Prevalence Of Depression In Children Research Articles

INCREASING AWARENESS OF DEPRESSION IN ADOLESCENTS AND CHILDREN THROUGH ONLINE CAMPAIGN ACTIVITIES

Cases of depression in children and adolescents show high rates in Indonesia. According to Riskesdas (2018) adolescents (15–24 years) in Indonesia have a percentage of depression around 6.2% and according to the Yogyakarta branch of Ikatan Dokter Anak Indonesia or Indonesian pediatrician association revealed that 3% of school-aged children and 6% of adolescents experience major depressive disorder. This sizable number comes from the assumption of the public that depression does not occur in children and adolescents. Therefore, the provision of information that increases public knowledge about depression in children and adolescents must be carried out so that both early and curative interventions can be carried out so that in the long run, the prevalence of depression in children and adolescents is reduced. This effort uses two methods 1) disseminating information through Instagram content @semicolonial.id, and 2) digital campaigns via Instagram of each campaign participant. The increase in knowledge of campaign participants (N = 21, Range age = 14–50 years, Mage = 23.5) was measured using pre-test and post-test. The data processing used a descriptive statistical data analysis through SPSS version 25. The results shows an increase in participants' knowledge before (Range = 40–100, Mean = 71.9) and after (Range = 60–110, Mean = 91.9) the campaign. In conclusion, this campaign was successful in increasing the knowledge of campaign participants about depression in children and adolescents.

Depression in Children with Epilepsy in a Teaching Hospital South/South Nigeria

Background: Epilepsy affects over 50 million in the world with a life time prevalence of 7.6%. It is the commonest paediatric neurological disorder and about 80% of these children live in the developing countries. Depression is the most common psychiatric comorbid condition in children with epilepsy.
 Objective: To investigate the prevalence of depression among children aged 9-18yr with epilepsy and evaluate factors associated with depression.
 Methods: 380 children with epilepsy were interviewed using researcher designed questionnaire, the clinical version of DICA-IV in a 2nd stage design, after having been screened with CES-DC. The study was descriptive with psychometric evaluation. Data obtained were analysed using SPSS version 22.0. p-values<0.05 were statistically significant.
 Results: Using the CES-DC with a cut- off point of 15 and above, 117 (30.8%) of the respondents had significant scores for depression. All the 117 who were interviewed with DICA-IV met the DSM-IV criteria for major depression with 40 (10.5%) of them currently very depressed requiring urgent attention. Sociodemographic factors of; sex revealed that males were more depressed than females p=0.000, OR: 0.86, Age showed 9-11yr with a strong association p=0.001, OR:1.91. Marital status- Divorced or separated parents showed a higher association p=0.01 OR:2.233. Children with longer duration of illness had a strong association p=0,025, OR:1.203 and the more frequent the seizures, the stronger the association p=0.001, OR:1,411.
 Conclusion: There is relativelhjy high prevalence of depression in children with epilepsy in Port Harcourt. More health education is needed to provide a comprehensive care.

Depression in Children and Adolescents with Chronic Kidney Disease-Review of Available Literature.

Depression is a significant health problem gaining increasing relevance, especially among children and adolescents. It is known that the incidence of depression is higher in patients suffering from chronic diseases, such as chronic kidney disease (CKD). This review aims to discuss the prevalence of depression in children and adolescents with CKD and its impact on the quality of life of these patients (HRQoL). The research was conducted using online databases with keywords: depression in children and adolescents, depression and chronic diseases, chronic kidney disease, and health-related quality of life. It was found that the risk for developing depression is higher for adolescents and females, and with the use of negative coping strategies, lack of caregiver nurturance, and poor socioeconomic status. In patients with pediatric CKD, the stage of the disease, age of CKD diagnosis, and type of treatment were found to significantly impact HRQoL and contribute to caregiver burden. Depression was more commonly found in children suffering from CKD. It causes significant mental distress to the child and contributes to the caregiver's burden. Screening for depression among CKD patients is advised. In depressed patients, transdiagnostic tools should be used to alleviate some of the symptoms. In children at risk of developing depression, preventative strategies should be considered.

