, the importance of early diagnosis, and treatment by medical staff, in order to prevent suicide amongst youth at-risk. However, some data showed an opposite conclusion. Most depression symptoms are reported more frequently by females; such as sadness and crying. Women have a higher probability to experience depression than men, with the prevalence of 19.2% and 13.5% respectively.

Risk factor

s for adolescent depression include a family history of depression, a personal history of trauma, family conflict, minority sexual orientation, or having a chronic medical illness. There tends to be higher prevalence rates and more severe symptoms in adolescent girls when compared to adolescent boys. These higher rates are also applicable in older adolescents when compared to younger adolescents. This may be due to hormonal fluctuations that may make adolescent women more vulnerable to depression. The fact that increased prevalence of depression correlates with hormonal changes in women, particularly during puberty, suggests that female hormones may be a trigger for depression. The gender gap in depression between adolescent men and women has been linked to young women's lower levels of positive thinking, need for approval, and self-focusing in negative conditions. Frequent exposure to victimization or bullying was related to high risks of depression, ideation and suicide attempts compared to those not involved in bullying. Nicotine dependence is also associated with depression, anxiety, and poor dieting, mostly in young men. Although causal direction has not been established, involvement in any sex or drug use is cause for concern. Children who develop major depression are more likely to have a family history of the disorder than patients with adolescent- or adult-onset depression. Adolescents with depression are also likely to have a family history of depression, though the correlation is not as high as it is for children.

Comorbidity

There is also a substantial comorbidity rate with depression in children with anxiety disorder, conduct disorder, and impaired social functioning. Particularly, there is a high comorbidity rate with anxiety, ranging from 15.9% to 75%. Conduct disorders also have a significant comorbidity with depression in children and adolescents, with a rate of 23% in one longitudinal study. Beyond other clinical disorders, there is also an association between depression in childhood, poor psychosocial and academic outcomes, as well as a higher risk for substance abuse and suicide.
The prevalence of psychiatric comorbidities during adolescence may vary by race and ethnicity.

Social causes

Adolescents are engaged in a search for identity and meaning in their lives. They have also been regarded as a unique group with a wide range of difficulties and problems in their transition to adulthood. Academic pressure, intrapersonal and interpersonal difficulties, death of loved ones, illnesses, and loss of relationships, have shown to be significant stressors in young people. While it is a normal part of development in adolescence to experience distressing and disabling emotions, there is an increasing incidence of mental illness globally. Depression is usually a response to life events such as relationship issues, financial problems, physical illness, bereavement, etc. Some people can become depressed for no obvious reason and their suffering is just as real as those reacting from life events. Psychological makeup can also play a role in vulnerability to depression. People who have low self-esteem, constantly view themselves and the world with pessimism, or are readily overwhelmed by stress, may be especially prone to depression. Community surveys find that women are more likely than men to say they are under stress. Other studies suggest that women are more likely than men to become depressed in response to a stressful event. Women are also more likely to experience certain kinds of severe stress such as child sexual abuse, adult sexual assaults, and domestic violence. Furthermore, depression can be the result of a bad experience, one of which might occur during athletics where social causes transcend into hierarchy practices in the form of bullying, which can root the initial cause.

Diagnosis

According to the DSM-IV, children must exhibit either a depressed mood or a loss of interest/pleasure in normal activities. These activities may include school, extracurricular activities, or peer interactions. Depressive moods in children can be expressed as being unusually irritable. These expressions may be displayed by "acting out," behaving recklessly, or reacting with anger/hostility. Children who do not have the cognitive or language development to properly express mood states can also exhibit their mood through physical complaints such as showing sad facial expressions and poor eye contact. A child must also exhibit four other symptoms in order to be clinically diagnosed. However, according to the Omnigraphics Health References Series: Depression Sourcebook, Third Edition, a more calculated evaluation must be given by a medical or mental health professional such as a physiologist or psychiatrist. Following the bases of symptoms, signs include but are not limited to, an unusual change in sleep habits ; a significant amount of weight gain/loss by the lack or excessive eating; experiencing aches/pains for no apparent reason that can be found; and an inability to concentrate on tasks or activities. If these symptoms are present for a period of two weeks or longer, it is safe to make the assumption that the child, or anybody else for that matter, is falling into major depression.

Assessment

It is recommended by the American Academy of Pediatrics that primary care providers screen children and adolescents for depression with validated screening tools, self-rated, or clinician-administered ones, once per year. However, there is no universally recommended screening tool and the clinician is free to choose from various validated ones based on personal preference. Once the screening tool indicates the potential presence of a depression, a thorough diagnostic assessment is recommended. In early 2016, the USPSTF released an updated recommendation for the screening of adolescents ages 12 to 18 years for major depressive disorder. Appropriate treatment and follow-up should be provided for adolescents who screen positive.