What is Childhood Depression?
Feeling hopeless and sad is a normal part of children’s lives. However, the issue get alarming when this feeling starts interfering with their everyday lives. If Children are feeling uninterested on activities that they used to like, also known as anhedonia, they may be diagnosed with childhood depression. The Diagnostic and Statistical Manual of Mental Disorder fifth edition (DSM-5) included some changes to disorders of childhood. According to DSM-5, dysthymic disorder is the feeling of persistently depressed that occurs throughout the day; for two years at least. To diagnose children with depression, the feeling of depressed mood and irritability must last at least one year. DSM-5 renamed childhood depression to persistent depressive disorder (American Psychiatric Association, 2015).
Childhood depression affects around three percent of U.S children. There are many undiagnosed cases of childhood depression in U.S. There are 3.2% of diagnosed childhood depressions of children aged between 3-17 years old (CDC, 2022). Combination of different factors plays a role in the development of depression in children. Girls and boys, in childhood, are at equal risk of getting depression. However, during adolescent, girls are more likely to fall into depression than boys. In 2017, a total of 3.2 million teenage depression cases have been reported. The cases increased by 8% compared to 2007. The total number of cases increased by 59% from 2007 to 2017. It was observed that the growth rate was faster for teenage girls (66%) than for teenage boys (44%) (Ghandour, et al., 2019).
Studies have proved that there are certain factors that may cause and act as risk factors in their lives which could increase the chances of the development of depression. Some of the most recognised risk factors are-
- Smoking
- Stress
- Physical and emotional abuse
- Trauma
- Loss of a parent or closed ones
- Break-up
- Conduct, attention or learning disorders
- Diabetes
- Chronic illness
There are cases where infants develop symptoms of depression at an early age. Genetics and family history are associated with childhood depression. Inconsistent parenting, stresses and negative thoughts are the most effective factors associated with childhood depression. It is also associated with family history of mood disorders. According to a study, when depressed adults were asked to narrate their childhood experiences, almost everyone reported experiencing abuse, neglect, rejection and abusive parents. It was observed that 30-40% of diagnosed depressive children have a biological parent who is mentally ill as well (CASA, 2022).
When children who went through stress, physical or emotional abuse, abuse of parents and injury, develop a long-term symptom and it starts to interfere with their activities and relationships, they may be diagnosed with PTSD; Post-Traumatic Stress Disorder. The common symptoms of PTSD in children are-
- Recurring nightmares
- Reliving the traumatic event
- Intense on-going sadness or fear
- Angry outburst
- Easily startled
- Cognitive dissonance
- Avoiding people or places that are related to the event
- Looking for threats
- Lack of positivity
Children who have been through traumatic events may seem fidgety, restless and have difficulty staying attentive and organized. Studies have reported that 1 to 6 percent of boys and 3 to 15 percent of girls have been diagnosed with PTSD in U.S. U.S child protection services receive around three million cases of PTSD each year. Out of three million cases, 5.5 million are children (ptsd.va.gov, 2022).
Medical examination is the first step towards the diagnosis of childhood depression. This conducted to rule out physical symptom that occurs due to psychological conditions. The psychiatric history is important to take to understand the child’s symptoms. The social and family history should be elicited. Direct interviews with children have proved to be effective. It can occur in many formats, including observation, interactions and open-ended questions.
The Prevalence of Childhood Depression in the US
Treatment options of childhood depressions are similar to the treatment of adult depression. It includes medication and psychotherapy (counselling). Psychotherapy is given priority for the treatment of childhood depression. Healthcare professional consider medications as a second option only if the symptoms are severe and when no improvements are observed with psychotherapy. Interpersonal therapy and Cognitive Behavioral therapy (CBT) have proved to be effective in the treatment of childhood depression. The combination of Medication and CBT proved to be more efficacious than medications alone (Crowe & McKay, 2017).
Same doses of medications cannot be prescribed to children as their neural pathways may have not been fully developed. Also, norepinephrine and serotonin systems have different maturation rates. Tricyclic antidepressants were prescribed to children but studies have observed that this medication showed no improvements in children. Professionals have names citalopram (Celexa), Fluoxetine (Prozac), and Sertraline (Zoloft) as the most beneficial medicine for children with depression. For children older than 12 years, escitalopram (Lexapro) is considered to be most effective. Medicines to children are given with lowest dosage possible and are titrated according to their response. Anti-depressants are not preferred for children as it is associated with increased risk of suicide. There are some adverse effects of the medications such as- nervousness, gastrointestinal effects, headache and restlessness. Psychiatric consultation is required if children do not respond to any of the medications (Olfson, King, & Schoenbaum, 2015).