Implementation of Depression Screening and Interventions Protocol in a Pediatric Neurology Residents’ Continuity Clinic: A Quality Improvement Project (P11-9.001)

<h3>Objective:</h3> We developed and implemented a depression screening and interventions (S&amp;I) protocol in our pediatric neurology residents’ continuity clinic. <h3>Background:</h3> The prevalence of depression in children with neurological disorders ranges from 10–30%. Co-morbid depression is an important factor in the care and quality of life of these patients. Early recognition of depression can lead to early engagement of mental health services and improvement of depressive symptoms. However, ubiquitous depression screening in pediatric neurology clinics remains a challenge. <h3>Design/Methods:</h3> A multidisciplinary team (resident leaders, program director, clinic manager, nurses, medical assistants, and social workers) developed the depression S&amp;I protocol. Patient Health Questionnaire-9 Adolescent (PHQ-9A) was administered to patients age 12 to 18 years, who were developmentally capable and agreed to complete the screening. Patients received individualized interventions based on our algorithm. Serial Plan-Do-Study-Act (PDSA) cycles were performed, over nine months, to improve efficacy and workflow. PDSA cycle 1 included protocol initiation and education of residents and clinic staff. PDSA cycle 2 included further promotion and addition of dotphrases in the electronic medical record (EMR) documentation. PDSA cycle 3 consisted of re-education and provision of reminder cards at workstations. Measures included percent of eligible patients screened and percent of screened patients who received appropriate interventions. <h3>Results:</h3> During PDSA cycle 1, 57% of eligible patients were screened, of which 79% received appropriate interventions. After PDSA cycle 2, screening and appropriate intervention rates remained stable at 58% and 81%, respectively. Following PDSA cycle 3, the screening rate increased by 13% while the appropriate intervention rate was relatively maintained (78%). During the study, 19% of patients had moderate and severe scores, and one patient endorsed active suicidal ideation. <h3>Conclusions:</h3> After implementation of the depression S&amp;I protocol, patient screening rates increased through education and EMR-based changes. Future research will include assessment of trends in patients’ scores and symptoms after protocol implementation. <b>Disclosure:</b> Dr. Choudhari has nothing to disclose. Dr. Lorenzo has nothing to disclose. Dr. Said has a non-compensated relationship as a Board of Directors, Representative of PCN with UCNS that is relevant to AAN interests or activities. Dr. Said has a non-compensated relationship as a Member, Professional Advisory Board with Epilepsy Foundation of Texas that is relevant to AAN interests or activities. Dr. Said has a non-compensated relationship as a Member, Diversity, Equity and Inclusion Committee with American Epilepsy Society that is relevant to AAN interests or activities.

Investigating the prevalence of depression in children and adolescents with cancer admitted to the oncology ward of Besat Hospital in Sanandaj

Introduction: Depression in children with cancer can complicate the course of the disease and cause many problems in the treatment process. Aim: The aim of this study was to determine the prevalence of depression in children and adolescents with cancer. Method: This study was a descriptive cross-sectional study. Forty children with cancer admitted to the oncology ward of Besat Hospital, Sanandaj, with an age range of 7- 17 years in 2016, who were selected and assessed using a demographic information checklist and the Children's Depression Inventory (Kovacs, 1979). After collecting data, the data were analyzed by SPSS-20 software using descriptive statistical tests and chi-square. Results: The 15% of the subjects had depressive symptoms and 47.5% were on the verge of depression. The prevalence of depression was 21.1% in girls and 9.5% in boys (p=0.54), and there was no significant difference in terms of cancer type (p=0.99), treatment method (p=0.81) and demographic indicators (p&gt;0.05). Conclusion: Due to the relatively high prevalence of depression in this group of patients, it is recommended that the necessary screenings be performed to identify and refer patients with depression to psychiatric or psychological clinics to receive appropriate and timely treatment to help improve the quality of life of these patients and their families.

