Depression in childhood. A survey of some pertinent contributions

La dépression chez l'adolescent. À propos d'une enquête réalisée auprès d'une population d'adolescents scolarisés

Afin d'évaluer la fréquence et les manifestations de la dépression à l'adolescence, une enquête a été réalisée auprès de 744 lycéens (439 garçons et 305 filles), âgés de 14 à 23 ans, et appartenant à 15 établissements d'enseignement du second degré du département du Nord. La première partie de l'enquête a consisté en la passation de deux autoquestionnaires: la version française de l'échelle CES-D (Center for Epidemiologic Studies-Depression Scale); et un questionnaire destiné à recueillir un certain nombre de renseignements concernant la situation sociodémographique du sujet, son état de santé et celui de ses parents, son mode de vie, ses relations familiales, son degré d'insertion scolaire et sociale. La deuxième partie a consisté en un examen clinique semi-standardisé visant à repérer les adolescents présentant un épisode dépressif majeur selon les critères diagnostiques du DSMIII-R. Sur les 728 lycéens examinés, 32 (18 garçons et 14 filles) présentaient un épisode dépressif majeur (soit une prévalence de 4,4%). Les critères diagnostiques du DSMIII-R les plus discriminants pour l'identification des adolescents déprimés ont été, par ordre d'importance décroissante: l'humeur dépressive, la diminution de l'intérêt ou du plaisir, l'agitation ou le ralentissement psychomoteur, la diminution de la capacité à réfléchir ou à se concentrer, et les idées récurrentes de mort. Le score moyen obtenu à la CES-D chez les adolescents déprimés apparaît très significativement supérieur à celui obtenu chez les adolescents non déprimés (28,9 ±8vs13,5 ± 8,2). Enfin, parmi les variables étudiées, certaines apparaissent significativement associées à la dépression; difficultés scolaires, problèmes de santé multiples et variés, attitudes particulières vis-à-vis du poids et de l'alimentation, problèmes de sommeil, conduites antisociales. Des problèmes de santé, en particulier d'ordre psychiatrique, sont aussi plus fréquemment retrouvés chez les parents des adolescents déprimés. En conclusion, cette étude montre que la dépression, dans sa forme typique, n'est pas rare à l'adolescence mais qu'elle est aussi souvent méconnue. C'est dire la nécessité de là rechercher devant tout problème psychopathologique survenant à l'adolescence. C'est dire aussi l'intérêt des études épidémiologiques visant à préciser la phénoménologie de la dépression à cet âge de la vie.

Preschool Depression: a Diagnostic Reality

PURPOSE OF REVIEW

We review findings related to predictors, correlates, outcomes, and treatment of preschool depression that have been published in the last 3 years.

RECENT FINDINGS

Preschool depression displays a chronic course through late adolescence and is associated with temperamental and personality traits, poorer physical health, and negative parenting practices. Preschool depression predicts deficits into adolescence, including social difficulties and blunted neural response to rewards. Depressed preschoolers can experience suicidal ideation and behaviors and display an accurate understanding of the finality of death. A treatment for preschool depression has now been validated that uses the parent-child relationship to enhance emotion development and reduce depressive symptoms. Preschool depression is homotypic with depression that occurs later in life. Future work elucidating mechanisms through which preschool depression develops and informs the sub-groups for which particular treatments may be most effective will have considerable implications for prevention and early intervention.

The Multidimensional Child and Adolescent Depression Scale: Psychometric Properties

Based on previous factor analyses of child and adolescent depression inventories, the following eight basic dimensions were identified, i.e., Pessimism, Weak Concentration, Sleep Problems, Anhedonia, Fatigue, Loneliness, Low Self-esteem, and Somatic Complaints. Each dimension was assessed by five items, so the Multidimensional Child and Adolescent Depression Scale has 40 brief statements answered on a 3-point intensity scale, i.e., None, Some, and A lot. The eight dimensions have good factorial validity and acceptable to good alpha and test-retest reliability, and good criterion-related validity using three self-report depression scales. The total scale score has from good to high coefficients of reliability and validity. The highest mean scores were on Fatigue and Anhedonia for Kuwaiti boys and girls, respectively, while the Loneliness subscale has the lowest mean score for both sexes. Girls attained significantly higher mean scores than boys for the total score as well as on all dimensions, with the exception of weak concentration. The scale has two compatible Arabic and English versions. It was designed to be useful in defining the profile of children's and adolescents' depression.

