Depression

Depression is a topic covered in the Select 5-Minute Pediatrics Topics.

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Basics

Description

  • General term that includes major depressive disorder (MDD), dysthymic disorder, depression associated with bipolar disorder, and adjustment disorder with depressed mood
  • Syndrome of persistent sadness or irritability associated with a variety of symptoms, resulting in functional impairment in the following:
    • Interpersonal (family, friends) relationships
    • Health (somatic complaints, unhealthy habits)
    • Work or school (task completion, grades)
    • Safety (high-risk behaviors including suicide)

Epidemiology

  • Point prevalence: 6–11% of adolescents (age 13–18 years), 3–4% in younger children
  • Lifetime prevalence: up to 20% will have diagnosable depression by adolescence
  • Ratio of females to males: 1:1 in school-aged children, 2–3:1 in adolescents
  • Often chronic with high rate of recurrence
  • Often unrecognized; up to 80% of affected adolescents do not receive appropriate care.

Risk Factors

  • Family history of depression, bipolar disorder, suicidal behavior in 1st-degree relative
  • Prior depressive episodes
  • Personal history of anxiety disorders, ADHD, learning disabilities, and early losses
  • Family dysfunction or caregiver–child conflict
  • Negative style of interpreting events and coping with stress
  • Substance abuse
  • Trauma history (e.g., victim of abuse, bullying)
  • Chronic illness (including obesity)

Commonly Associated Conditions

  • 40–70% of children and adolescents with depression have comorbid psychiatric disorders:
    • Anxiety disorders
    • Somatization disorders
    • Disruptive behavioral disorders (e.g., ADHD, oppositional defiant and conduct disorders)
    • Eating disorders
    • Substance abuse
    • Physical or sexual abuse

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Basics

Description

  • General term that includes major depressive disorder (MDD), dysthymic disorder, depression associated with bipolar disorder, and adjustment disorder with depressed mood
  • Syndrome of persistent sadness or irritability associated with a variety of symptoms, resulting in functional impairment in the following:
    • Interpersonal (family, friends) relationships
    • Health (somatic complaints, unhealthy habits)
    • Work or school (task completion, grades)
    • Safety (high-risk behaviors including suicide)

Epidemiology

  • Point prevalence: 6–11% of adolescents (age 13–18 years), 3–4% in younger children
  • Lifetime prevalence: up to 20% will have diagnosable depression by adolescence
  • Ratio of females to males: 1:1 in school-aged children, 2–3:1 in adolescents
  • Often chronic with high rate of recurrence
  • Often unrecognized; up to 80% of affected adolescents do not receive appropriate care.

Risk Factors

  • Family history of depression, bipolar disorder, suicidal behavior in 1st-degree relative
  • Prior depressive episodes
  • Personal history of anxiety disorders, ADHD, learning disabilities, and early losses
  • Family dysfunction or caregiver–child conflict
  • Negative style of interpreting events and coping with stress
  • Substance abuse
  • Trauma history (e.g., victim of abuse, bullying)
  • Chronic illness (including obesity)

Commonly Associated Conditions

  • 40–70% of children and adolescents with depression have comorbid psychiatric disorders:
    • Anxiety disorders
    • Somatization disorders
    • Disruptive behavioral disorders (e.g., ADHD, oppositional defiant and conduct disorders)
    • Eating disorders
    • Substance abuse
    • Physical or sexual abuse

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