Incidence of depression in children and adolescents
Upon entering puberty, the incidence of depression is 2 to 3 times higher in girls than in boys.
Depression occurs in preschool children between 0.3 and 1.4%, in preadolescents from 1 to 3%, and is equally present in adolescence in boys and girls. Entering puberty, the frequency is 2 to 3 times higher in girls than in boys, and it occurs in 4 to 8% of young people in adolescence.
Factors associated with the occurrence of depression can be divided into biological, environmental factors and personality characteristics.
Biological factors are genetic inheritance, neurotransmitter dysregulation, the influence of pubertal hormones and others.
Personality characteristics are, for example, a negative cognitive style, a negative view of oneself, the world and the future.
Environmental factors include stressful life events, losses, neglect, abuse.
Criteria for diagnosing depression
When diagnosing depression in children and adolescents, classification systems apply the same criteria as for adults, and the criteria are:
- lowered, depressed mood
- reduced interest and enjoyment of previously enjoyable activities
- changes in body weight and appetite (loss or increase)
- insomnia or excessive sleep
- fatigue or loss of energy
- psychomotor acceleration or deceleration
- reduced ability to concentrate, think
- feelings of worthlessness or guilt and feedback thoughts about suicide, a suicide plan, or a suicide attempt
Symptoms of depression in children and adolescents
Differences in the manifestation of the clinical picture of depression in adults and children and adolescents do exist, so children and adolescents will often have an irritable mood, anger, children will often indicate a feeling of boredom, decreased interest or loss of interest in play and other mental health problems; depressed children do not reach the developmentally expected body weight, they know how to show changes in sleep: early morning awakening or excessive sleep. Increased psychomotor restlessness or slowness with scanty spontaneity is observed; but sometimes, like adults, they report a lack of energy; self-criticism, blaming oneself; present suicidal ideas, plans, and suicide attempts. Due to the difficulty of directing and maintaining attention and the difficulty of concentration, difficulties in the adoption of materials and a decline in academic functioning often occur.
Childhood and symptoms
Depending on the developmental age of the child, the clinical picture of depression manifests itself in different ways.
Children, especially smaller ones, often “talk” about depressive difficulties by projecting them on the somatic plane, so in childhood we talk about the manifestation of depressive difficulties through somatic complaints such as abdominal pain, headache, nausea, complaints of muscle pain and the like.
Depending on the developmental age of the child, the clinical picture of depression manifests itself in different ways. Preschoolers have a sad facial expression, withdraw from play, show difficulty eating, stunted growth compared to peers, and changes in sleep patterns. They often complain of no stomach aches, headaches, have bouts of crying and outbursts of anger. Night and separation fears and nocturnal urination often occur.
Younger school children and pre-adolescents act sad, isolate themselves, have difficulty concentrating, can speak for themselves in negative terms “stupid, I’m not worth it …”, and have learning difficulties, but it is not uncommon for them to be irritable, easily plan and enter interpersonal conflicts.
Symptoms in adolescence
Some depressed adolescents tend to take addictive drugs and show disturbances in terms of behavior.
The clinical picture of adolescent depression is increasingly similar to the clinical picture in adults, but certain specifics are also present. They are more likely to be irritable and more likely to have violent emotional reactions. Sleep problems such as waking disturbances, frequent waking at night or excessive sleep, and appetite are more common, whether it is loss of appetite or overeating. Decreased self-confidence, the experience of worthlessness, hopelessness and suicidal ideas, as well as suicidal plans and attempts, were expressed. Some depressed adolescents tend to take addictive drugs and show disturbances in terms of behavior. Difficulties with concentration are pronounced and interfere with learning difficulties.
Research shows that about half of depressed children / adolescents have another mental disorder. The most common of these are anxiety disorders, substance abuse, behavioral disorders, personality disorders, ADHD (a disorder characterized by restlessness, impulsivity, and difficulty paying attention).
Clinical assessment and interviews with the child and parents are most important for diagnosing depression at this sensitive age.
It is important to recognize and diagnose the symptoms of depression, comorbid disorder and possible suicidal risk in a timely manner. Clinical assessment, interview with the child and parents are the most important for making a diagnosis, and information on the child’s functioning in kindergarten, school, extracurricular activities, and measurement scales are of great importance.
It is important to collect heteroanamnestic data (developmental course as well as deviations), to know the determinants of normal child development and deviant determinants, to know the criteria for diagnosing depression as well as specifics with regard to the child’s developmental age. After the diagnosis, it is recommended to be included in the treatment.
Treatment of depression
When introducing drugs, the child’s age, physiology, psychological characteristics, but also possible side effects are taken into account.
Depression treatment is individual, involving the psychoeducation of the child / adolescent and parents in an understandable way about the symptoms of depression, treatment and prognosis. Treatment begins with the inclusion of the child in psychotherapy (psychodynamically oriented psychotherapy, cognitive-behavioral psychotherapy, family therapy). In children and adolescents with symptoms of mild and moderate depression, treatment is carried out through psychotherapy. In case of severe depressive symptoms, psychopharmaceuticals, antidepressants from the group of selective serotonin reuptake inhibitors (fluoxetine, escitalopram, citalopram, sertraline) are used. When introducing pharmacotherapy, a subspecialist in child and adolescent psychiatry takes into account the child’s developmental age, physiology, as well as the psychological characteristics of the child / adolescent, considers possible side effects, and informs the child / adolescent and parent / guardian.
Picking up, storing and taking the medicine are the sole responsibility of the parents / guardians. In case of suicidal risk, suicidal plans and attempts, a specialist in child and adolescent psychiatry evaluates and indicates hospitalization.
The goal of treatment
Depressive disorder occurs in both children and adolescents, and early recognition of symptoms, timely diagnosis, assessment of comorbidities and suicidal risk, and involvement in treatment are of the utmost importance.
The goal of treatment is to eliminate the symptoms, ensure safety for the child in case of suicidal risk, prevent recurrent depressive episodes, enable the proper functioning of the child in school, family and raise the overall quality of life.
Clinical experience shows that children / adolescents who have support in a family, peer and school environment show better therapeutic progress and a better prognosis, so this is crucial in the optimal approach to a sick young person.