Childhood and Adolescent Depression
SHASHI K. BHATIA, M.D., and SUBHASH C. BHATIA, M.D., Creighton University,
Department of Psychiatry, Omaha, Nebraska
A
t any given time, up to 15 per-
cent of children and adolescents
have some symptoms of depres-
sion. Five percent of those nine
to 17 years of age meet the criteria for
major depressive disorder,1,2 and 3 percent
of adolescents have dysthymic disorder.3 The
incidence of depressive disorders markedly
increases after puberty. By 14 years of age,
depressive disorders are more than twice as
common in girls as in boys, possibly because
of differences in coping styles or hormonal
changes during puberty.4 Adolescent depres-
sive disorders often have a chronic, waxing-
and-waning course, and there is a two- to
fourfold risk of depression persisting into
adulthood.5,6 Depression impacts growth and
development, school performance, and peer
or family relationships, and it can be fatal.
Major depressive disorder is a leading cause
of youth suicidal behavior and suicide.7,8
More than 70 percent of children and ado-
lescents with depressive disorders or other
serious mood disorders do not receive appro-
priate diagnosis and treatment.9 Possible
reasons for this may be the stigma attached
to these disorders, an atypical presentation, a
lack of adequate child mental health training
for health care professionals, an inadequate
number of child psychiatrists, and inequali-
ties in mental health care insurance.
Underdiagnosis and undertreatment are
greater problems in children younger than
seven years, in part because of this age
group’s limited ability to communicate neg-
ative emotions and thoughts with language
and consequent tendency toward somatiza-
tion. Thus, young children with depression
may present with general aches and pains,
headaches, or stomachaches. Additionally,
if a parent has major depressive disorder, he
or she may minimize the child’s depressive
symptoms through a lack of awareness or an
unwillingness to recognize symptoms