Depression in childhood and adolescence
is a mood disorder characterized by prolonged unhappiness or irritability, accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, or loss of appetite; low self-regard or 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 dyscontrol instead of the more common sad, empty, or hopeless seen with adults. Children who are under stress, experience loss, or have attention, learning, behavioral, or anxiety disorders are at a higher risk for depression. Childhood depression is often comorbid with mental disorders outside of other mood disorders; most commonly anxiety disorder and conduct disorder. 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. This year, 51 percent 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 young depression sufferers in Western cultures ranges from 1.9% to 3.4% among primary school children and 3.2% to 8.9% among adolescents. 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 until age 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 than men. These risk factors then combine with the typical stresses and challenges of adolescent development to trigger the onset of depression.Suicidal intent
Like their adult counterparts, children and adolescent depression sufferers are at an increased risk of attempting or committing suicide. Suicide is the third leading cause of death among 15-19 year olds. Adolescent males may be at an even higher risk of suicidal behavior if they also present 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, as well as the importance of early diagnosis and treatment by medical staff, to prevent suicide among depressed or at-risk youth.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 prevalences of 19.2% and 13.5% respectively.
Risk factor
In childhood, boys and girls appear to be at equal risk for depressive disorders; during adolescence, however, girls are twice as likely as boys to develop depression. Before adolescence rates of depression are about the same in girls and boys, it is not until between the ages of 11-13 that is begins to change. Young girls around this age, physically, go through more changes than young boys which put that a higher risk for depression and hormonal imbalance. It is known that girls experience menstruation, something that boys do not experience while going through puberty. This is suspected to be a cause for girls have a higher prevalence of depression than boys, with the consensus that hormonal fluctuations may render individual women to be 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 is mostly due to young women's lower levels of positive thinking, need for approval, and self-focusing negative conditions. Frequent exposure to victimization or bullying was related to high risks of depression, ideation and suicide attempts compare 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 and 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 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, intra personal 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 often experience distressing and disabling emotions, there is an increasing incidence of mental illness globally, mainly because of the breakdown in traditional social and family structures. Depression is usually a response to life events such as relationship or 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 make up can also play a role in vulnerability to depression. People who have low self-esteem, who 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.Diagnosis
According to the DSM-IV, children must exhibit either a depressed mood or a loss of interest or 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, which may be displayed by "acting out," behaving recklessly, or often reacting with anger or 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 lack or excessive eating; experiencing aches/pains for no apparent reason that can 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
Among the psychological assessments for identifying whether or not children and adolescents are experiencing depression or depressive symptoms is the Children's Depression Inventory. 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.Correlation between adolescent depression and adulthood obesity
According to research conducted by Laura P. Richardson et al., major depression occurred in 7% of the cohort during early adolescence and 27% during late adolescence. At 26 years of age, 12% of study members were obese. After adjusting for each individual's baseline body mass index, depressed late adolescent girls were at a greater than 2-fold increased risk for obesity in adulthood compared with their non-depressed female peers. A dose-response relationship between the number of episodes of depression during adolescence, and risk for adult obesity was also observed in female subjects. The association was not observed for late adolescent boys or for early adolescent boys or girls.Correlation between child depression and adolescent cardiac risks
According to research by RM Carney et al., any history of child depression influences the occurrence of adolescent cardiac risk factors, even if individuals no longer suffer from depression. They are much more likely to develop heart disease as adults.Distinction from major depressive disorder in adults
