Major Depression In Children Research Articles

Cohort profile: BioMD-Y (biopsychosocial factors of major depression in youth) – a biobank study on the molecular genetics and environmental factors of depression in children and adolescents in Munich

PurposeBioMD-Y is a comprehensive biobank study of children and adolescents with major depression (MD) and their healthy peers in Germany, collecting a host of both biological and psychosocial information from...

Clinical implication of children's depression rating scale-revised score: Linking the children's depression rating scale-revised score and clinical global impression using patients data from clinical trials.

The Children's Depression Rating Scale-Revised (CDRS-R) score has been widely used to assess the severity of major depression in children and adolescents; however, the clinical implications of changes in the CDRS-R score remain unclear. We evaluated these clinical implications by assessing the relationship between changes in the CDRS-R score and changes in the Clinical Global Impression of Improvement (CGI-I), in clinical research on major depression. We used data from four clinical trials involving two antidepressants and evaluated the relationship between CDRS-R score changes and the CGI-I score using the equipercentile linking method. CDRS-R score changes corresponding to a minimally improved (score of 3) CGI-I score was approximately 14 points. Our findings from the linking analyses are useful for interpreting the clinical implications of changes in the CDRS-R score.

Gender differences in vulnerability to maternal depression during early adolescence: Girls appear more susceptible than boys

AbstractMaternal depression has consistently demonstrated reliability as a predictor of major depression in children. However, the effect of gender as a potential moderator remains under‐researched. This study examined gender differences in depression and hypothesized that maternal depression would be more greatly associated with depression in girls by early adolescence. A representative sample of 7237 participants from the Growing Up in Ireland national longitudinal study of Irish children was examined across two waves when participants were aged 9 and 13. Separate multiple regression analyses were run for girls and boys to ascertain if maternal depression and other key variables predicted child depression by age 13. A third analysis looked at the effect of gender. Maternal depression when the children were aged 9 was found predictive of depressive symptomology by age 13 in girls but not for boys. Additionally, conflict with caregivers, household income, and bullying were significant predictors for both genders. Gender significantly predicted youth depression when the child was female (R² = .13, ƒ2 = .25). These findings indicate that late childhood to early adolescence is a vulnerable period for girls during which they appear more susceptible to developing depressive symptomology than boys, particularly when exposed to maternal depression.

Major Depression in Children with Transfusion-Dependent Thalassemia Is Strongly Associated with the Combined Effects of Blood Transfusion Rate, Iron Overload, and Increased Pro-inflammatory Cytokines.

Beta-thalassemia major patients are treated with repeated blood transfusions, which may cause iron overload, which in turn may induce immune aberrations, and show an increased risk of depression. The aim of the present study is to examine whether repeated blood transfusions, iron overload, and immune-inflammatory responses are associated with depression in children (6-12years) with transfusion-dependent thalassemia (TDT). The Children's Depression Inventory (CDI), iron status (serum iron, ferritin, transferrin, TS%), and serum levels of CCL11, IL-1β, IL-10, and TNF-α were measured in TDT with (n = 54) and without (n = 57) a major depression-like episode (MDLE) and in healthy children (n = 55). The results show that MDLE due to TDT is associated with a greater number of blood transfusions and increased iron overload and IL-1β levels. Partial least squares path analysis shows that 68.8% of the variance in the CDI score is explained by the number of blood transfusions, iron overload, and increased levels of IL-1β and TNF-α. The latter two cytokines partly mediate the effects of iron overload on the CDI score, while the effects of blood transfusions on the CDI score are partly mediated by iron overload and the path from iron overload to immune activation. Iron overload is also associated with increased IL-10 and lower CCL11 levels, but these alterations are not significantly associated with depression. In conclusion, blood transfusions may be causally related to MDLE in TDT children and their effects are in part mediated by increased iron overload and the consequent immune-inflammatory response. The results suggest that effects of iron overload and its consequences including inflammation and oxidative stress toxicity may cause MDLE. Current treatment modalities with folic acid and vitamin C are insufficient to attenuate iron overload and immune-inflammatory responses and to prevent MDLE in children with TDT.