Can psychopathology at age 7 be predicted from clinical observation at one year? Evidence from the ALSPAC cohort

One of the challenges of developmental psychopathology is to determine whether identifiable pathways to developmental disorders exist in the first months or years of life. Early identification of such disorders poses a similar challenge for clinical services. Using data from a large contemporary birth cohort, we examined whether psychopathology at age seven can be predicted from clinician observation at one year. Two groups of clinical raters observed videos of caregiver-infant interaction. Neither group of raters could reliably identify any precursors of later development of psychopathology in the one-year-old infants in this setting.

Preschool depression: homotypic continuity and course over 24 months

CONTEXT

Childhood depression is a serious and relapsing psychiatric disorder. However, to date studies have focused mostly on children aged 6 years and older. Validation for depression in preschool children has been provided by 2 independent study samples. While several studies have demonstrated stability and poor outcomes of internalizing symptoms in preschoolers, there has not yet been longitudinal data available to inform the course of preschool depression and whether it shows homotypic continuity into early childhood.

OBJECTIVE

To examine the 24-month course of preschool depression and whether it showed homotypic vs heterotypic continuity or was a developmentally transient phenomenon.

DESIGN

Blindly rated, prospective, 24-month, longitudinal follow-up study.

SETTING

Community sites. Patients Three hundred six preschoolers aged 3 to 6 years recruited from community sites and oversampled for symptoms of depression. Main Outcome Measure Recurrence/stability of depression and predictors of course.

RESULTS

Preschoolers with depression at baseline had the highest likelihood of subsequent depression 12 and/or 24 months later compared with preschoolers with no baseline disorder and with those who had other psychiatric disorders. Preschoolers with depression at baseline were more likely to have later depression rather than other psychiatric disorders. Findings from a logistic regression analysis indicated that when controlling for demographic variables, risk factors, and comorbid disorders, depression during the preschool period and family history of affective disorders were the most robust and significant predictors of later depression.

CONCLUSIONS

Preschool depression, similar to childhood depression, is not a developmentally transient syndrome but rather shows chronicity and/or recurrence. Homotypic continuity of preschool MDD during a 24-month period was found. These results underscore the clinical and public health importance of identification of depression as early as preschool. Further follow-up of preschoolers with depression is warranted to inform the longitudinal course throughout childhood.

Age, Race, and Gender Differences in Depressive Symptoms: A Lifespan Developmental Investigation

This study considered depressive symptoms among a normative sample of 1,900 children, adolescents, and adults (950 males and 950 females) divided across four age-levels to investigate the developmental progression of depressive symptoms by age, race/ethnicity, and gender. The national normative sample of the Clinical Assessment of Depression (CAD) was used in this study, which provided a large, reliably assessed, representative sample for group comparisons. CAD age, gender, race/ethnicity analyses revealed that depressive symptoms appear to be experienced at fairly uniform levels across the age-span, by both genders, and among Whites, Blacks, and Hispanics. Specific differences within age, race, and gender groups and interactions are discussed.

Effects of obesity and obesity-induced stress on depressive symptoms in Korean elementary school children

BACKGROUND

Obesity is becoming prevalent in Korean children. Because body image is becoming increasingly important, it is likely that obesity-induced stress has a significant effect on childhood depression.

AIMS

To examine the correlation between obesity-induced stress and depressive symptoms in Korean elementary school students.

