John R. Stafford
Brandman University
Abstract
Depression affects
individuals for a variety of reasons and manifests in both physical and mental dysfunction
that impacts the daily lives of adults and children, sometimes with
debilitating results. Although age is not a major factor in determining
depression, there is evidence that certain age and gender groups are more
likely to suffer the dysfunction. Individual personality, moods, societal
influences, and biological aspects aid in determining how and individual will
react to various triggers and symptoms.
Keywords: Depression, Childhood
Depression, Depression in Adolescents
Clinicians
and researchers continue to pursue studies on how depression affects adults and
children, often in the same household. Rapid changes in societal influences and
variations in the home environment are both fundamental aspects of how parents
and their children develop depression (England, et al., 2009). Although
numerous studies indicate a genetic and biological influence, environmental
factors also affect how adults and children perceive their inner-self and how
they will react in stressful situations (England, et al., 2009). John Bowlby
(1907-1990), a well-known British psychologist studied the interactions between
biology and environmental effects on childhood depression and asserted that a
well-adjusted child requires affection, guidance, and a feeling of equality and
independence.
Cytryn (2003)
states “Prior to 1970, childhood depression was not considered a valid clinical
entity by American psychiatrists” (p.1). Before formal recognition, depressive
symptoms observed in pre-adolescents and children suffering from chronic
illness, or another recognized dysfunctions was associated with the perceived dominant
physical or mental condition (Crytyn, 2003). One problem with the history of
depression in children and young adults, especially those diagnosed with major
depressive disorder is the timeframe of the original diagnosis. Around the
1980s child abuse started to become a major area of concern, both in the
medical and psychological fields, but also in the general public. Many children
and young adults diagnosed with depressive disorders during this time, may have
been diagnosed without a complete understanding of the underlying causations of
the dysfunction; abuse or sexual assault in particular (Hynes, & McCune,
2002).
Other factors in children diagnosed during this time were
other conditions that are now fully
recognized, and treatments that were used in part to treat young patients. During this time, ADHD and hyperkinetic disorder was not fully accepted or diagnosed, which most likely resulted in many young patients receiving incomplete or inaccurate diagnosis and treatment (Hynes, & McCune, 2002). Furthermore, antidepressants prescribed to young patients suffering from depression at the time was omitted for young patients displaying comorbid conduct disorder over concerns that the patient may overdose on the medication (Hynes, & McCune, 2002).
recognized, and treatments that were used in part to treat young patients. During this time, ADHD and hyperkinetic disorder was not fully accepted or diagnosed, which most likely resulted in many young patients receiving incomplete or inaccurate diagnosis and treatment (Hynes, & McCune, 2002). Furthermore, antidepressants prescribed to young patients suffering from depression at the time was omitted for young patients displaying comorbid conduct disorder over concerns that the patient may overdose on the medication (Hynes, & McCune, 2002).
Human Development1
An important aspect of a person’s mental well-being is how he
or she develops. Childhood development is a consideration in how well adjusted
a person will be as an adult. Children raised in loving, supportive and
emotionally stable environments are usually able to adapt to situations easier (Conway,
Rancourt, Adelman, Burk, & Prinstein, 2011). In contrast, children raised
in less stable, abusive, or emotionally unsupportive environments are prone to
suffer higher levels of difficulty adjusting to conditions in adolescence and
adulthood. Depression is just one of
adverse outcome for people raised in
environments in which alcoholism, mental and physical abuse and neglect are
prominent. Experiences like a loss in
childhood, the death of a family member, a personal tragedy like sexual assault,
and other mental or physical traumas also serve as triggers for depressive
episodes.
Socialization.
The study of
social influence on depression helps clinicians understand how social forces
affect people suffering from depression. Considering depression is one of the
most common diagnoses in the Untied States, it is fair to note that many
previous studies were focused more on adults than young children or adolescents
(Conway, et al., 2011). Established models of cognitive-interpersonal
influences continue to produce research data emphasizing the understanding of
developmental variances and social processes related to depressive episodes and
various methods used in treatment and maintenance (Conway, et al., 2011). Data
gathered from ongoing research indicates that the transition from childhood to
adolescence presents a concern of vulnerability to contexts of depression;
noted as being more prevalent in girls than boys. Naturalistic clinicians
continue to examine the depression socialization hypothesis to shed more light
on the integrational transmission of depression and the temporal association
between mothers and children with depression (Conway, et al., 2011).
Previous
research primarily focused on how socialization affected adults suffering from
depression. However, newer studies are emphasizing the importance of
socialization in adolescents and young children diagnosed with depression
(Conway, et al. 2011). The study conducted by Conway, Rancourt, Adelman, Burk,
and Prinstein was carried out to examine and identify the connection of an
individual’s depression to specific friendship groups, and average levels of
depressive symptoms within the group. This study asserted that the mean levels
of depression socialization effects in a peer group as a predictor of an
individual’s depression symptoms over time (Conway, et al., 2011). The study
found that peer influence and the child’s unique position in a social group
might affect the degree of socialization induces depression. The study also
indicated that adolescents with fewer friends or social circles had a higher
risk of developing depression (Conway, et al., 2011).
Risk Factors.
