IACAPAP e-Textbook of Child and Adolescent Mental Health.
J. M. Rey (2018)
Chapter E.1
Depression in children and adolescents
Epidemiology
Prevalence varies depending on the population, the period considered, informant, and criteria used for diagnosis. Most countries concur that about 1 to 2% of pre-pubertal children and about 5% of adolescents suffer from clinically significant depression at any one time. The cumulative prevalence (accumulation of new cases in previously unaffected individuals) is higher.
Gender and culture
The ratio of depression in males and females is similar in pre-pubertal children. It becomes about twice as common among females during adolescence.
Burden of illness
Depression poses a substantial burden to the individual suffering from this disorder and the society at large. Interpersonal relationships are particularly likely to suffer when someone is depressed. Depression is likely to progress into a chronic, recurring disease if not treated.
The burden of depression is increased because it appears to be associated with behaviours linked to other chronic diseases, although the nature of this association is unclear.
Age of onset and course
Depressed patients can display symptoms of depression at any age. The pattern varies slightly according to developmental stage.
Age at onset does not seem to define separate depressive subgroups. Earlier onset is associated with multiple indicators of greater illness burden in adulthood across a wide range of domains.
Adolescents often have a reactive affect and can, with effort, hide their symptoms.
Course
Clinical depression in youth follows a recurring course. An episode of depression in clinically referred patients last 7 to 9 months on average, but it can be shorter in non-referred community samples. Depressive episodes are, on average, a spontaneously remitting illness. Recurrence is high even after treatment.
Predictors of recurrence include: poorer response to treatment, greater severity, chronicity, previous episodes, comorbidity, hopelessness, negative cognition style, family problems, low socioeconomic status, and exposure to abuse or family conflict
Subtypes of depression
Different types of depression may have implications for treatment and prognosis.
Etiology and risk factors
The etiology of depression is complex, multifactorial, and the object of much academic argument.
Depression in youth appears to be the result of complex interactions between biological vulnerabilities and environmental influences. Biological vulnerabilities may result from children’s genetic endowment and form prenatal factors. Environmental influences include children’s family relationships, cognitive style, stressful life events, and school and neighbourhood characteristics.
Comorbidity
Comorbidity is the simultaneous occurrence of two or more distinct illnesses in the one individual. Depression comorbid with other disorders frequently in children and adolescents.
Berkson effect: comorbidity is particularly the cause in clinical settings because the likelihood of referral is a function of the combined likelihood of referral for each disorder individually.
Patients with comorbid disorders show greater impairment than those with a single diagnosis. It is also associated with worse adult outcomes.
Psychiatric disorders that often
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