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Depression and suicidal behavior in children and adolescents has been a
controversial topic for decades. In fact, the medical community did not recognize the disorder in youth until the 1970s. Recently, research and clinical writing have focused on
the appropriate diagnosis of children with affective (emotional) disorders, identification of
those at risk for mood difficulties, and investigation of effective interventions.
Depression in children and adolescents must be distinguished from the
"normal" blues and emotional distress that are typical at various ages. The symptom of depressed mood or sadness is not the same as depression as a
disorder. A depressive disorder refers to a pattern of behaviors that are pervasive,
persistent, and disruptive to normal functioning, and typically interfere with social
activities and interests, academic pursuits, family life, and personal satisfaction.
Although difficult to determine accurately, it is estimated that 3 to 10% of children
experience a depressive episode at some time before age 15. At any specific time, the
number or cases of depression in school-aged children is between 2 and 10%. Depression is significantly more common in males
before age 10. By age 16, females have a greater incidence of depression.
Children with a family history of depressive disorders are at greater risk of
experiencing a depressive disorder themselves; they also appear to
develop their first depressive episode earlier than children of non-depressed parents.
Children from chaotic or conflicted families, or children and teens who are substance
abusers, are also at greater risk of depression.
What are the symptoms of depression in children?
The symptoms of depression in children and adolescents are many and varied. Early
literature focused on "masked" depression, in which a child's depressed mood was
evidenced by acting out or angry behavior. While this does occur, particularly in younger
children, many children display sadness or dysphoric (exaggerated) mood similar to adults
who are depressed.
The primary symptoms of depression revolve around sadness, a feeling of
hopelessness, and changes in mood. Key symptoms are:
- Persistent feelings of sadness, hopelessness
- Irritability
- Decreased interest in usual or pleasurable activities
- Social withdrawal
- Changes in appetite
- Changes in sleep
- Fatigue and low energy
- Physical complaints with no apparent causes
- Psychomotor retardation or agitation
- Feelings of worthlessness or guilt
- Impaired thinking or concentration
- Thoughts of death or suicide
Not all children will show all symptoms; most will display different symptoms at
different times in different settings. Although some children may continue to function
reasonably well in structured environments, most youth with significant depression will
display several indications of decreased functioning. The most common are a change in
social activities, decreased academic interest and performance, or a change in appearance.
The possibility that the child is using alcohol or drugs must be considered, particularly in
children over age 12.
There is no specific test, medical or psychological, that will "test for"
depression. The diagnostic evaluation should consist of detailed clinical interviews
with the child and parent(s), as well as additional psychological testing as appropriate.
Depression checklists can be useful screening tools but most can be easily altered by the child to present the image
he or she desires.
Information provided by teachers and peers can be useful corroborating data, particularly
about pre-morbid (before disease) functioning and recent changes. Complete psychological
and/or psychiatric assessment is typically recommended to assess for other conditions, to
determine suicide risk, and to offer treatment recommendations.
Suicide
Adolescent suicide is the second leading cause of death among youth and
young adults in the United States. While girls attempt suicide nine times more often than boys, boys
are nearly five times as likely to complete suicide. Youth with a family
history of violence, alcohol abuse, or physical or sexual abuse are at greater risk for
suicide, as are those with major depressive symptoms. Although relatively rare in children
under 12, young children do attempt suicide and may do so impulsively when upset or angry.
Warning signs for suicidal behavior include:
- Significant depressive symptoms (changes in eating, sleeping, activities)
- Social isolation
- Talk of suicide/hopelessness/helplessness
- Increased acting out behaviors (sexual/behavioral)
- Increased risk-taking behaviors
- Frequent accidents
- Substance abuse
- Focus on morbid themes
- Talk about death and dying
- Increased crying, non-emotion, and loss of interest
- Giving away possessions
How is depression in children treated?
Treatment options for depression in children are similar to those for adults
experiencing affective problems and include psychotherapy (counseling) and medication.
Intervention is different, however, in the role that family and environment play in the
treatment process. Although medication is often used in addition to psychotherapy for
children with serious depression, there are no well-controlled studies documenting the
effectiveness of medication over psychotherapy in children. Anecdotal evidence supports
the necessity of psychotherapy, particularly cognitive-behavioral psychotherapy, for all
children with significant depressive behaviors, and the addition of medications for those
with severe or debilitating depression or for those who do not respond to psychotherapy
alone.
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