2.29 Integrated Care in Pediatric Depression: A Review

The US Surgeon General has issued an advisory to highlight the urgent need to address the nation’s youth mental health crisis. The prevalence of depression in children and adolescents has been increasing; it is reported that 15% of adolescents have MDD. There is a shortage of pediatric mental health providers. Access to care is a major concern, and the majority of patients are seen by primary care physicians (PCPs). We conducted a systematic review of RCTs comparing integrated care with the usual care provided in primary care clinics in pediatric patients diagnosed with depression.

The prevalence of depression, anxiety, and stress among high school adolescent's children in public and private schools in Rangareddy district Telangana state: A cross-sectional study.

BACKGROUND:The depression, anxiety, and stress is a major educational problem among students all around the world. The purposes of this study were to determine the depression, anxiety, and stress among the high school adolescent children in public and private schools in Rangareddy district, Telangana state.MATERIALS AND METHODS:The present study was a cross-sectional study. The study sample considered 120 children from private schools and 259 children from public schools were studied. The study tool used was a questionnaire containing DASS (Depression, Anxiety, and Stress scale and sociodemographic characteristics. The data were expressed as proportion and mean values (Analysis of variance, independed t-test, and Pearson correlation) spatially tests were used at a significance level of P < 0.05).RESULTS:The overall prevalence of depression in children from the public school was found to be only 5%, that of anxiety was 20.8%, and that of stress was 15.8%; the overall prevalence of depression in children from private schools was found to be 1.9%, that of anxiety was 20.5%, and that of stress was 20.1%.CONCLUSION:In both schools, anxiety and atress were found to be more among study participants. Depression was observed to be less. But if they have more anxiety and stress and if not taken proper care at this point of time, it might get converted into a state of Depression.

Prevalence of Depression in Children with Specific Learning Disorder: The Role of Child-Parent and Child-Teacher Relationship

Objective: This study aimed to investigate the prevalence of depression in children with a Specific Learning Disorder (SLD) and the role of the child-parent and child-teacher relationship in predicting its symptoms. Methods: The research design was a correlation. From the total number of children with SLD, 596 students were selected by census method in Brujerd, Nahavand, and Malayer cities. The level 2—Depression—Parent/Guardian of Child version, child-parent (parent version), and child-teacher (teacher version) relationship scales were used to collect the data. Pearson correlation and simultaneous multivariate regression were used to analyze the data. Results: The results showed that severe, moderate, and mild depression rates in children with SLD were 15.10%, 25.17%, and 9.90%, respectively. There was a significant negative correlation between the closeness of child-parent (mother and father) and the teacher-child relationship with depression. There was a significant positive correlation between conflict and dependence on child-parent (parent) and teacher-child relationship with depression. All dimensions of the child-parent and child-teacher relationship except the closeness child-father relationship had a significant role in predicting depression in children with SLD. Based on the results, child-parent and child-teacher interactions reduce depressive symptoms in children with SLD. Conclusion: Based on the results, child-parent and child-teacher interaction training are suggested to reduce the symptoms of depression in children with SLD.

Childhood Depression: About 40 Cases Treated in the Child Psychiatry Unit of the Psychiatric Department of Conakry

Background&nbsp;: In this study we sought to determine the prevalence of depression in children, identify the contributing factors, the clinical signs and describe the various therapeutic behaviors Methods: It is a retrospective, descriptive and transversal study of ten years duration (from January 1, 2009 to December 31, 2019). It focused on 40 cases of depression in children aged from 1 to 12 years old and whose files included the different parameters of our study. Results: The prevalence of depression was 10.25%. The 20 cases collected were between 6 and 12 years old, 60% were male and 70% were referred by the nursing staff. The symptomatology described in the literature has been found in the majority of our patients. Ambulatory follow-up was the most predominant follow-up method, 95%; the combination of drug therapy and psychotherapy was the most used type of treatment, equivalent to 85%. The evolution was marked by complete remission (95%) of the symptomatology. Depression is a psychopathological disorder whose consequences are numerous, often identified at the relational and school level. This clinical reality is still unknown by the majority of the population and even by the Guinean medical community. Conclusion An awareness work on psychopathological disorders in children in general and depression in particular would be necessary.

Depression in children with epilepsy from western China: A cross-sectional survey.