METHODS

The study participants were 2,305 elementary school children and their parents in the districts of Jeju-si, Seogwipo-si, Namjeju-gun and Bukjeju-gun on Jeju Island, Korea, who completed questionnaires involving demographic information, an obesity-induced stress scale and the Korean form of Kovacs' Children's Depression Inventory (CDI) from September to December 2006.

RESULTS

After controlling for significant independent variables that are wellknown correlates of depressive symptoms in children (e.g. age, gender, residence, family monthly income, obesity status of both parents, family history of chronic illness, and time spent with mother), obesity-induced stress had an odds ratio of 1.128 (95% CI 1.111-1.146).

CONCLUSIONS

Reducing the prevalence of depressive symptoms in elementary school children in Jeju Island will require special attention, particularly the development of coping strategies to resolve obesity-induced stress in various areas including school, family and society.

Internalizing disorders in early childhood: a review of depressive and anxiety disorders

This article reviews the use of the broad category of internalizing disorders and data on young children using this definition. It also reviews the emerging support for more specific internalizing diagnoses in very young children. The current empiric database on nosology and treatment of mood and anxiety disorders in young children is examined, and a clinical case example is included. Identification of recent advances in the understanding and treatment of anxiety disorders in young children and areas in which future studies are needed also are explored.

Emotions and the Development of Childhood Depression: Bridging the Gap

There is a gap between scientific knowledge about typical and atypical emotional development and efforts to identify and serve children's mental health needs. The gap can be bridged with research that integrates clinical perspectives into the study of emotional development. We illustrate this by discussing typical emotional development in early childhood and how it differs from the atypical features of emotion seen among preschool-age children with depression. We suggest new research directions that integrate the study of typical emotional development with clinical evidence of risk for and presence of affective disorders in young children.

Child maltreatment and vulnerability to depression

This investigation explored differences in depressive symptomatology among low-socioeconomic status children aged 7–12 years from abusive (N = 46), neglectful (N = 35), and nonmaltreating (N = 72) homes. Measures of aggression and self-esteem also were included. Children from abusive homes evidenced significantly more depressive symptomatology than children from either neglectful or nonmaltreating families. Additionally, children from physically abusive homes exhibited lower self-esteem than did nonmaltreated children. While significant differences among groups on aggression did not emerge, all groups evidenced higher levels of acting out behaviors than would be expected in a nonclinic group of children. Results were discussed in terms of the effects of physical abuse on depression and the importance of intervening to prevent the deleterious effects of abuse. Additionally, the impact of neglect and poverty status on the presence of aggression was discussed.

Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology

We review recent research on the presentation, nosology and epidemiology of behavioral and emotional psychiatric disorders in preschool children (children ages 2 through 5 years old), focusing on the five most common groups of childhood psychiatric disorders: attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. We review the various approaches to classifying behavioral and emotional dysregulation in preschoolers and determining the boundaries between normative variation and clinically significant presentations. While highlighting the limitations of the current DSM-IV diagnostic criteria for identifying preschool psychopathology and reviewing alternative diagnostic approaches, we also present evidence supporting the reliability and validity of developmentally appropriate criteria for diagnosing psychiatric disorders in children as young as two years old. Despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. We review the implications of these conclusions for research on the etiology, nosology, and development of early onset of psychiatric disorders, and for targeted treatment, early intervention and prevention with young children.

An observational analysis of behavior in depressed preschoolers: further validation of early-onset depression

OBJECTIVE

To investigate whether higher levels of negative and lower levels of positive behaviors could be observed in a sample of depressed preschoolers. Support for the validity of preschool depression is now available; however, objective evidence of negative behaviors among depressed preschoolers is needed.

METHOD

A structured observational parent-child interaction task was conducted. The behaviors of 152 preschoolers (ages 3.0-5.6) in three study groups (depressed, disruptive, and healthy) were examined with further analyses of depressed subgroups based on severity and comorbidity.