PP125 PhotoVoice: Promoting Knowledge Exchange About Patients’ Experiences

IntroductionIn the past decades the community-based participatory research method known as PhotoVoice has gained relevance, but there are few published studies on its application in the field of health technology assessment (HTA) and clinical practice guidelines (CPGs). The aim of this presentation was to describe a PhotoVoice project linked to a CPG on major depression in children and adolescents.MethodsThe design of the study was adapted to the main objective, which was to enhance the understanding of major depression and improve clinical practice with the contributions of clinicians, methodologists, and patients. Seven adolescents and ten of their family members participated in the study through PhotoVoice sessions and focus groups. The audio recordings of all sessions were transcribed verbatim and coded, and a thematic analysis was undertaken.ResultsSix themes emerged: (i) a lack of understanding and information about depression in childhood and adolescence; (ii) the importance of support groups; (iii) the need to favor early care and access to services; (iv) the adaptation of therapeutic strategies tailored to individual needs; (v) the sensitivity of professionals; and (vi) fostering interaction between the health and education systems. Photographic exhibitions were planned to share the main results. These exhibitions were promoted to increase public awareness and reduce stigmatization, and to reach clinicians and policy makers. From a methodological point of view, the use of PhotoVoice in this study helped to effectively incorporate the lived experiences, concerns, and preferences of patients and their relatives into the CPG. The study also confirmed the value of photographs and participatory methods. The main limitations and strengths of the study, as well as suggestions for future research, are also outlined.ConclusionsPhotoVoice is a flexible, effective, and innovative method of obtaining information about patients’ perspectives and experiences, and it offers the added value of being able to reach the main stakeholders, including policymakers and the public.

Lithium Treatment in Children and Adolescents.

There is a resurgence of interest in lithium treatment of bipolar disorders in part related to its unique anti-suicidal and neuroprotective effects. This is a narrative review of key studies pertaining to the effectiveness and tolerability of lithium treatment in pediatric populations. Evidence supports that lithium is an effective and generally well-tolerated acute treatment for pediatric mania compared to placebo. Lithium may be less effective than risperidone for treating chronic mixed/manic symptoms in young children but comparable to anticonvulsants. However, in comparison, risperidone was associated with higher weight gain and prolactin levels. There is a lack of evidence inform maintenance treatment in children who benefit from lithium. Other indications that require further study include treatment of refractory or recurrent major depression in children at confirmed familial risk of bipolar disorder, as well as the treatment of acute suicidal ideation/behavior and refractory aggression. There is inadequate data about the full variety of benefit and tolerability of lithium treatment in pediatric patients. However, given the potential for protection against suicide and neurotoxic effects of illness, further studies should be a priority.

PCPI Helps Organizations Produce Clinically Valid Quality Measures

PCPI Helps Organizations Produce Clinically Valid Quality Measures

Accuracy of Depression Screening Tools to Detect Major Depression in Children and Adolescents: A Systematic Review.

Depression screening among children and adolescents is controversial, and no clinical trials have evaluated benefits and harms of screening programs. A requirement for effective screening is a screening tool with demonstrated high accuracy. The objective of this systematic review was to evaluate the accuracy of depression screening instruments to detect major depressive disorder (MDD) in children and adolescents. Data sources included the MEDLINE, MEDLINE In-Process, EMBASE, PsycINFO, HaPI, and LILACS databases from 2006 to September 30, 2015. Eligible studies compared a depression screening tool to a validated diagnostic interview for MDD and reported accuracy data for children and adolescents aged 6 to 18 years. Risk of bias was assessed with QUADAS-2. We identified 17 studies with data on 20 depression screening tools. Few studies examined the accuracy of the same screening tools. Cut-off scores identified as optimal were inconsistent across studies. Width of 95% confidence intervals (CIs) for sensitivity ranged from 9% to 55% (median 32%), and only 1 study had a lower bound 95% CI ≥80%. For specificity, 95% CI width ranged from 2% to 27% (median 9%), and 3 studies had a lower bound ≥90%. Methodological limitations included small sample sizes, exploratory data analyses to identify optimal cut-offs, and the failure to exclude children and adolescents already diagnosed or treated for depression. There is insufficient evidence that any depression screening tool and cut-off accurately screens for MDD in children and adolescents. Screening could lead to overdiagnosis and the consumption of scarce health care resources.

Functional and structural brain correlates of risk for major depression in children with familial depression.

Despite growing evidence for atypical amygdala function and structure in major depression, it remains uncertain as to whether these brain differences reflect the clinical state of depression or neurobiological traits that predispose individuals to major depression. We examined function and structure of the amygdala and associated areas in a group of unaffected children of depressed parents (at-risk group) and a group of children of parents without a history of major depression (control group). Compared to the control group, the at-risk group showed increased activation to fearful relative to neutral facial expressions in the amygdala and multiple cortical regions, and decreased activation to happy relative to neutral facial expressions in the anterior cingulate cortex and supramarginal gyrus. At-risk children also exhibited reduced amygdala volume. The extensive hyperactivation to negative facial expressions and hypoactivation to positive facial expressions in at-risk children are consistent with behavioral evidence that risk for major depression involves a bias to attend to negative information. These functional and structural brain differences between at-risk children and controls suggest that there are trait neurobiological underpinnings of risk for major depression.