While there are many similarities to adult depression, especially in expression of symptoms, there are many differences that create a distinction between the two diagnoses. Research has shown that when a child's age is younger at diagnosis, typically there will be a more noticeable difference in expression of symptoms from the classic signs in adult depression. One major difference between the symptoms exhibited in adults and in children is that children have higher rates of internalization; therefore, symptoms of child depression are more difficult to recognize. One major cause of this difference is that many of the neurobiological effects in the brain of adults with depression are not fully developed until adulthood. Therefore, in a neurological sense, children and adolescents express depression differently.Treatment
Clinicians often divide treatment into three phases: In the acute phase, which usually lasts six to 12 weeks, the goal is to relieve symptoms. In the continuation phase, which can last for several more months, the goal is to maximize improvements. At this stage, clinicians may make adjustments to the dose of a medication. In the maintenance phase, the aim is to prevent relapse. Sometimes the dose of a drug is lowered at this stage, or psychotherapy carries more of the weight. Unique differences in life experience, temperament, and biology make treatment a complex matter; no single treatment is right for everyone. Psychotherapy and medications are commonly used treatment options. In some research, adolescents showed a preference for psychotherapy rather than antidepressant medication for treatment. For adolescents, cognitive behavioral therapy and interpersonal therapy have been empirically supported as effective treatment options. The use of antidepressant medication in children is often seen as a last resort; however, studies have shown that a combination of psychotherapy and medication is the most effective treatment. Pediatric massage therapy may have an immediate effect on a child's emotional state at the time of the massage, but sustained effects on depression have not been identified.Treatment programs have been developed that help reduce the symptoms of depression. These treatments focus on immediate symptom reduction by concentrating on teaching children skills pertaining to primary and secondary control. While much research is still needed to confirm this treatment program's efficacy, one study showed it to be effective in children with mild or moderate depressive symptoms.
Talk therapy
There are a variety of common types of talk therapy. These can assist people to live more fully,helps to improve good feelings and have a better life. Effective psychotherapy for children always includes parent involvement, teaching skills that are practiced at home or at school, and measures of progress that are tracked over time. In many types, men are encouraged to open up more emotionally and communicate their personal distress, while women are encouraged to be assertive of their own strengths. Often psychotherapy teaches coping skills while allowing the teens or children to explore feelings and events in a safe environment.Cognitive therapy
aims to change harmful ways of thinking and reframe negative thoughts in a more positive way. Aims of cognitive therapy include various steps of patient learning. They learn to monitor their negative thoughts, to become aware of the link between their thoughts, the effect their thoughts have on them and their behavior, to become aware of and change the negative, depressive thoughts which affect their health and state of mind CBT-trained therapists work with individuals, families, and groups. The approach can be used to help anyone irrespective of ability, culture, race, gender, or sexual preference. It can be applied with or without concurrent psychopharmacological medication, depending on the severity or nature of each patient's problem. The duration of cognitive-behavioral therapy varies, although it typically is thought of as one of the briefer psychotherapeutic treatments. Especially in research settings, duration of CBT is usually short, between 10 and 20 sessions. In routine clinical practice, duration varies depending on patient comorbidity, defined treatment goals, and the specific conditions of the health care system.Behavioral therapy
helps change harmful ways of acting and gain control over behavior which is causing problems.Interpersonal therapy
Interpersonal therapy helps one learn to relate better with others, express feelings, and develop better social skills. Interpersonal therapy helps the patient identify and cope through reoccurring conflicts within their relationships. Typically, the therapy will focus on one of the four specific problems, grief, social isolation, conflicts about roles and social expectations, or the effect of a major life change.Family therapy
The principles of group dynamics are relevant to family therapists who must not only work with individuals, but with entire family systems. Family counseling can help families understand how a child's individual challenges may affect relations with parents and siblings and vice versa.Therapists strive to understand not just what the group members say, but how these ideas are communicated. Therapists can help families improve the way they relate and thus enhance their own capacity to deal with the content of their problems by focusing on the process of their discussions. Virginia Satir expanded on the concept of how individuals behave and communicate in groups by describing several family roles that can serve to stabilize expected characteristic behavior patterns in a family. For instance, if one child is considered to be a "rebel child", a sibling may take on the role of the "good child" to alleviate some of the stress in the family. This concept of role reciprocity is helpful in understanding family dynamics because the complementary nature of roles makes behaviors more resistant to change.