RESULTS

Anhedonically depressed preschoolers emerged as demonstrating less enthusiasm, more avoidance, more noncompliance, and having a more negative overall experience than healthy controls. This more severe and proposed melancholic anhedonic subgroup also displayed less enthusiasm than nonanhedonically depressed preschoolers. Furthermore, the "pure" anhedonic depressed preschoolers without disruptive comorbidity emerged as the only depressed subgroup that was significantly distinguishable from healthy preschoolers.

CONCLUSIONS

Findings provide the first objective evidence of more negative and fewer positive behaviors among depressed preschoolers. Notably, the finding that anhedonically depressed preschoolers demonstrated significantly less enthusiasm than those with nonanhedonic depression provides the first objective evidence of the manifestation of anhedonia, a key sign of preschool depression. The implications of the finding that the "pure" anhedonic depressed subgroup without disruptive comorbidity was most distinguishable from comparison groups are explored.

Predictors of depression in very young children--a prospective study

BACKGROUND

There have been only a few previous population-based studies of symptoms of depression in young children. There are no previous population-based studies which examine the factors which might be casually associated with depression in very young children.

METHODS

Data are from a cohort study of pregnant women who gave birth to a live singleton baby in a large public hospital in Brisbane, Australia. The Mater-University of Queensland Study of Pregnancy (MUSP) involves a 5-year follow-up, with mothers completing a short form of Child Behaviour Checklist (CBCL) describing the mental health of their child. Five groups of variables (socio-demographic, pre- and perinatal, maternal mental health, maternal lifestyle and maternal attitude to the child) were used to predict CBCL depression scores at the 5-year follow-up.

RESULTS

There are many factors associated with maternal reports of symptoms of depression in 5-year-old children. These include marital partner changes, mother's health problems in pregnancy, child health over the first six months of life, maternal anxiety and marital satisfaction early in the child's development and the mother's attitude towards caregiving. A multiple risk factor model indicates higher rates of depression for children experiencing multiple exposures to risk. While a number of exposures are associated with increased risk, many of those children perceived to be depressed appear to lack any measured exposures.

CONCLUSION

Many children as young as 5 years of age are observed to experience multiple symptoms of depression. The majority of children exposed to high levels of risk do not appear to become depressed; they appear to be resilient. The majority of children who experience multiple symptoms of depression appear to lack any known exposures to risk.

Mental health status of runaway adolescents

There are 47.22 million homeless and runaway adolescents roaming on the streets of our country (Voluntary Health Association of India - VHAI) of which one lakh are in Delhi.1 Very little is known about them, their needs or their experiences.

OBJECTIVE

(1). To assess the psychological problems amongst the runaway adolescent boys. (2). To determine possible risk factors.

METHODS

This study was cross-sectional in design and done at a child observation home for boys in Delhi. All runaway boys aged 10 to 16 years of age were included in the study. The study was conducted from 15th June to 15th July 2001. A comprehensive schedule consisting of five parts, viz identification data, hopelessness scale for children by Kazdin, Beck depression inventory, Psychological survey questionnaire and RUTTER-B2 scale were used to assess various mental health problems.

RESULTS

20.7% of children were found to have high hopelessness and 8% of children had depression. 2% of children revealed that they had attempted suicide at any point of time in life. Among children with high hopelessness, 3.2% had ever attempted suicide. 8.3% of the depressed children gave history of suicidal attempts. 38% of children gave history of physical abuse, 14.6% of sexual abuse and a large number reported substance abuse. 69.33% were found to have behavioral problems (i.e. scored above the recommended cut off score of 9). 81% of children had antisocial behavior, 7.8% were neurotic and 10.5% remained undifferentiated.

CONCLUSION

Runaway adolescents suffer from a wide array of mental health problems and there is a need for a broad based psychosocial intervention programme.