Reducing Major Depression in Children at High Risk: Opportunities for Prevention

The profound negative impact of a parent's Major Depressive Disorder (MDD) on his or her children is of increasing concern to public health and mental health professionals. Children of a depressed parent have a markedly elevated risk for psychiatric illness, including a fourfold increased risk for MDD. The objective is to examine the scientific literature for ways to reduce this high risk to the offspring. First, we consider the relation between effective treatment of a parent's depression and reduced risk to the offspring, and review the effectiveness of treatments for adult M1DD. We then review emerging evidence that risk for psychopathology can be reduced in children of depressed parents by preventive intervention, including targeting two pathways hypothesized as links between parental MDD and offspring psychopathology: parenting skills and child coping. Three 5-year PubMed searches, and a Cochrane Database search, and one Medline and two PsycLit searches (to 1970) were completed (search words in combinations included: depression, prevention, treatments, depression in families, family interaction, adolescents). Randomized controlled studies are included, and review studies and meta-analyses are highlighted to provide a critical overview of the considerable scientific literatures for specific steps that can be taken to reduce the high risk of depression to the offspring of parents with MDD. A deliberate clinical focus on better treatment of MDD in parents is clearly needed and has the potential additional benefit of reducing psychopathology in their children. Altering clinical treatment to address MDD "co-occurring" in both parent and child is supported by the scientific literature. There is also good evidence that preventive intervention with high-risk adolescents reduces the incidence of MDD. Targeting parenting skills and teaching children how to better cope with a parent's illness that they cannot control, appears to reduce MDD in the offspring.

Journal Digest

Journal Digest

The Cochrane library and the treatment of major depression in children and youth: an overview of reviews

AbstractBackgroundMajor depression (MDD) in children and adolescents is a mood disorder that has up to 25% lifetime prevalence by the end of adolescence. Pharmacological and nonpharmacological treatments are recommended to reduce symptoms, increase psychosocial functioning, and prevent relapse. Traditionally, decisions for these treatments were made based on reported effects for adults, but a body of pediatric‐based evidence is now emerging to inform treatment decisions.ObjectivesTo synthesize the evidence currently in the Cochrane Library Database of Systematic Reviews (CDSR) related to the question: ‘In children and youth with diagnosed major depression, do pharmacologic or nonpharmacologic treatments improve symptom response, response rates, functional capacity, adherence and persistence, and decrease cost and adverse events?’.MethodsCDSR was searched using the term ‘depression’ in the title for all systematic reviews examining pharmacologic and nonpharmacologic interventions for the treatment of depression in children ⩽18 years. Data were extracted and entered into tables; data were synthesized using qualitative and quantitative methods.Main ResultsOf the studies included in the CDSR, there was no significant improvement in treatment outcomes in depressed children and adolescents treated with pharmacological (tricyclic antidepressant [TCA] or selective serotonin reuptake inhibitor [SSRI]) or nonpharmacological (exercise) interventions.Author's ConclusionsAlthough this overview indicates no clear evidence for pharmacological and nonpharmacological interventions for treatment of depression in this age group, the CDSR does not include several recent research publications in this area that demonstrate beneficial effects of treatment. In context of existing research there may be a moderate effect of SSRI in moderate to severe depression in children and youth. Best practice recommendations are consideration of treatment with SSRI (fluoxetine first line) in moderate to severe depression with close monitoring and weighing risk/benefit profile based on individual assessment. Psychotherapeutic interventions not in this overview, including Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), have some evidence of effectiveness in mild to moderate depression. Although exercise remains an important part of healthy living, there is no evidence to support its use in treatment of depression in children and adolescents. This overview in the context of recent research indicates the need for ongoing study in this important area of child and youth mental health. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Depressed Teens Sustain Gains From Long-Term Treatment

Depressed Teens Sustain Gains From Long-Term Treatment

Proper studies of selective serotonin reuptake inhibitors are needed for youth with depression

Evidence of a possible association between the use of selective serotonin reuptake inhibitors (SSRIs) and suicide in youth presents a vexing problem for clinicians, youth and their families. Are these medications the most effective treatment for major depression in children, adolescents and young

Predicting Remission in Depressed Children Treated with Fluoxetine

Fluoxetine is the only antidepressant that has been evaluated for treatment of pediatric depression in more than one randomized controlled trial, and it often is the initial medication selected for treatment of major depression in children and adolescents. Current guidelines suggest a change of medication at 6 to 8 weeks when patients have an insufficient response. To …

The use of antidepressants to treat depression in children and adolescents.

The dramatic increase over the past 10 years in the amount of available clinical research on the use of antidepressants to treat major depression in children and adolescents has substantially improved our knowledge of the safety and efficacy of these medications in the pediatric population. Many questions remain, however, that highlight the need to continue research in this patient population rather than relying on the extrapolation of data from trials involving adults. In this article, we review the current state of research into antidepressant therapy for major depression in children and adolescents. In addition, we discuss methodologic issues and clinical implications specific to the pediatric population.

