Childhood depression is a condition that often affects children of all ages and significantly impairs their function, growth, and development. Although its prevalence is lower than that observed in adults, it still presents a significant disease burden and effect on the quality of life. Usually, those who suffer the condition have varied manifestations of the symptoms of the condition and careful and focuses evaluation of behavior and activity is essential in establishing the diagnosis. Various risk factors are associated with the incidence of the disease among children, and their conclusive handling is crucial in both management and prevention. The timely and accurate diagnosis of depression facilitates the initiation of appropriate interventions to ensure recovery and minimize the undesirable consequences that result from the psychiatric disorder.
Incidence and
Diagnosis
Depression among children who are yet to reach puberty is less common than in adults. The prevalence rate is estimated at 2% with a slight difference in the rates for boys and girls. However, the incidence rates increase gradually as the children approach teenage with those for the girls rising at a faster pace such that by the mid-teen years, the prevalence would have doubled to about four percent and the girls have a considerably higher rate than boys of the same age (Maughan et al., 2012). The criteria for the diagnosis of depression in children is similar to that of adults. According to the DSM-IV, diagnosis is dependent upon the fulfillment of the criteria of possessing at least one of the primary characteristics of either depressed mood or anhedonia, referring to the lack of interest in pleasurable activities. The presence of a depressed mood among children is demonstrated by behaviors such as acting out, being easily irritable, reckless behavior as well as hostility and anger. Very young children who may be yet to develop lingual capability may also have depressed mood which manifests mainly in the facial expressions of poor eye-contact as well as sadness and frowning. Additionally, anhedonia may be observable in activities such peer interactions and leisure activities like school games and other co-curricular activities. In addition to the two primary symptoms, the child should demonstrate four other symptoms of depression for a definitive diagnosis.
Risk Factors
One of the major risk factors for childhood depression is a positive family history. The factor is just as significant in children as it is among adults and adolescents, making it the most significant risk factor across all the ages. Accordingly, children whose parents have a history of depression are three-four times more likely to develop depression as compared to children whose parents have no history of depression. Although genetic studies have not yet conclusively established specific genes that facilitate the heredity of depression risk, research provides sufficient evidence to implicate inherited factors in the observed familial effect in the occurrence of depression in children.
In addition to such inherited factors, various studies also implicate psychosocial mechanisms in the transmission of depression risk in families. Such studies demonstrate that even in discordant families where there is no biological relationship between the parents and the offspring, the children still tend to show family-related risk for depression which would, therefore, be attributed to psychosocial factors (Thapar et al., 2012). The main contributor to psychosocial factors of depression is stress among the parents. One particular example is in single-parent families where only one parent is the sole provider and caretaker for the children. The parent usually performs dual roles, a situation that is often a source of stress for both the parent and the child. Due to the often-excessive demand on the parent to provide for both their needs and those of their children, single parents may have to work more frequently and for longer periods than in two-parent families where responsibilities are shared. Consequently, the single parents end up spending less time with their children and the parental role of a care-taker is thus neglected inadvertently. In addition to that, the stressful nature of the parent's life may make them develop unexpected behavioral change as they demonstrate negative emotions such as anger, frustration, and intolerance towards their children. As the children sense the helplessness and stress of their parents, they also experience depressive emotions and a psychological burden that may ultimately lead to the development of overt depression.
Another factor that significantly contributes to the development of childhood depression is exposure to a conflict-laden environment. Such an environment is particularly significant if it is the home environment where the parents engage either frequent quarrels, fights or both in the presence of children. When parents are unable to constructively resolve the disputes they often engage the children as they vent their stress and frustration to them, sometimes even unconsciously. Since there is a physiological vulnerability of the children to issues between their parents, exposure to conflict and violence places a physiological and psychological burden on the children, arousing them emotionally and triggering the emotional and physiologic manifestations that are characteristic of depression.
Consequences of Disease
There are numerous consequences for depression among children. First, the depressed children experience growth and developmental abnormalities as they demonstrate defective weight gain, slow brain development resulting in poor academic performance and other cognitive functions. The most significant is the increased suicidal tendencies and ideations as evidenced by the fact that suicide is one of the leading causes of death among children in teenage. The increased incidence of suicide cases among depressed children is comparable to a similar trend among the adults. Research also shows that childhood depression is a significant risk factor for the development of obesity later in adulthood. The risk is particularly higher for the girls and is proportional to the number of depression episodes experienced during the female’s teenage years. In addition to that, childhood depression also predisposes an individual to the development of cardiac disease. Various studies have shown that the contributory effect of depression as a risk factor for depression remains significant even when depression is not present at the current moment. Children who experience depression, even if mild are at an increased risk for cardiovascular diseases in adulthood regardless of gender (Stikkelbroek et al., 2016).