This study investigated the prevalence of depression among children with epilepsy and evaluated factors associated with depression.Participants who met the selection criteria were included in this cross-sectional study, which was conducted at the Pediatric Neurology Department of the West China Women's and Children's Hospital from January to May 2018. Depression status among children with epilepsy was evaluated by the Depression Self-Rating Scale for Children (DSRSC). Information on sociodemographic characteristics, co-morbid diseases and family conditions were collected as independent variables. Variables found in univariate analysis to affect depression were used in a multiple linear regression model on factors related to depression among children with epilepsy.A total of 124 patients participated in the study, with a response rate of 93.9% (124/132). In this sample, 60.5% (75/124) of patients were male and the mean age of patients was 11.17 ± 2.29 years. The mean score on the DSRSC was 9.65 ± 6.45 and 16.9% (21/124) of children with epilepsy were considered to have depression. According to the multiple linear regression analysis, the DSRSC scores showed a significant correlation with comorbidities (B = 0.178; standard error (SE) = 1.123; P = .043), attitude towards seizures (B = -0.180; SE = 1.171; P = .039) and adverse reaction to medications (B = 0.233; SE = 1.797; P = .008).There is relatively high prevalence of depression in children with epilepsy in western China. More health education is needed to reduce the rate of depression in children with epilepsy, particularly for those patients with comorbidities, negative attitudes towards seizures and adverse reactions to medications.

0958 The Prevalence of Depression in Children With Chronic Sleep and Respiratory Disorders

Abstract Introduction In 2017, 13.3% of US adolescents aged 12 to 17 had at least one major depressive episode (NIMH, 2019). The risk of depression is higher in children with sleep apnea, and children with depression or anxiety have a 1.2-1.8 times higher rate of asthma related ED visits. Therefore, the purpose of this study was to determine the prevalence of depression symptoms in children with chronic disorders. We hypothesized that subjects with sleep disorders would have a higher prevalence of positive depression scores than subjects with respiratory disease, and that the prevalence would be highest in subjects with both conditions. Methods The Patient Health Questionnaire-9 (PHQ-9) was administered to children between the ages of 12 and 18 to screen for depression as part of a pulmonary or sleep clinic visit. Each patient’s PHQ-9 results were scored as normal, mild, moderate, or severe for levels of depression severity. Additionally, a chart review was conducted to gather their demographic and clinical data. Results Of a total of 87 subjects,71 (81.6%) had a respiratory disorder and 40 (46.0%) subjects had a sleep disorder. Due to the amount of overlap of respiratory and sleep disorders amongst the subjects, depression severity rather than chronic disease was chosen as the primary outcome. Using multiple linear regression, when all other factors were held constant, the average depression score increased by 5.0 when patients had a combination of asthma and obstructive sleep apnea (p-value = 0.02) and also increased by 2.4 for subjects who were female (p-value = 0.01). Conclusion It is important to identify depression in children with chronic illness, as it can lead to higher healthcare utilization. Additionally, as mental health status may significantly impact health outcomes for patients with chronic disease, it would be beneficial to evaluate mental health in all pediatric patients with chronic disease. However, further research is needed to investigate these associations. Support None

The prevalence of depression in children and adolescents under 18 years of age treated for mental disorders in Poland between 2005 and 2016.

The prevalence of depression in Polish children and adolescents under 18 years of age treated for mental disorders has increased in the last few years in Poland. The purpose of this study was to examine the prevalence of major depression in a population of Polish children and adolescents under 18 years of age treated for mental disorders, stratified by sex and place of residence, in the years 2005, 2009, 2014, and 2016. We analysed the psychiatric treatment data of children and adolescents under the age of 18 years in Poland compiled by the Institute of Psychiatry and Neurology in Warsaw for these years. Major depression was moderately prevalent among children and adolescents treated in all evaluated types of mental health facilities, with a prevalence in this population ranging from 0.8% in 2005 to 4.3% in 2016. The rates of young patients with mood disorders increased from 3.1% in 2005 to 7.0% in 2016. Risk factors for developing major depression in our research group were: being female and living in an urban area. Our findings suggest the need to increase the service capacity for children and adolescents as well as to intensify preventive measures to improve the mental health status of this age group.