Recognition of childhood depression: personal reminiscences

Prior to 1970, childhood depression was not considered a valid clinical entity by American psychiatrists. One of the early clues was provided in the 1950s by the author's observation of depressive symptoms in children and young adolescents with undescended testicles. This finding was extended to children with several chronic diseases, many of whom exhibited depressive symptoms as well. Eventually, depressive symptomatology was found in children without any physical disorders. This was followed by the introduction of a diagnostic instrument, called the Children's Affective Rating Scale (CARS), later converted into a more formal system called the Child Assessment Schedule (CAS). A provisional classification of childhood depression was published in 1972. Our examination of children with depressive disorders has revealed several modes of family interaction, of which the most important were: separation from important love objects; depreciation and rejection; and affective disorders in parents. Several children with bipolar disorder stimulated our interest in this disorder and led to a pilot study of children of bipolar, lithium-responding parents. Some of these children with bipolar illness had a clear-cut response to lithium and were strong augmenters of the average evoked potentials (EPs). Next, our group investigated the urinary excretion of norepinephrine and its metabolites in chronically depressed children who differed from a normal control group. The foregoing studies, along with major contributions by other child psychiatrists, eventually led to the acceptance of childhood depression as a clinical entity in US psychiatry. The acceptance of juvenile bipolar disorder had to await further research by a new generation of child and adult psychiatrists.

Preschool major depressive disorder: preliminary validation for developmentally modified DSM-IV criteria

OBJECTIVE

To investigate the validity of developmentally modified DSM-IV criteria for preschool major depressive disorder (MDD).

METHOD

Subjects between the ages of 3.0 and 5.6 years were ascertained from community and clinical sites for a comprehensive assessment that included an age-appropriate psychiatric interview with the parent about the child. Minor developmental modifications to the formal DSM-IV MDD criteria were tested, including translations of symptoms to describe age-appropriate manifestations and setting aside the duration criterion. Preschool children who met modified criteria were compared with psychiatric and normal control groups.

RESULTS

Validation for the modified criteria was supported by a specific and stable symptom constellation, social impairment, greater family histories of affective disorders, and higher child-reported symptoms of depression on an age-appropriate puppet interview. Preschool children with MDD displayed "typical" symptoms of depression, as well as vegetative signs. Standard DSM-IV criteria failed to capture 76% of children who met these modified criteria.

CONCLUSIONS

Evidence that preschool children can manifest typical symptoms of MDD when age-adjusted symptoms states are assessed is provided. Findings also suggest that standard DSM-/V criteria may not be sufficiently sensitive for preschool children, as they failed to capture a substantial proportion of symptomatic children. Minor modifications to DSM-IV criteria are recommended to capture clinically significant preschool MDD.

An examination of the tripartite model of anxiety and depression and its application to youth

The ability to differentiate anxiety and depression has been a topic of discussion in the adult and youth literatures for several decades. The tripartite model of anxiety and depression proposed by L. A. Clark and D. Watson (1991) has helped focus the discussion. In the tripartite model, anxiety is characterized by elevated levels of physiological hyperarousal (PH), depression is characterized by low levels of positive affect (PA), and negative affect (NA) or generalized emotional distress is common to both. The advent of the model led to the development of measures of tripartite constructs and subsequent validity studies. The tripartite model and resultant activity concerning the model was largely devoted to adult samples. However. those interested in anxiety and depression among youth are now incorporating the tripartite model in their work. This paper examines the current influence of the tripartite model in the youth literature, especially with regard to measuring anxiety and depression.

Should depression in young school-children be diagnosed with different criteria?

In a two-stage epidemiological study 5686 randomly selected 8 to 9-year-old children were screened using the CDI (Children's Depression Inventory), of whom 418 were questioned with the DISC-C1 (Diagnostic Interview Schedule for Children). According to DSM-III criteria the prevalence of MDD (Major Depressive Disorders) was 0.48% and of DD (Dysthymic Disorder) 0.06%. The prevalence rates did not change when DSM-III-R and DSM-IV criteria were employed. Fifteen children reported suicidal thoughts but according to DSM-III criteria only 1 of these children was depressed. Duration and frequency of depressive symptoms are essential for making a diagnosis of depressive disorder by the DSM-III, but children's reliability in reporting them is questionable. Omitting the duration and frequency of symptoms from the DSM-III criteria raised the prevalence of MDD to 4.0% and of DD to 2.2%. Eight of the children with suicidal thoughts were depressed. By the adapted DSM-III-R and DSM-IV criteria the prevalence rate of MDD was 4.0% and of DD 9.7%.