Recognizing
the risk factors for depression in children and adolescents is imperative when
trying to assess and treat the problem. Some recognizable risk factors include
poor peer relationships, difficulty in coping with situations, a history of depression
in another family members, conflicts in the home, and negative thoughts or
behaviors (Clark, Jansen, & Cloy, 2012). Some figures indicate that
approximately 2.8 percent of children under the age of 13 and 5.6 percent of teenagers
suffer from some form of depression, and about 60 percent will have recurring
symptoms during adulthood (Clark, Jensen, & Cloy, 2012). Furthermore,
adults who suffered depression during childhood or adolescent years are more
prone to have suicidal ideations than adults that did not suffer from
depressive symptoms (Clark, Jensen, & Cloy, 2012).
Diagnosing, Treating, and Red Flags
Diagnosing, identifying red flags, and providing proper
treatment is essential in addressing depression. Left untreated, the symptoms of depression become more severe,
which can lead to extreme situations of withdrawal, declining social
activities, educational detriment, and
even suicidal ideation. Parents, teachers, and other adults that interact with
children or adolescents need to be aware of particular behaviors and temperament changes potentially associated with
depression and address their concerns accordingly.
Diagnosing
A primary issue of diagnosing children and young people with depression is the determination of
the classification of depression the patient is suffering. Initial observations
from parents, teachers, or other adults may not be sufficient because these
individuals lack the proper training and understanding of the investigative techniques clinicians use to make
appropriate assessments. The information
provided by those who observe the behaviors is valuable to a clinician will
provide a solid starting point.
The criteria for diagnosing depression begin with a detailed
exploration of risk factors, family history, and gaining an understanding of
the potential causations. This explorative process will aid in determining the level of severity, and
identification of the proper DSM classification of depression that patient is
experiencing. Persistent Depressive Disorder was
chosen as the example for this paper and associated vignette. The criteria for Persistent Depressive Disorder include notable
depression or irritability lasting the majority of the day (American Psychiatric
Association, 2013). These symptoms must be recurring for the majority of the time
for a period no less than one-year. The patient must also display at least two
other symptoms like poor appetite or overeating, insomnia or hypersomnia, a
lack of energy or low self-esteem, difficulties in concentration or decision
making, and feelings of hopelessness (American Psychiatric Association, 2013).
Treating
There are various methods used to treat patients with depression. However, the
classification of depression the patient is suffering
is a major factor in making the proper treatment plan (Castro, & Garthright, 2013). A treatment plan for patients with symptoms of mild depression is
not appropriate for a patient suffering from a
major depressive disorder. Estimates indicate that approximately 70 to
80 percent of children suffering from depression
will experience positive results with proper treatment (Clark, Jansen, &
Cloy, 2013). Effective treatment methods
include Interpersonal Therapy [IPT] and Cognitive Behavioral Therapy [CBT]. Other
methods include pharmacotherapy using SSRI’s to enhance positive results. A combination
of Cognitive Behavioral Therapy and Pharmacotherapy treatments usually lead to higher
efficacy of long-term treatment plans (Clark, Jansen, & Cloy, 2013).
Red Flags
Red flags are also warning signs of the severity of
depression a person is experiencing.
People suffering mild depressive states are
likely to display more clement symptoms that may not be immediately recognized
as red flags, whereas an individual suffering from severe depressive states is apter so show recognizable critical behaviors (Clark, Jansen, & Cloy,
2012). Some key red flags to take note of are parental
loss or separation, suicidal ideation, biological factors, and cognitive distortions.
Other risk factors associated with family, environment, or societal like the history
of depression in other family members, discord in the household, childhood
neglect or abuse, bullying from peers, drug or alcohol abuse (Clark, Jensen, &
Cloy, 2012).
Conclusion
There is no magical solution
to treating depression. Multiple classifications, treatment options, and
individual factors of the patient inject complications for any clinician.
However, proper exploration of the patient’s history, family situations, and
social interactions all serve as fundamental aspects of determining the
severity and classification for assessment and treatment of the patient. Using
proper treatment methods enhances the patient’s ability to overcome many, if
not all, of their symptoms and resume and healthy lifestyle. However, left
untreated the patient is at higher risk
of developing worsening symptoms and recurring depressive episodes later in
life.
References
Diagnostic and statistical manual of mental disorders (5th Ed). (2013). Washington DC: American Psychiatric Association.
Castro, J., & Garthright, M. M.
(2013). Depression in Children and Adolescents (pp. 1-28,
Working Paper No. 4600016732). The University of Arkansas For Medical
Sciences.
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Clark, M. S., Jansen, K. L., & Cloy, J.
(2012). Treatment of Childhood and
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Retrieved from http://www.aafp.org/afp/2012/0901/p442.html
Conway, C. C., Rancourt, D., Adelman, C. B.,
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Cytryn, L. (2003). Recognition of childhood depression. Journal of Affective
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England, M. J., Aguilar-Gaxiola, S., Barnard,
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(2009). Depression in parents, parenting, and children: opportunities
to improve identification, treatment, and prevention. Retrieved April 12,
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Vignette
1A 14-year old adolescent
boy is brought for assessment by his mother. The patient reports of
having feelings of worthlessness and irritability
for most of the day. His appetite is poor,
and he states that he can go without eating anything for certain periods of time and that he has difficulty sleeping at
night. He states that he has a constant feeling of fatigue and has trouble focusing on his school work and chores.
He mother interjects that most of his symptoms have been manifesting for the
past year and states that she doesn’t understand why his mood has changed so dramatically.