Prevalence of Depression in Patients with Juvenile Idiopathic Arthritis Presenting at a Tertiary Care Hospital.

Background and objectiveJuvenile idiopathic arthritis (JIA) is an idiopathic autoimmune rheumatic disorder in children. JIA has been associated with depression and has a negative psychological impact on patients' quality of life. The aim of the study is to determine the prevalence of depression in patients with JIA presenting at a tertiary care hospital in Islamabad, Pakistan.Materials and methodsThis cross-sectional study, conducted at the Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, included 100 children aged >6 years who had been diagnosed with JIA according to the 2004 revised International League of Associations for Rheumatology classification. Physical disability was measured using the Childhood Health Assessment Questionnaire disability index (CHAQ-DI), whereas depression was assessed by measuring their Center for Epidemiological Studies Depression Scale for Children (CES-DC) scores. Results were analyzed using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp.), with p-values ≤ 0.05 considered statistically significant.ResultsThe 100 patients included 54 male patients (mean age, 16.3 ± 4.9 years) and 46 female patients (mean age, 18.6 ± 5.1 years). CES-DC scores showed that 72 patients with JIA had significant depression. Of these 72 patients, 50 (69.4%) had mild, 21 (29.2%) had moderate, and one (1.4%) had severe disability according to CHAQ-DI criteria. Age was the only effect modifier significantly associated with significant depression in patients with JIA (P < 0.05).ConclusionA cross sectional survey was carried out to find prevalence of depression in children with JIA. Physical disability and depression were measured using standardized tools. The percentage of significant depression among children with JIA is very high in our local population and was significantly associated with disease severity. Our findings emphasize the need to initiate early and prompt measures to prevent depression and reduce overall morbidity in patients with JIA.

Depression. Anxiety and Stress among high school adolescent children in public and private schools: A comparative study

Background: With increasing competition children today experience more stress and academic pressure which is harmful for the well-being of the children and can result in devastating life situations. Objective: To study and compare the prevalence of depression, anxiety and stress among high school adolescent children in public and private schools Methods: A cross sectional comparative study was carried out among high school adolescent children. 120 children from private schools and 259 children from public schools were studied. DASS questionnaire was used to assess the depression, anxiety and stress among the study subjects. The data was expressed as proportion, and mean values. Appropriate statistical tests were applied. Results: In public schools, the female’s proportion was more compared to males 58.3% vs. 42% respectively while in private schools, both sexes were equally distributed. In public schools’ majority of the children were in tenth class while in private schools’ majority were in the ninth class at the time of the study. the overall prevalence of depression in the children from the public schools was found to be only 5%, that of anxiety was 20.8% and that of stress was 15.8%. the overall prevalence of depression in children from private schools was found to be 1.9%, that of anxiety was 20.5% and that of stress was 20.1%. 19% resorted to TV watching, 8.4% used internet, 17.4% reported playing, 13% engaged themselves in music, 37% spent time with friends, and 6% said they were busy with some or the other hobbies to cope with the depression, anxiety and stress. The mean score of depression and anxiety was found to be similar in children from public and private schools. But the stress score was significantly higher in children from public schools i.e. 21.6 compared to children from private schools i.e. 16.9 (p < 0.05). Conclusion: In both the school’s anxiety and stress were found to be more among study participants. Depression was observed to be in less. But if they have more anxiety and stress and if it not taken proper care at this point of time, it might get converted into a state of depression.

Clinical Practice Guidelines for the management of depression in children and adolescents.

Over the last half century, it is now well established that depression can occur at any age, and it has been documented as early as infancy. In terms of epidemiology, different studies which have evaluated the prevalence of depression in children and adolescents suggest that the prevalence varies according to the different age groups. Prevalence figures reported for infants vary from 0.5% to 3% in clinic population, whereas in preschool children, the prevalence rate for major depression (1.4%) has been reported to be higher than depression not otherwise specified (0.7%) and dysthymia (0.6%). Studies done in community settings suggest the prevalence of depression in children to range from 0.4% to 2.5% and among adolescents to be from 0.4% to 8.3%. Lifetime prevalence through adolescence is considered to be as high as 20%. Prior to puberty, depression is known to have equal gender representation; however, among adolescents, the male: female ratio is 1:2. Over the years, it has also been understood that depression in children and adolescents is a chronic and relapsing condition, which does not remits spontaneously and hence, there is a need to identify and treat the same at the earliest to reduce its long-term negative consequences. Childhood depression has been shown to lead to an increased risk of poor academic performance, impaired social functioning, suicidal behavior, homicidal ideation, and alcohol/substance abuse. It is also associated with an increased risk of recurrent depressive episodes. Unfortunately, a major proportion of depression in children and adolescents is underdiagnosed and undertreated.

