Depression in childhood. A survey of some pertinent contributions

Diagnosing affective disorder in adolescents: the use of the Schedule for Affective Disorders and Schizophrenia

The Schedule for Affective Disorders and Schizophrenia was administered to 42 consecutively hospitalized psychiatrically disturbed adolescents. The SADS proved to be a good measure of current affective disorder and also identified a large number of adolescents with a positive past history of affective disorder. These patients had not been so identified by traditional assessment means. The use of a semi-structured interview is to be encouraged in the assessment period of psychiatrically disturbed adolescents and in further research at attempts to define the parameters of depressive disorders occurring in adolescents.

Depression in pre-pubertal, children

Pre-pubertal depression has attracted a great deal of interest recently. The literature is reviewed with a particular focus on the better designed studies. While isolated symptoms of depression are relatively common, definite depressive disorder is much less prevalent. The majority of studies have focused on the most severely depressed subgroup of children. While effective treatment regimes are being developed for this small group of children, there is no evidence that such regimes should be applied to every depressed child. Major gaps exist in our knowledge of the range of depressive symptomatology in pre-pubertal children, the relationship of developmental factors to depressive symptoms, the reliability and validity of existing diagnostic tools, and the effectiveness of traditional child psychiatric treatment modalities for depression.

Depression in learning disabled children

In order to investigate the prevalence of depression amongst LD children, 103 completed the Children's Depression Inventory. Fourteen percent of the sample scored at or above the critical cutoff, more than in the general population but not significantly so at the .05 level. Comparing the most depressed children with the least depressed, upper versus lower quartiles, revealed that the former were much lower in self-esteem, tended to be oversensitive and shared traits associated with neuroticism. No differences between the two groups were found, however, with respect to age, sex, intelligence, type of learning disability or parental expectations. It is suggested that in dealing with depressed LD children their affective state and their personality be taken into account as well as their obvious cognitive handicap.

The expression and possible origins of depression in male adolescent delinquents

The literature on adolescent delinquent behaviour and psychopathy contains the view that much of the delinquent behaviour is masking a depressive underlay, and that psychopaths may be in a chronic state of helplessness which they defend against through their anti-social behaviour. The current study examined the levels of trait depression in two groups of adolescent male offenders in a state training school. The group classified as anti-social personalities showed higher levels of trait depression than a group of first committals. The role of a perceived lack of paternal care, and, to a lesser extent, maternal over-protection emerged as the main variables explaining the variance in the trail depression scores. The quality of parental care appeared more important than continuity, with perceived affectionless control being significantly related to high trait depression scores. The importance of the mother in the development of persistent anti-social behaviour was highlighted as was the role of the father in relation to trait depression and overall delinquent development.

Animal models and human depressive disorders

Clinical depressive disorders are complex in presentation, dissimilar in origins and course, and often pleomorphic in character. An adequate understanding of their origins, biological substrates, and amenability to established and novel forms of therapy demands biological and social interventions which cannot always readily or ethically be carried out in a clinical setting. One useful complementary approach to clinical research utilizes preclinical models for laboratory investigations in parallel. The present paper reviews current approaches to modelling depression using animals, with particular emphasis upon phylogenetic constraints, systematic validity and reliability, and nosological limitations. Preclinical models are useful and necessary adjuncts for adequately understanding depression in humans. However, their utility remains a direct function of a continuing dialogue between clinical and laboratory research, and demands scrupulous observation and methodological rigor on the part of both clinicians and experimental researchers.

A clinical and EEG sleep study in the differential diagnosis of pre-pubertal depression: state of the art

The diagnosis of depression in childhood and adolescence remains problematic. We present an overview of the literature on the diagnosis of childhood and adolescent depression with particular reference to the potential utility of EEG sleep studies. A case of a pre-pubertal boy with depressive symptomatology is presented to illustrate some of the diagnosis difficulties and the application of EEG sleep studies in their resolution. The need for further systematic investigation of EEG sleep correlation of depression in childhood and adolescence is emphasized.

Depression in children admitted to hospital for orthopaedic procedures

One hundred children between the ages of 7 and 12 admitted to a hospital for orthopaedic procedures were studied to determine the frequency of depression, according to the DSM III diagnostic criteria for major depressive disorder. Of the total sample, 23 showed evidence of depression. Loss of interest or pleasure was the most frequent symptom. Significantly more parents of these depressed children were themselves found to have adjustment or emotional problems. The authors emphasize the importance of paying special attention to this high risk group of child patients because of their propensity to depression and other emotional disorders.

Depression in children: parent, teacher, and child perspectives

Depressed and nondepressed children were found to differ in the types of behavior problems manifested at home and at school. Children rated as depressed by their parents on the Personality Inventory for Children evidenced significantly more conduct problems, anxiety, impulsive hyperactivity, learning problems, psychosomatic problems, perfectionism, and muscular tension at home than children rated as nondepressed. Depressed children were rated by their teachers as displaying more inattention-passivity than nondepressed children. A significant but modest relationship was found between parent report and child self-report of the child's depression. Depressed children attributed positive events to external causes and negative events to internal causes significantly more than did nondepressed children. The specificity of these results to depression was also examined; the particular features of childhood depression are compared to the features of adult depression.

Children and depression--the children of depressed parents; the childhood of depressed patients; depression in children

In order to understand the development of depression in children, three types of data are reviewed: (1) studies of the children of depressed parents; (2) studies of the childhood histories of depressed adults; (3) direct studies of depression in children. These data support an increased frequency of depression and other psychopathology in the children of depressed adults. An examination of the homes of children with a depressed parent reveals a disruptive, hostile, and rejecting environment. This atmosphere is also found in the homes of depressed children and in the homes of children who become depressed as adults. Methodological issues are discussed which will help sort out the relative influences of genes and environment in future studies.

A data-based typology of depressed adolescents

To develop a data-based classification of depressive adolescents, a face valid depression scale for adolescents was applied to MMPI protocols of 212 adolescent psychiatric patients of ages 12 to 18, to identify a depressive subsample which turned out to have 36 females and 10 males. Complete linkage cluster analysis was applied to this subsample and three hierachically organized depressive groups were obtained: "Restless" and "Socially Frustrated", which joined into a higher order group, and "Endogenous". Discriminant function analysis was applied for differentiating and cross-validating the obtained groups.

Three types of childhood depression

This study appears to substantiate clinical impressions regarding the three types of prime symptom depression seen in children. The affectual group occurs in younger children, and seems to give way to a mid-latency negative self-esteem type. Often such negative self-esteem is seen in multiple placement children or in others with chronic losses. Finally, there seems to be a rather uncommon type of guilt depression arising in late latency. By no means all negative self-esteem depressions merge into later guilt depressions. Most likely this latter group represents newly emerging childhood depressive symptoms in those who are old enough to experience an adult type of mourning response. This type of depression is particularly common in those with recent bereavements, and this was true of all the highest D3 scorers. Further clinical investigation of these preliminary findings is continuing.

Hyperkinetic syndrome: The role of depression

The hyperkinetic syndrome is one of many manifestations of minimal brain dysfunction and emotional distrubance. Both physical and psychologic factors can be seen in its etiology. Depression has often been found to be related to hyperkinesis. The children described in this study give ample support to the frequency of this relationship. Some preliminary hypotheses are also drawn about the dynamics of the relationship between depression and the hyperkinetic syndrome.