Only in the past two decades has depression in children been taken very seriously. An NIMH-sponsored study of 9- to 17-year-olds estimates that the prevalence of any depressive disorder is more than 6 percent in a 6-month period, with 4.9 percent having major depression. Before puberty, boys and girls are equally likely to develop depressive disorders. After age 14, however, females are twice as likely as males to have major depression or dysthymia. The risk of developing bipolar disorder remains approximately equal for males and females throughout adolescence and adulthood.
Research has revealed that depression is occurring earlier in life today than in past decades. In addition, research has shown that early-onset depression often persists, recurs, and continues into adulthood, and that depression in youth may also predict more severe illness in adult life. Depression in young people frequently co-occurs with other mental disorders, most commonly anxiety, disruptive behavior, or substance abuse disorders, as well as with other serious illnesses such as diabetes. The depressed younger child may say he is sick, refuse to go to school, cling to a parent, or worry that the parent may die. The depressed older child may sulk, get into trouble at school, be negative, grouchy, and feel misunderstood.
Among both children and adolescents, depressive disorders confer an increased risk for illness and interpersonal and psychosocial difficulties that persist long after the depressive episode is resolved; in adolescents there is also an increased risk for substance abuse and suicidal behavior. Unfortunately, these disorders often go unrecognized by families and physicians alike. Signs of depressive disorders in young people are often viewed as normal mood swings typical of a particular developmental stage. In addition, health care professionals may be reluctant to prematurely "label" a young person with a mental illness diagnosis. However, early diagnosis and treatment of depressive disorders are critical to healthy emotional, social, and behavioral development.
Although the scientific literature on treatment of children and adolescents with depression is far less extensive than that for adults, a number of recent studies have confirmed the short-term efficacy and safety of treatments for depression in youth. Larger research studies on treatments are underway to determine which ones work best for which youngsters. Additional research is needed on how to best incorporate these treatments into primary care practice.
Bipolar disorder, although rare in young children, can appear in both children and adolescents. The unusual shifts in mood, energy, and functioning that are characteristic of bipolar disorder may begin with manic, depressive, or mixed manic and depressive symptoms. It is more likely to affect the children of parents who have the illness. Twenty to 40 percent of adolescents with major depression go on to reveal bipolar disorder within five years after the onset of depression.
Depression in children and adolescents is associated with an increased risk of suicidal behaviors. This risk may rise, particularly among adolescent males, if the depression is accompanied by conduct disorder and alcohol or other substance abuse. In 2000, suicide was the third leading cause of death among young males, age 10 to 24. NIMH-supported researchers found that among adolescents who develop major depressive disorder, as many as seven percent may die by suicide in the young adult years. Therefore, it is important for doctors and parents to take seriously any remarks about suicide.
NIMH researchers are developing and testing various interventions to prevent suicide in children and adolescents. Early diagnosis and treatment, accurate evaluation of suicidal thinking, and limiting young people's access to lethal agents-including firearms and medications-may hold the greatest suicide prevention value.
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This information has been provided with the kind permission of the National Institute of Mental Health (www.nimh.gov).