Depression in children with thalassemia major: prevalence and contributing factors

Background Thalassemia major is a chronic disease requiring lifetime treatment. A recent study showed that 11-62% of thalassemia patients developed depression, which is associated with high morbidity and mortality. Understanding the extent of the problem related to depression and its contributing factors is important for early management.&#x0D; Objective To determine the prevalence and contributing factors for depression in children with thalassemia major.&#x0D; Methods This cross-sectional observational analytic study included thalassemia major patients aged 7 to &lt;18 years in the Department of Child Health, Dr. Moh. Hoesin General Hospital (RSMH) in Palembang from June to July 2018 and had received blood transfusions at least 3 times. Subjects completed the Children’s Depression Inventory (CDI) questionnaire. Depression was defined as a total score &gt; 13. Data were analyzed using SPSS for Windows ver. 22.0.&#x0D; Results There were 64 patients included in this study, with mean age 12 (SD 3) years and 82.8% female. Most subjects came from families with low socio-economic status and low parental education. Deferiprone was the most commonly used type of iron-chelating agent. Depression was detected in 34.4% of respondents. Multivariate analysis revealed that factors affecting depression in children with thalassemia major were low maternal education (OR 4.014; 95%CI 1.066 to 15.112) and use of deferasirox (OR 4.129; 95%CI 1.168 to 14.601).&#x0D; Conclusion Prevalence of depression in children with thalassemia major is 34.4%. Low maternal education and deferasirox use as an iron-chelating agent are associated with depression in children with thalassemia major.

A Population-based Prevalence Study of Depression Among Children and Adolescent Based On Calgary Health Utilization Data

Introduction The rate of mental disorders among children and adolescent has doubled in the Calgary Health Region over the last 15-years. Objective To examine prevalence of depression in children and adolescent and determine the most frequent ICD diagnosis given a physician-assigned depression diagnosis. Aims We examined the annual and 15-year cumulative prevalence of major depression in a population of children and adolescent in the Calgary Health Region and determined the most frequent diagnosis of physical disorders given a depression diagnosis. Methods We used direct physician billing data for the Calgary health region (Calgary, Alberta) from 1994-2009 for treatment of any presenting concern (n = 763449). We identified 537 unique individuals (191 males) with a physician-assigned diagnosis of major depression. Odds ratios were used to identify the most frequent physical disorders given a depression diagnosis. Results The 15-year cumulative prevalence among help-seeking population for major depression was 22.6 per 10,000. The annual rates of major depression increased twofold from 1.7 to 4.5 per 10,000. The cumulative prevalence rates of major depression were 29 (CI 26-33) per 10,000 for females and 16 (CI 14-18) per 10,000 for males. ICD codes under injury and poisoning were found to have the highest odds ratio followed by genitourinary system in relation to Major Depression diagnosis. Conclusion The twofold increase of major depression is consistent with the overall doubling of mental disorders among children and adolescent in the Calgary health region and has important planning and policy implications.