Responding to Healthy People 2000: depression in our youth, common yet misunderstood

Pediatric health care providers are concerned with the physical health, growth, and development of youth. The U.S. Public Health Service has recommended that children's mental status be reviewed during routine assessments, and the promotion of mental health is one of the priorities set by Healthy People 2000. Pediatric nurses must be able to assess mental status, including depression, in children and adolescents, and to identify pathology early. This paper presents an overview of depression, historical perspectives, risk factors, a developmental approach to assessment, common treatment regimens, and nursing implications for this mental health concern in children and adolescents.

The stability of depressed mood in young adolescents: a school-based survey

To test the stability of self-reported depressed mood in a school-based sample of young adolescents, 268 schoolchildren completed two self-rating scales measuring depressed mood, the Depression Self Rating Scale and the Child Depression Inventory, at three timepoints over a period of 6 months. Depressed mood in the sample, as measured across the whole range of the scales, was reasonably stable. A subgroup of children was identified for whom the mean scores of both scales at all three timepoints was close to, or above, the cut-off points, representing a stably depressed mood similar to that found in clinical populations. The present findings indicate that depressed mood within a section of the general child population may be more stable and less transient than previously thought.

Children's coping styles and report of depressive symptoms following a natural disaster

The present study examined the relationship between children's coping styles (Spirito, Stark, & Williams, 1988) and self-reported levels of depressive symptoms (Kovacs, 1983) following a major stressor. 257 third- to fifth-grade children consented to participate in the study, 5 months following a hurricane. The number of coping strategies employed was positively related to depression scores, whereas coping efficacy was negatively related to depression scores. Social withdrawal, self-blaming, and emotional regulation were associated with more severe depressive symptoms. Lower levels of symptomatology were found among children who sought social support and engaged in cognitive restructuring. The overall symptom level in the sample did not exceed that of normative samples. Results are discussed in terms of competing theories of childhood depression.

Sex differences in the manifestations of depression in young people. A study of French high school students part I: Prevalence and clinical data

The first part of this study investigates the prevalence and clinical manifestations of major depressive episodes in young people. The sample for this investigation consisted of 744 high school students (439 males and 305 females), aged 14 to 23 years, and attending 15 high schools in the North of France. Assessment of major depressive episodes according to DSM-III-R criteria was performed by medical doctors using a semi-structured interview and by means of the French version of the Center for Epidemiologic Studies-Depression Scale (CES-D). Thirty-two students (18 males and 14 females) were found to have a major depressive episode with a prevalence of 4.1% in males and 4.7% in females. However, the results also showed that the significant manifestations of major depression differed according to sex and suggested that manifestations of major depression in female young people might differ from those observed in adults more markedly than in males. This may explain that the diagnostic performance of the CES-D was found to be higher in males than in females and that the female prevalence of major depression was found to be lower than those usually obtained with adolescent-specific diagnostic criteria.

Infantile depression, nonorganic failure to thrive, and DSM-III-R: a different perspective

A controversy exists regarding the classification of nonorganic failure to thrive within the psychiatric nomenclature. There are a number of DSM-III-R diagnoses that may be applied to NOFTT, including Reactive Attachment Disorder of Infancy (RADI) and Major Depressive Disorder (MDD). The behaviors characteristic of NOFTT are symptomatic of depression, and are similar to those exhibited by infants with anaclitic depression as well as those of the adult with depression. The correspondence of the behaviors of NOFTT and the DSM-III-R criteria for Major Depression are reviewed, as are the conceptual and therapeutic reasons to view NOFTT infants as suffering from Depression.

