Depression in Children and Adolescents
In 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.