Prevalence of Depression in Children With Asthma

Background: Asthma has high prevalence in children (7-10%). Many psychiatric factors including personality traits, psychiatric diseases, family environment and demographic characteristics such as age and gender can influence treatment success. Children with moderate to severe asthma have more psychiatric, social and physical problems. Objectives: The current study aimed to evaluate the psychiatric features and correlation of demographic features in children with asthma for their better treatment. Materials and Methods: The current study was observational and cross-sectional with completion of General Health Questionnaire - 28 (GHQ-28) and Demographic Information Questionnaire. The population constituted 177 subjects. The samples were selected by accessible method. Data were analyzed by SPSS-16 (Statistical Package for Social Science), and correlation between the variables was investigated through T and Chi-Square tests. Results: The mean age of participants was 10 ± 4 years (66% girls and 34% boys). The incidence of depression was found to be 45%, which occurred in 64.5% of the boys and 35.5% of the girls. Among the children`s parents with psychiatric disturbance 2.6% smoked cigarettes, and 53.9% and 46.1% of the children with depression were born naturally by cesarean, respectively. Significant correlation existed between questionnaire score, social interaction, weight, and height of children (P > 0.05). Significant correlation was found between social interaction and gender (P = 0.023). Conclusions: Despite high incidence of depression among hospitalized children with asthma, and correlation of some demographic variables, it is recommended that they are evaluated for psychiatric status and treatment along with treating their asthma. Serious psychological problems as well as recommended treatment for patients with asthma should be considered.

Depression in paediatric chronic fatigue syndrome

ObjectiveTo describe the prevalence of depression in children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and investigate the relationship between depression in CFS/ME and clinical symptoms such as fatigue, disability,...

Interventions for childhood depression.

Professor Du has provided a succinct summary of child and adolescent depression and its treatment with antidepressants.[1] There remains some controversy over the prevalence of depression in children and adolescents: Professor Du reports that 20% of individuals experience depression prior to the age of 18 while other epidemiological reports indicate that the rate is closer to 17%.[2]–[4] But this difference in rates is relatively small and may be due to methodological differences in the studies. As noted by Professor Du, suicidal ideation may increase in depressed children and adolescents who receive antidepressant treatment, but the rates of suicidal acts do not appear to increase. Overall, the beneficial effects of antidepressants, at least among depressed teenagers, appear to outweigh the risks.[5] Fortunately, the incidence of depression is lower in children than in adolescents. Antidepressant use is of greatest concern in younger children: physicians are more willing to prescribe fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) ‘off label’ for older adolescents with depression than they are for younger adolescents and children. For children, non-pharmacological psychosocial treatments such as Behavioral Activation[6],[7] (that may more easily be rendered age-appropriate than cognitive-behavioral therapy [CBT] or interpersonal psychotherapy [IPT]) are increasingly available and appear to be efficacious. A new and important direction of research on childhood depression is the focus on preventing depression. Investigators throughout the world have implemented and evaluated specific interventions to prevent the occurrence of a first full-criteria episode of depression in children. Universal prevention programs are applied to entire populations of children (e.g., all the students in a school). Indicated prevention programs are targeted on selected ‘high-risk’ (or ‘at-risk’) children–those with identifiable risk factors (e.g., cognitive distortions) or subsyndromal depressive symptoms.[8],[9] Universal programs have produced small effect sizes and their long-term results have, at best, been described as ‘mixed’.[10] Findings for Indicated prevention programs have been more encouraging: a CBT-based prevention program[11] effectively prevented depressive episodes among children of parents who suffered from depressive disorders; and a large U.S. prevention study based on CBT principles[12] prevented depression among at-risk children (unless there was a depressed mother in the child's household). Similarly, a school-based CBT program[13] administered by current school staff to at-risk 14- and 15-year olds (the peak age for the onset of adolescent depression) in Iceland prevented an initial episode of depression and the preventive effects were maintained over a 1-year follow-up period. This program is currently being evaluated in a prevention program in schools in Portugal. These findings about the prevention of childhood depression are important for a number of reasons. First, the prevention of an initial episode of depression among children at risk prevents the personal, social and societal effects of a Major Depressive Episode. Second, data show clearly that once a first episode of depression has occurred, the risk of a second episode is greatly increased, so the prevention (or at least delay) of an initial episode may forestall the development of a chronic relapsing condition.[3] The delay in onset of the initial episode also allows more time for the development of academic and social skills and more time for the maturation of neural pathways of resilience among at-risk youth. And since antidepressant use is more acceptable in older than younger adolescents, delay of the initial episode of depression will have the result that a wider range of alternative treatments are available if and when a Major Depressive Episode occurs.