Childhood Depression (eBook)

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History

Prior to the early 1980s depressive disorders were not regularly diagnosed in youth. Psychodynamic approaches viewed children as incapable of experiencing adult-like depression due to inadequate super-ego development (Mahler, 1961). Another dominant view was that children displayed other syndromes, such as externalizing symptoms, as a means of expressing their dysphoria – a masked depression. However, in 1980 Carlson and Cantwell published a seminal article, titled “Unmasking Masked Depression,” in which they applied adult diagnostic criteria to youth and found they could reliably diagnose depression, particularly when using a systematic interview, and that children with other masked symptoms (e.g., conduct, anorexia) did not necessarily meet criteria for depression. Decades of careful research followed to evaluate the diagnostic reliability, risk factors, course, family aggregation, associated psychosocial circumstances and features, and treatment of youth depression.

1.1  Diagnostic Criteria and Description

In this section, we discuss some of the basic terms, categories, and criteria for describing and diagnosing depressive disorders in youth that are described in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) and the ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (World Health Organization, 1993) – two of the most widely used classification systems. Table 1 provides the categories of depressive disorders that are listed in the two systems.

Although there are differences in the symptoms listed in these two classification systems, depressive disorder categories and symptoms are highly overlapping. Importantly, for most of these disorders, children and adolescents are diagnosed using the same diagnostic criteria used to diagnose depressive disorders in adults.

Both systems include, under mood disorders, diagnoses of major depressive disorder (MDD), disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and depression secondary to a medical condition or to a medication/substance. There are also categories for specified and unspecified depressive disorders. Additional relevant diagnoses are included under |2|adjustment disorders, including adjustment disorder with depressed mood and adjustment disorder with mixed anxiety and depressed mood, as these are frequent presentations of depression in youth. To enhance readability, and given the high overlap between these two systems, we focus on DSM-5 diagnostic categories and criteria throughout this volume. Descriptions of some of the most commonly encountered depressive disorders in youth are included below.

1.1.1  Major Depressive Disorder

MDD is the most commonly diagnosed depressive disorder in adults and children. Over the years it has frequently been referred to as the common cold of psychological disorders but its impact is far more serious. A diagnosis of MDD requires at least a 2-week duration with five of the following symptoms occurring most days for most of the day with at least one of the first two being present: depressed mood, significant loss of interest and/or pleasure in activities, weight loss/diminished appetite, sleep disturbance, psychomotor disturbance, fatigue/loss of energy, feelings of worthlessness or excessive guilt, impaired concentration or indecisiveness, and recurrent thoughts of death or |3|suicidal thoughts or behaviors. For youth, mood may be irritable – a frequent parental experience. In addition to these primary symptoms are a plethora of associated symptoms, such as hopelessness, pessimism, and helplessness.

MDD should not be diagnosed if symptoms are due to the impact of a substance or a medical condition, are better explained by another disorder (e.g., psychotic), or if there is a history of mania or hypomania. Specifier codes are used to delineate episode type (single episode or recurrent), severity (mild, moderate, severe, with psychotic features), course (full or partial remission), and accompanying features (anxious distress, mixed features, melancholia, atypical, types of psychotic feature, catatonia, seasonal pattern). For MDD to be considered recurrent there must be at ...