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Childhood Depression

Explore the characteristics, diagnosis, signs, and management of childhood depression, including risk factors for suicide and available treatments. Learn how to recognize and address the challenges children face.

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Childhood Depression

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  1. Childhood Depression

  2. Characteristics • A prolonged unhappy or irritable mood • Change of attitude toward family, friends, life • Marked change in eating and sleeping habits • Develops slowly unless reactive • Lasts from a few weeks to years or permanent • Is associated with suicide.

  3. Mood • Mood disturbance: cannot ‘snap out of it’ • unhappy, tearful • pessimistic, negative • self destructive • hypersensitive, irritable • may look ill, lack ‘bounce’ • writes poetry with morbid themes • may claim being ‘bored’

  4. Cause unknown in most cases Environmental factors (reactive) • war and social instability • death of a loved one • rape, injury, chronic illness • family problems (violence, drug abuse, divorce), dysfunctional family • poor school experience (bullying) Physical / Genetic • Change in the concentration of neurotransmitters. Reduced serotonin, Increased 5-hydroxytryptamine 2 (5-HT2), abnormal noradrenergic activity • Linked to a family history, illness occurs earlier when family history, highest where an identical twin commits suicide Psychological factors: • learning difficulties • excessive sense of responsibility for others • excessive sensitivity, ego vulnerability • low self esteem, poor body image • internal locus of control for -ve outcomes • external locus for +ve outcomes

  5. Diagnosis • May be under-diagnosed in UK • Children sometimes unable to express how they feel • Misdiagnosed as conduct disorder • May be masked by co-existing mental illness

  6. Signs • Low self esteem • worthless, useless, stupid, ugly, running away, hate themsleves • Doesn’t care what happens to him / her • No interest in doing well • Sleep problems (usually sleeping less) • all night TV watching • difficulty in getting up in the morning • Food problems • anorexia • bulimia

  7. School • poor concentration • dropped performance • lost interest • truancy • disruptive • suicide threats Problems with friends • Losing friends • Lonely • Lack of interest in usual activities.

  8. Suicide Management Naïve methods should be taken seriously He may do better next time Serious risk in children and adolescents • 2000 annually in US, increasing • Most in adolescence and young adults • Peak incidence 15 years • Boys > Girls [3:1] (but <girls have depression and suicide attempts [9:1]) Commonest methods: • Females: Overdose, Wrist cutting • Males: Gunshot (US), Hanging

  9. Risk factors (suicide) • drug and alcohol misuse • availability of guns (US) • homosexuality • child abuse • family history • personal crisis • family conflict • life change • mental illness • serious chronic illness

  10. Treatment • Selective serotonin re-uptake inhibitors (SSRIs, Prozac) • Psychotherapy • Active listening • Advice and encouragement • Family therapy • Treatment of co-existing conditions

  11. Treatment • Poorly organised in this country (? better in US) • Stigma of treatment • Effective?? • No fast cure • Cause and pathology not understood • Some drugs may be useful (also dangerous) • Range of treatments indicate lack of effectiveness • Society lacks ‘someone to talk to’ • Stressors that may not seem important to an adult may be significant to a young person

  12. Further reading Brown, H., N. Pearson, et al. (2013). "Physical Activity Interventions and Depression in Children and Adolescents." Sports Medicine43(3): 195-206. Davis, N. M. (2005). "Depression in children and adolescents." Journal of School Nursing (Allen Press Publishing Services Inc.)21(6): 311-317. Greenberg, B. R. (2009). "How to recognize depressive disorders in children and adolescents." JAAPA: Journal of the American Academy of Physician Assistants (Haymarket Media, Inc.)22(3): 38-42. Murphy, K. (2004). "Recognizing depression in children." Nurse Practitioner29(9): 18. PaixÃO, M. J. G. (2013). "Systematic review summary - Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents." Singapore Nursing Journal40(3): 50-52. Pilcher, E. (2008). "Childhood depression in contemporary Australian society." Nuritinga(9): 1-9. Thomas, S. P. (2012). "Preventing Childhood Depression." Issues in Mental Health Nursing33(5): 271-271. van der Veek, S. M. C., R. A. Nobel, et al. (2012). "The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression." Psychology & Health27(11): 1359-1374.

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