Children with depression suffer from loneliness and anxiety which could act as a hindrance in treatment. Medications create hormonal dis-balance and nurse interventions are necessary to keep children stable till the end of the treatment. Nurses also teach the patients and their families about the treatment and the potential side-effects to keep the ready and informed. Therefore, psychological nursing care becomes an important of the treatment. Nurses first understand the psychological changes in children and then provide the necessary education to patient and the families. Nurses ameliorate resistance and anxiety and help children establish the correct cognitive outlook. The role of psychiatric nurse is crucial for the treatment of childhood depression. Psychiatric nurses help the medical doctors to develop a suitable treatment plan and utilize their therapeutic skills to help patients and their families learn about variety of options. They offer services, including psychotherapy and diagnosis of disorders (Sun, Cui, Fu, Ma, & Li, 2017).
American Nurse’s Association has designed psychiatric scope and standards. There are six standards of practice which includes- assessment, diagnosis, identification, planning, implementation and evaluation. The purpose of these standards is to guide the nurses to make right diagnosis and create a treatment plan accordingly. Psychiatric Nurses are expected to follow these standards. Furthermore, there are rules that talk about the rights of children with depression. It is a must for physicians to follow medical ethics. Not following would create ethical issues (Silén, Haglund, Hansson, & Ramklint, 2015). For example, if physicians do not follow confidentiality it would be an ethical issue. Healthcare professionals are not allowed to release the information of children to public or discuss about the same with other psychiatrists (Völlm, Bartlett, & McDonald, 2016). If physicians have lack of information regarding childhood depression then it becomes a case of ethical issue. Legal issues in psychiatric care include- psychiatrists in Court, results of insanity pleas and absconding behaviour in children with depression.
Conclusion
In conclusion, childhood depression is not a rare mental illness. The negligence towards changing behaviour of children has increased the number of undiagnosed cases of childhood depression. According to studies, the cases of depression in young girls are twice more than the cases of boys. Parental abuse, environment, stress, genetics and family history are risk factors of childhood depression. Health professional prefer psychotherapy for the treatment and keep medications as their last option. Medication does work effectively but comes with adverse consequences. To handle the adverse reactions of medications and to keep children and their families understand the illness, nurse interventions are required. They help organize treatment plan and support the families. Professionals need to follow proper standards to prevent the occurrence of ethical and legal issues.
Reference
American Psychiatric Association. (2015). Depressive Disorders: DSM-5® Selections. American Psychiatric Pub.
CASA. (2022, April 12). CHILDHOOD DEPRESSION. https://www.azcourts.gov/casa/Training/Training-Courses/Childhood-Depression
- (2022, April 12). Anxiey and depression in children: get the facts. https://www.cdc.gov/childrensmentalhealth/features/anxiety-depression-children.html#:~:text=3.2%25%20of%20children%20aged%203,1.9%20million)%20have%20diagnosed%20depression.
Crowe, K., & McKay, D. (2017). Efficacy of cognitive-behavioral therapy for childhood anxiety and depression. Journal of Anxiety Disorders, 49, 76-87. https://doi.org/10.1016/j.janxdis.2017.04.001
Ghandour, R., Sherman, L., Vladutiu, C., Ali, M., Lynch, S., Bitsko, R., et al. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in US children. The Journal of pediatrics, 206, 256-267. https://doi.org/10.1016/j.jpeds.2018.09.021
Olfson, M., King, M., & Schoenbaum, M. (2015). Treatment of young people with antipsychotic medications in the United States. JAMA psychiatry, 72(9), 867-874. 10.1001/jamapsychiatry.2015.0500
ptsd.va.gov. (2022, April 12). How Common is PTSD in Children and Teens? https://www.ptsd.va.gov/understand/common/common_children_teens.asp#:~:text=Learn%20how%20many%20children%20and%20teenagers%20have%20PTSD.&text=Studies%20show%20that%20about%2015,certain%20types%20of%20trauma%20survivors.
Silén, M., Haglund, K., Hansson, M., & Ramklint, M. (2015). Ethics rounds do not improve the handling of ethical issues by psychiatric staff. Nordic Journal of Psychiatry, 69(6), 1700-1707. https://doi.org/10.3109/08039488.2014.994032
Sun, Q., Cui, C., Fu, Y., Ma, S., & Li, H. (2017). Nursing interventions in depressed children with low serum levels of BDNF. Experimental and Therapeutic Medicine, 14(4), 2947-2952. https://doi.org/10.3892/etm.2017.4921
Völlm, B., Bartlett, P., & McDonald, R. (2016). Ethical issues of long-term forensic psychiatric care. Ethics, Medicine and Public Health, 2(1), 36-44. https://doi.org/10.1016/j.jemep.2016.01.005
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