Depression

DESCRIPTION

• General term that includes major depressive disorder (MDD), persistent depressive disorder (previously dysthymia), disruptive mood dysregulation disorder, and premenstrual dysphoric disorder
• Syndrome of persistent sadness or irritability associated with a variety of cognitive and physiologic symptoms, leading to 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)
• Recognizing depression is a critical health care intervention for primary care clinicians.
  • Untreated depression has significant impact on morbidity and mortality.
  • Lifelong depression causes economic, sociologic, and physiologic burdens.
  • Suicide is the second leading cause of death for adolescents.

EPIDEMIOLOGY

• Global prevalence of depression symptoms doubled (to 25.2%) in the first year of the COVID-19 pandemic.
• 12-month prevalence of MDD was increasing prior to the COVID-19 pandemic, from 8.1% of adolescents aged 12 to 17 years in 2009 to 15.8% in 2019.
• 12-month prevalence of MDD is age-dependent (in 2019, 12.2% of aged 12 to 14 years; 19.4% of aged 15 to 17 years).
• Lifetime prevalence for MDD is 19%; point prevalence for elevated depressive symptoms increased to 37% between 2011 and 2020.
• Ratio of females to males: 1:1 in school-age children, 3:1 in adolescents
• Often chronic with high rate of recurrence and comorbidity with other psychiatric disorders
• Less than half of affected individuals receive disorder-specific care.

RISK FACTORS

• Adverse childhood experiences and negative social drivers of health
• Structural racism and historical trauma
• Family history of depression, bipolar disorder, suicidal behavior in 1st-degree relative
• Prior depressive episodes and personal history of anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), learning disabilities, and conduct problems
• Bereavement (i.e., losses including death of a family member or friend; parent divorce; parent deployment; relocation)
• Family dysfunction or caregiver–child conflict
• Negative style of interpreting events and coping with stress
• Substance use (including chronic use of marijuana)
• Exposure to adversity (e.g., child maltreatment, bullying)
• Chronic conditions and disabilities (including acne, obesity)
• Lack of connectedness (including that which results from engaging social media)
• Global crises such as the COVID-19 pandemic and climate change

Many people may have multiple risk factors; however, not everyone with an exposure to adversity or chronic conditions will go on to develop depression (moderators include resilience and response to treatment)

COMMONLY ASSOCIATED CONDITIONS

40–70% of children and adolescents with depression have comorbid psychiatric disorders:

• Anxiety disorders
• Somatization disorders
• Disruptive behavioral disorders (e.g., oppositional defiant and conduct disorders)
• Eating disorders
• Learning problems or disabilities (e.g., ADHD)
• Substance use
• Child maltreatment