Depression

Description

• General term that includes major depressive disorder (MDD), persistent depressive disorder (dysthymic disorder), depression associated with bipolar disorder, disruptive mood dysregulation 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

• 12-month prevalence of MDD: 7.5% of adolescents (age 13 to 18 years), 3–4% in younger children
• Lifetime prevalence: 11% will have diagnosable depression by adolescence.
• Ratio of females to males: 1:1 in school-aged children, 2:1 in adolescents
• Often chronic with high rate of recurrence and comorbidity with other psychiatric disorders
• <45% of affected individuals receive disorder-specific care.

Risk Factors

• Family history of depression, bipolar disorder, suicidal behavior in 1st-degree relative
• Personal history of anxiety disorders, ADHD, learning disabilities, and conduct problems
• Prior depressive episodes
• Family dysfunction or caregiver–child conflict
• Negative style of interpreting events and coping with stress
• Substance abuse
• Exposure to adversity (e.g., victim of abuse, bullying)
• Chronic illness (including obesity)
• Not everyone with exposure to adversity or chronic illness will go on to have MDD (some moderators are 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
• ADHD
• Substance abuse
• Physical or sexual abuse