Skip to main content

Abstract

Children with depression often first present with symptoms in the primary care setting. Because the clinical presentation in children can vary from the classic melancholy presentation that characterizes adult depression, symptoms often go unrecognized or misdiagnosed. Depression can be a debilitating disorder that impairs a child’s functioning at school and home. Recurrence of a depressive episode and persistent symptoms are common, and therefore, impairment can continue into adulthood, affecting the child’s trajectory. This chapter describes signs and symptoms of depression, along with risk and protective factors. It goes on to discuss making a diagnosis within a primary care setting, determining treatment options, and evaluating the need for specialty care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. WHO. Depression. Geneva: World Health Organization; 2017. Available from: http://www.who.int/mediacentre/factsheets/fs369/en/.

    Google Scholar 

  2. American Psychiatric Association. Depressive disorders. Diagnostic and statistical manual of mental disorders. 5th ed. Philadelphia, PA: American Psychiatric Association; 2013.

    Book  Google Scholar 

  3. Dulcan MK, editor. Depressive and disruptive mood dysregulation disorders. 2nd ed. Philadelphia, PA: American Psychiatric Association Publishing; 2016.

    Google Scholar 

  4. Birmaher B, Brent D. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1503–26.

    Article  Google Scholar 

  5. Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, et al. Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry. 1996;35(11):1427–39.

    Article  CAS  Google Scholar 

  6. Sullivan PF, Neale MC, Kendler KS. Genetic epidemiology of major depression: review and meta-analysis. Am J Psychiatry. 2000;157(10):1552–62.

    Article  CAS  Google Scholar 

  7. Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord. 2004;82(2):217–25.

    Article  Google Scholar 

  8. Kendler KS, Thornton LM, Gardner CO. Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression. Am J Psychiatry. 2001;158(4):582–6.

    Article  CAS  Google Scholar 

  9. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, et al. Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science. 2003;301(5631):386–9.

    Article  CAS  Google Scholar 

  10. Martin A, Volkmar FR, Lewis M. Lewis’s child and adolescent psychiatry: a comprehensive textbook. Philadelphia, PA: Wolters Kluwer Health; 2007.

    Google Scholar 

  11. Birmaher B, Arbelaez C, Brent D. Course and outcome of child and adolescent major depressive disorder. Child Adolesc Psychiatr Clin. 2002;11(3):619–37.

    Article  Google Scholar 

  12. Costello EJ, Pine DS, Hammen C, March JS, Plotsky PM, Weissman MM, et al. Development and natural history of mood disorders. Biol Psychiatry. 2002;52(6):529–42.

    Article  Google Scholar 

  13. Dixon JF, Ahrens AH. Stress and attributional style as predictors of self-reported depression in children. Cogn Ther Res. 1992;16(6):623–4.

    Article  Google Scholar 

  14. Garber J, Keiley MK, Martin NC. