Depression is increasing rapidly among children and adolescents and is a communicable mental illness faced by half a billion children. Depression is defined formally in different ways, such as being characterized by persistent sadness, a loss of interest in everything, and a cessation of day-to-day activities. Other definitions of depression include a reduction in functioning in at least two areas, i.e., work and studies, daily activities, or relationships; a high rate of melancholic symptoms, noticeable sadness, irritability, or actions taken for personal satisfaction; and a significant drop in concern. Depression subtly increases among girls rather than boys, and it is most likely spread among children aged 14-17 years during unique months and weekends. Parental and child marital conflict is associated with the development and persistence of childhood anxiety and depression.
Clinical depression is a severe form of depression and the worst-case scenario can lead to death and relapse. Although the study of childhood depression is increasing, children’s depressive conditions are not well addressed, and children are often treated as minor adults. There are multiple differences between childhood depression and depression in adults. The response has evolved to address depressive disorders in children by developing treatments that target specific age groups. Regardless of their age group, many therapists and psychologists believe that treating depression in children is the best way to ensure that the child grows healthily and produces good results. Children who develop a major depressive disorder are likely to develop panic disorder or obsessive-compulsive disorder. Although childhood depression is less commonly addressed, it is a serious matter and should be reconsidered as such.
Signs and Symptoms of Depression in Children
In most cases, the effects of depression go undetected for years, until it is in its severe stages. Given the importance and implications of depression, it is essential to recognize its early signs and symptoms. Contrary to popular belief that children do not experience depression and the psychological turmoil that leads to it, children experience periods of sadness and depression based on their cognition and mental health. In this section, we discuss children suffering from mental issues in the form of depression. Further, we provide a checklist full of symptoms that parents, educators, family members, and healthcare workers may use to detect depression in children.
Children tend to display symptoms of depression clarifying in nature over time. Children with major depressive disorder may have one episode of depression in their lifetime. Moreover, they are likely to have another episode of depression in the future. It is crucial to notice the sadness and emotional disconnect for a considerable period to diagnose clinical depression. However, teachers, parents, caregivers, and healthcare workers may raise a child’s symptom profile, indicating depression, while their doctor or psychologist diagnoses and treats the child. Since the early symptoms of childhood depression tend to be subtle, parents and healthcare experts are likely to dismiss several illnesses as simple problems. For instance, the child not focusing well in school cannot imply that he or she might be experiencing depression. The same rule goes for other typical behavioral changes as well.
Risk Factors and Causes of Depression in Children
Depression in children is a complex disorder that has multiple potential causes, including biological, psychological, and environmental influences. The fact that childhood depression exists as part of a complex neurodevelopmental syndrome, of which the predisposing factors are often biological in nature, results in the need to consider the full range of risk and protective factors when considering the causes of the condition. The focus on genetic contributions and the likelihood of neurobiological changes both reflect this theoretical stance. Psychological factors indicate that children who experience traumatic events are at increased risk compared to other young people. Observations indicate that family support is protective, and parental concern and distress based on the severity of the child’s distress predicted subsequent change.
For decades, family studies have suggested that familial factors play an important role in the aetiology of depression in children and adolescents. Similarly, low socioeconomic status has been found to be a perinatal risk factor, along with family size and overcrowded housing. The experience of neglect and lack of family connectedness has a role as predisposing factors. A recent report acknowledged the extent of exposure of children and spouses to continuing and intensive domestic violence and noted the evidence of long-lasting effects of traumatization. Traumatic events still need to be confirmed as truly predisposing factors, but the influence of family dynamics as moderate predisposing factors has been replicated. It is important to acknowledge that it has not always proven possible to demonstrate that biological factors are of a causal nature. The weight of contribution of biology, psychology, and social factors likely varies from case to case and may, in fact, reflect the interaction between the various life domains and the vulnerability of the individual. This interaction of factors, known as the diathesis-stress paradigm, is now accepted to be equally valuable in the understanding of child disorder. The demonstration of the role of biological variables has strengthened the stance of clinical professionals regarding the fact that they deal with a disorder as opposed to a behavioral anomaly. There is evidence of the value to sufferers and professionals of differentiating ‘depression’ from ‘mental disorder’. We currently lack research that specifically addresses how unique or common the predisposing factors to depression are. This area is fundamental if prevention strategies are to be developed in a stratified fashion.
Impact of Depression on Children’s Development
Depression can have serious consequences for a child’s overall development. Depressive symptoms can interfere with the development of general social and emotional skills that are necessary for sound social functioning in family, school, and peer settings. Chronic depressive symptoms can also interfere with cognitive development and academic performance. The first few years of a child’s life are a particularly important time for the growth of these abilities. Several researchers have suggested that the quality of the earliest interactions between the baby and his parents has significant impacts on the later social and emotional functioning of the school-age child and adolescent. School difficulties can, in turn, lead to increased problem behaviors and peer difficulties. Depression with these associated characteristics has important implications for a child’s development. Untreated depression during childhood is likely to have a negative long-term impact on the child’s functioning and mental health. Longitudinal studies have found that childhood depression often continues into adolescence and adulthood, especially if it is untreated. Prolonged untreated depression in children has been linked with various social and academic outcomes in young adulthood, including academic failure, school dropout, and social isolation. Long-term chronic depression is associated with a range of health problems in adulthood. Additionally, depressed children are at risk for developing chronic health problems. Therefore, prompt intervention is critical because these outcomes are preventable. Finally, research has shown that delays in reaching developmental milestones are predictors of later emotional disorders. This is evidence of a possible bidirectional relationship between depression and developmental functioning. Similarly, low cognitive ability has been found to be a predictor of later depressive disorders. Some researchers have found that executive function problems are specific risk factors for the development of later anxiety disorders in girls. Depressive symptoms may disrupt child development because the onset and offset of developmental delays and milestones correspond with peaks and remissions of symptoms, respectively. Moreover, if a symptom interferes with a developmental task when it first arises, it may cascade throughout development, slowing or blocking developmental patterns. For example, a child who isolates herself from peers in early preschool because of social withdrawal and is not able to make friends may have difficulty learning to trust her peers later in preschool. As such, it is particularly important to identify and treat depressive symptoms in the young child to prevent potential consequences on development. The resilience and well-being of children in the future is, in part, directly due to a depressed parent or caregiver. Therefore, depressed children are also at risk for familial and parenting factors that are transmissive of later problems.
Diagnosis and Treatment of Depression in Children
Diagnosis of depression in children and adolescents involves subjective symptoms, using guidelines to capture what is present and to rule out what is not present and is not relevant. Treating a child who has a severe emotional problem without depression runs the same risk of underdiagnosis as treating a child with severe emotional problems under other conditions. Two sets of guidelines are in use for establishing a diagnosis of a major depressive episode and for determining its severity in children and adolescents. Several other screening tools have been validated in significant studies.
A comprehensive evaluation for a major depressive episode takes place in an interview to elicit the components of a history of symptoms, an interview to determine the presence of symptoms, and rating-intensive interviews to assess severity. Diagnosis of depression must be based on an interview with the child alone, an interview with the child and parent together, and enough direct parent observation to validate what is being said by the child and the interviewer. A comprehensive evaluation by someone with clinical skill in depression can elicit a higher diagnosis rate and come to a more comprehensive approach. Broad-based and evidence-based approaches to the treatment of depression in children include psychotherapy, with cognitive-behavioral therapy perhaps being the best tested, some medications, and probably other alternative treatments. There is little evidence that combining treatment works better than any single treatment. It is generally recommended that a treatment plan which includes psychotherapy and often medications and family therapy is best, and that the approach needs to be individualized based on the child’s personal needs. An approach that involves the family in education and support is also broadly accepted, although doing this by itself in place of more organized treatments does not work well. Parent and educator collaboration is an important aspect of treatment. It is generally agreed that it is important to strengthen the child’s ability to grow and feel better over the time of therapy. Ongoing assessment of the treatment plan, making changes when the child or adolescent is not getting better, is critical to successful treatment.