Childhood depression

The U.S. Agency for Healthcare Research and Quality reports that in 2006 $98.9 billion was spent on the care and treatment of children. The most costly category of illness was mental disorders, affecting about 4.6 million children.

While depression can begin at any age, a substantial proportion of patients have their first episode of Major Depressive Disorder (MDD) during childhood or adolescence. A recent study estimated the prevalence of MDD among adolescents aged 13 to 18 years to be 5.6 percent. As in adults, depression is more common in girls than boys.

Shockingly, as many as 8 percent of youth with adolescent-onset depression are estimated to have completed suicide by young adulthood. Suicide is the third leading cause of death among those aged 15 to 24 years and the sixth leading cause among those aged 5 to 14 years.

MDD is also associated with decreased school performance, poor social functioning, early pregnancy, increased physical illness, and increased risk of substance abuse. Depressed adolescents have more psychiatric and medical hospitalizations than adolescents who are not depressed. Additionally, the cost of medical care (general medical combined with mental health care) is higher for children with depressive disorders than children without mental health diagnoses. Young adults who have adolescent-onset MDD are at increased risk of impairment in work, social interactions, and family functioning.

Onset risk is fairly low until the early teens, at which time it rises steadily. One study of adult primary care patients found that 38 percent of depressed patients' initial onset of MDD was before age 18.

An additional outcome of concern is that MDD may convert to a bipolar disorder, which involves episodes of mania or hypomania. Twenty to thirty percent of clinically referred youth with a diagnosis of MDD will develop a bipolar illness during the subsequent 5 to 10 years. This is a considerably higher rate than that of adults, which is estimated at less than 10 percent.

Researchers have identified several familial and personal factors that appear to increase the risk of depression, such as parental depression, anxiety, stress, and interpersonal conflict. In addition, negative life events and health issues, such as chronic pain, may increase the likelihood of depression. Having a depressed parent, for example, may increase risk due to both genetic predisposition to depression inherited from the parent and the effects of the depressed parent's behavior, who are more likely to be irritable and inconsistent and less warm and interactive than parents who are not depressed. By the age of 18 years, 40 to 67 percent of these youth are estimated to have met criteria for depression at some point during their lives.

Treatment for children and adolescents with depression is even less readily available than for adults. A survey of pediatricians found that only about a quarter of pediatricians believe that treating child and adolescent depression is their responsibility. Further, 86 percent of pediatricians were not confident that they could successfully treat child and adolescent depression with medication, and 90 percent of pediatricians were not confident that they could successfully treat child or adolescent depression with counseling. According to this survey, the main barriers to treating depression in youth for pediatricians are: inadequate time to provide counseling or education (endorsed as a barrier by 68 percent of surveyed pediatricians), inadequate time to collect an adequate history (56 percent), incomplete training to diagnose or counsel (56 percent), and incomplete knowledge of treatment for depression (44 percent).


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