Management
There are various modalities that are often used in the management of childhood depression. The first form of management is the use of various anti-depressant medications. Different classes of drugs are often used together in combination therapy. The selective serotonin receptor inhibitors include drugs such as Lexapro and Prozac. The use of the drugs results in reduced depression in some children but other children's depression may be refractory to them. Another class of drugs that are used in the treatment of depression are the tricyclic antidepressants. They consist of drugs such as, nortriptyline amitriptyline and desipramine. The drugs from this class are efficacious but are associated with significant adverse effects. Consequently, clinical practice leans towards the use of selective reuptake inhibitors (SSRIs) such as sertraline, fluvoxamine, and fluoxetine instead for better tolerance (De Abreu et al., 2013).
The other treatment modality that is extensively applied in the management of depression among children is cognitive behavioral therapy. The treatment encompasses a professional-guided evaluation of self to recognize both self and environmental distortions which are the ones often responsible for the negative perception of self that is prevalent among depressed children and adolescents. The therapy is not exclusive to just the children. On the contrary, recommendations advocate for the involvement of the parent in the therapy sessions for optimal benefits. The therapy emphasizes three domains for the achievement of comprehensive results. The first is cognitive, under which the patients are guided towards a correction of their negative thinking. The second is behavioral and focuses on promotive health behavior and habits such as being assertive, developing important social skills and exercising prudence in the scheduling of activities. The third domain is physiological and it aims at equipping the patient with useful techniques for relaxing such as mediation and the inducement of pleasant imagery that brings calmness upon an individual in periods of stress and anxiety (De Abreu et al., 2013).
Another very important intervention in the management of childhood depression is the use of family therapy. The measure recognizes the role played by the family not only in the development of the condition but also its impact on the rate and degree of recovery for the patients. First, the involvement of the entire family takes care of other members such as the mothers, who may also suffer depression and whose disease may be having a bearing on the child’s. Familial care also helps to eliminate the home factors such as conflict that may be contributing to the incidence of the disease. Research shows that failure to involve the entire family often results in lower recovery rates, higher cases of recurrence as well as non-compliance to medications and therapeutic instructions. An emerging practice in family therapy is the use of psychoeducational family programs. During such endeavors, the parents are taught about various ways of preventing the incidence of disease, methods of recognizing depression in their children and the measures that they may take to manage the condition when present.
The achievement of the best results in the management of depression requires the adoption of a comprehensive approach. Combination therapy which employs interventional modalities such as cognitive and family therapy in conjunction with pharmacological treatment ensures faster and longer-lasting recovery for the children. Additionally, definitive treatment should be coupled with patient and family education and the initiation of various preventive strategies. Eventually, it is worth noting that prognosis is dependent on the provision of optimal care for the patients to avoid recurrence whose five-year rate can be as high as 70%. The incidence of adult depression is much higher among untreated children than in those who receive treatment in their childhood. Timely and effective treatment is also important to avert the undesirable consequences of relapse and other comorbidities.
Conclusion
In conclusion, it is evident that depression has a significant prevalence rate among the children cutting across all ages from infancy to teenage. The major risk factors include positive family history, exposure to a conflict-prone environment as well as psychosocial factors that arise from disadvantageous social settings. The condition bears various consequences to the children including suicidal tendencies and predisposition to various conditions such as obesity and cardiac disease later in life. Effective management ensures a good prognosis and encompasses the employment of a multi-disciplinary approach consisting of various modalities such as pharmacological treatment, cognitive therapy, and other family interventions.
References
De Abreu, L. C., Lima, N. N., Do Nascimento, V. B., Melo de Carvalho, S., Neto, M. L., Brasil, A. Q., … Reis, A. O. (2013). Childhood depression: A systematic review. Neuropsychiatric Disease and Treatment, 1417. doi:10.2147/ndt. s42402
Maughan, B., Collishaw, S., " Stringaris, A. (2013). Depression in childhood and adolescence. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 22(1), 35–40.
Stikkelbroek, Y., Bodden, D. H., Kleinjan, M., Reijnders, M., " Van Baar, A. L. (2016). Adolescent depression and negative life events, the mediating role of cognitive emotion regulation. PLOS ONE, 11(8), e0161062. doi: 10.1371/journal.pone.0161062
Thapar, A., Collishaw, S., Pine, D. S., " Thapar, A. K. (2012). Depression in adolescence. The Lancet, 379(9820), 1056-1067. doi:10.1016/s0140-6736(11)60871-4