[Major depression in the child: validation of the syndrome and pharmacologic treatment]

The concept of childhood depression has been the object of controversies over many years. Recent developments have permitted rapid progress in many areas of research. The author offers an update on the validity of the diagnosis of major depression in childhood and on pharmacological treatment. He then attempts to delineate the uses and limitations of this therapeutic approach. In the latter part, practical advice on the use of drugs in childhood depression is given.

Childhood and adolescent depression. II: Research in clinical populations

The tremendous increase in interest in childhood and adolescent depression that has occurred since the early 1970s has resulted in a large and contradictory literature. Development of the concept of childhood depression, and the many clinical studies of depression and its concomitants, both psychosocial and biological, are critically reviewed. A number of methodological and theoretical problems are discussed.

A comparison of depressed and nondepressed disturbed children on measures of attributional style, hopelessness, life stress, and temperament

Upon admission to a hospital treatment program, clinically depressed and nondepressed children (aged 9-17 years) were assessed on measures of attributional style, hopelessness, depression, life stress, and child temperament. The depressed group tended to attribute positive events to specific and unstable factors when compared with the nondepressed sample. Group differences also were found on child temperament measures. However, no differences were reported between the diagnostic groups on self-reported depression, hopelessness, or life stress. The findings suggested that there may not be a unique constellation of cognitive characteristics in depressed children when compared with a nondepressed clinical sample. For both depressed and nondepressed groups, treatment did appear to affect self-reported depression and overall ratings of depressogenic attributional style.

Childhood depression

The spectrum of depressive disorders found in children and adolescents presents diagnostic and treatment challenges for the physician. The increasing scientific rigor of child and adolescent mental disorder research has explicated the importance of clinical diagnoses. Distinctions have to be made between depressive symptoms that are transient and situational specific and the constellation of depressive symptoms that represent clinical disorders such as bipolar disorder, cyclothymia, major depressive disorder, or dysthymia. The clinically sensitive physician attuned to the diagnostic criteria of these disorders has the opportunity to promote effective treatment and to reduce the morbidity associated with these conditions. The established severity and persistence of these disorders over time suggests the need for definitive medical management of these conditions. The recognition of childhood depression as a medical entity of varying severity, persistence, and prognosis represents the first step in effective treatment.

Relations among self-esteem, depression and anxiety of children

930 boys and girls enrolled in Grades 2 through 9 participated in a study of the relations among self-esteem, depression, and anxiety. The criterion measures correlated significantly for all children, boys and girls in both elementary and junior high groups. Depression correlated higher with total self-esteem for all children, boys and girls in elementary and junior high school groups.

Test-retest reliability of Battle's Depression Inventory for Children

1,089 boys and girls, aged 7 through 14 yr., enrolled in Grades 2 through 9, participated in an assessment of the test-retest reliability of Battle's Depression Inventory for Children, Form C. Pearsonian correlations at Times 1 and 2 (2 weeks later) for subjects in Grades 2 through 6 were .79, .77, and .80 for all children, boys, and girls, respectively. Values for subjects in Grades 7 through 9 were .79, .85, and .70 for all children, boys, and girls, respectively.

Relationship between self-esteem and depression among children

62 boys and girls enrolled in Grades 4 through 9 participated in the study. The correlations were significant and ranged from .44 to –- .83 between scores on all facets of a modified version of Beck's Depression Inventory and the Culture-free Self-esteem Inventory for Children, Form A.

Research note: the use of the Birleson Depression Scale with a non-clinical sample of boys

Attempts have been made to develop self-rating scales to assess depression in children. One of these scales, the Birleson Self-rating Scale, was administered to a non-clinical sample of boys which was larger, and covered a wider age-range, than Birleson's own non-clinical group. A comparison is made with Birleson's findings, and in addition data from the administration of the scale to a group of boys aged 13 to 18 years is presented.