Face-Memory and Emotion: Associations With Major Depression in Children and Adolescents

Face-Memory and Emotion: Associations With Major Depression in Children and Adolescents

Face-memory and emotion: associations with major depression in children and adolescents.

Studies in adults with major depressive disorder (MDD) document abnormalities in both memory and face-emotion processing. The current study used a novel face-memory task to test the hypothesis that adolescent MDD is associated with a deficit in memory for face-emotions. The study also examines the relationship between parental MDD and memory performance in offspring. Subjects were 152 offspring (ages 9-19) of adults with either MDD, anxiety disorders, both MDD and anxiety, or no disorder. Parents and offspring were assessed for mental disorders. Collection of face-memory data was blind to offspring and parent diagnosis. A computerized task was developed that required rating of facial photographs depicting 'happy,"fearful,' or 'angry' emotions followed by a memory recall test. Recall accuracy was examined as a function of face-emotion type. Age and gender independently predicted memory, with better recall in older and female subjects. Controlling for age and gender, offspring with a history of MDD (n = 19) demonstrated significant deficits in memory selectively for fearful faces, but not happy or angry faces. Parental MDD was not associated with face-memory accuracy. This study found an association between MDD in childhood or adolescence and perturbed encoding of fearful faces. MDD in young individuals may predispose to subtle anomalies in a neural circuit encompassing the amygdala, a brain region implicated in the processing of fearful facial expressions. These findings suggest that brain imaging studies using similar face-emotion paradigms should test whether deficits in processing of fearful faces relate to amygdala dysfunction in children and adolescents with MDD.

Age at Time of Trauma Predicts Type of Disorder Developed Later

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessAge at Time of Trauma Predicts Type of Disorder Developed LaterJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:20 Aug 2004https://doi.org/10.1176/pn.39.16.0390022aWhat happens when children experience a traumatic event—say, a serious accident, a serious illness, a fire, or a rape? Are they more likely to develop a major depression or posttraumatic stress disorder (PTSD)? They are more likely to develop the former.And how about adolescents who experience a very traumatic event? They are more likely to develop PTSD.So suggests a study conducted in eastern Germany and headed by Andreas Maercker, M.D., Ph.D., a professor of clinical psychology at the University of Zurich in Switzerland. The results appeared in the June British Journal of Psychiatry.Maercker and his colleagues based their study on 1,966 women, average age 22 years, who lived in Dresden, Germany. The subjects were questioned about traumatic events and their responses during both childhood and adolescence, as well as whether they had experienced a major depression during childhood or adolescence. The assessment was carried out using the Diagnostiches Interview bei psychischen Storungen-Forschungsversion. It is a modified version of the Anxiety Disorder Interview Schedule for DSM-IV-Lifetime version.Of the 1,966 subjects, 498 had experienced a traumatic event during either childhood or adolescence. Of those 498 subjects, 210 had experienced a trauma at age 12 years or younger (defined as children), and 288 after age 13 (defined as adolescents).In the child trauma group, 41 (23 percent) had experienced a major depression, and 30 (17 percent) had experienced posttraumatic stress disorder. In the adolescent trauma group, 16 (7 percent) had experienced a major depression, and 33 (13 percent) had experienced posttraumatic stress disorder.“We were able to show that experiencing a traumatic event in childhood (up to age 12 years) is related to higher rates of major depression than is experiencing a traumatic event in adolescence (after age 13 years),” the researchers observed in their report. “This age-related difference could not be found for posttraumatic stress disorder. In other words, there is a higher probability of developing major depressive disorder if a trauma is suffered during childhood than if the trauma occurs in adolescence.”Maercker told Psychiatric News, “The main result—the high prevalence of major depression in children—surprised me.”Why might traumatized children be more likely to experience a major depression rather than posttraumatic stress disorder? Perhaps because their brains are not yet developed enough to experience posttraumatic stress disorder. “We assume that development of posttraumatic stress disorder requires a certain maturation of memory organization and arousal modulation, which is not achieved before adolescence,” the researchers explained in their report.Two limitations of the study were that it was conducted only on women and that it was conducted retrospectively and might therefore be open to recall bias. Nonetheless, a 1991 study produced similar results—after a disaster, fewer posttraumatic stress disorder symptoms were found in children than in adolescents.An abstract of the study, “Age of Traumatisation as a Predictor of Posttraumatic Stress Disorder or Major Depression in Young Women,” is posted online at<http://bjp.rcpsych.org/cgi/content/abstract/184/6/482>.▪ Br J Psychiatry 2004 184 482 ISSUES NewArchived

Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents

Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents