Depression in Children and Adolescents
prepubertal children, MDD occurs equally among boys and girls (Depression
Guideline Panel, 1993). MDD in childhood is considered to have high recurrence
rates with up to 70% recur-rence in 5 years. After puberty, girls experience an
increased rate of depression as compared with boys. There is increased risk of
depressive disorder in children and adolescence when one or more of the parents
are depressed. The earlier the age of onset of depression, the higher the
familiar loading. In addition, a number of childhood psychosocial risk factors
have been identified to be associated with juvenile-onset MDD. These risk
factors include: more perinatal insults, motor skill abnormalities, instability
in caregivers and psychopathology in the first-degree relatives.
Adolescent-onset depression often takes on a more chronic course associated with dysthymic symptoms. In adolescence, MDD ap-pears to be
associated with greater fatigue, worthlessness and more prominent vegetative
signs while DD has more prominent changes in mood, irritability, anger and
hopelessness. The signs and symptoms used for diagnosis in children and
adolescents are identical to those used for diagnosis in adults. The sequelae
of depression in children and adolescents is often characterized by disruption
in school performance, social withdrawal, increased behavioral disruption and
substance abuse. Differential diagno-sis among children and adolescents with
MDD include behavioral disorders such as conduct disorder, attention deficit
hyperactivity disorder and bipolar disorder.
Later-onset MDD in adolescents is also associated with decline in school
performance, social withdrawal, or disruptive behavior. The critical
differential diagnostic consideration in ad-olescents with MDD is the
misdiagnosis of depression when the clinical presentation will evolve into a
diagnosis of bipolar disor-der. When depression occurs during adolescence, it
often heralds a severe disorder with recurrent course and a family history of
MDD is often noted. An additional psychosocial risk factor in later-onset
depression in adolescence is childhood sexual abuse.
In a community sample of adolescents, ages 14 to 18 years, onset of MDD
was associated with female gender and suicidal ideation. The mean age of onset
for the first episode of MDD was 14.9 years. Episodes of MDD were relatively
longer in adoles-cents who had onset before the age of 15.