Characteristics Associated with Depression Severity in 270 Juveniles in a Major Depressive Episode.

Giulia Serra,Stefano Vicari,Maria Pia Casini,Gino Maglio,Ross J Baldessarini,Camilla Frattini,Monia Trasolini,Maria Elena Iannoni

doi:10.3390/brainsci11040440

Abstract

Introduction: Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk. Objectives: To identify clinical and demographic factors associated with the severity of depression in juveniles diagnosed with a major mood disorder, as a contribution to improving clinical treatment and reducing risk of suicide. Methods: We analyzed factors associated with depression severity in 270 juveniles (aged 6–18 years) in a major depressive episode, evaluated and treated at the Bambino Gesù Children’s Hospital of Rome. Depressive symptoms were rated with the revised Children’s Depression Rating Scale (CDRS-R) and manic symptoms with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (K-SADS-MRS). Bivariate comparisons were followed by multivariable linear regression modeling. Results: Depression severity was greater among females than males (55.0 vs. 47.2), with the diagnosis of a major depressive disorder (MDD) vs. bipolar disorder (BD; 53.8 vs. 49.3), and tended to increase with age (slope = 1.14). Some symptoms typical of mania were associated with greater depression severity, including mood lability, hallucinations, delusions, and irritability, whereas less likely symptoms were hyperactivity, pressured speech, grandiosity, high energy, and distractibility. Factors independently and significantly associated with greater depression severity in multivariable linear regression modeling were: MDD vs. BD diagnosis, female sex, higher anxiety ratings, mood lability, and irritability. Conclusions: Severe depression was significantly associated with female sex, the presence of some manic or psychotic symptoms, and with apparent unipolar MDD. Manic/psychotic symptoms should be assessed carefully when evaluating a juvenile depressive episode and considered in treatment planning in an effort to balance risks of antidepressants and the potential value of mood-stabilizing and antimanic agents to decrease the severity of acute episodes and reduce suicidal risk.

Highlights

Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk
The prevalence of depression increased significantly from childhood to late adolescence, especially among females; it peaked at 13% for 15–17 years old females, including 5% with severe depression
We analyzed factors associated with depression severity in 270 severely ill juveniles diagnosed with a major affective disorder (MDD or bipolar disorder (BD)) at the Mood Disorder Program of Bambino Gesù Children’s Hospital in Rome

Summary

Introduction

Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk. Objectives: To identify clinical and demographic factors associated with the severity of depression in juveniles diagnosed with a major mood disorder, as a contribution to improving clinical treatment and reducing risk of suicide. Results: Depression severity was greater among females than males (55.0 vs 47.2), with the diagnosis of a major depressive disorder (MDD) vs bipolar disorder (BD; 53.8 vs 49.3), and tended to increase with age (slope = 1.14). Factors independently and significantly associated with greater depression severity in multivariable linear regression modeling were: MDD vs BD diagnosis, female sex, higher anxiety ratings, mood lability, and irritability. The Global Burden of Disease Study in 2010 identified depression as the second leading cause of years lived with disability (YLDs), accounting for about 10%. Severe depression is associated more with greater risk of psychiatric comorbidity, suicide and functional impairment than are mild or moderate forms [3]

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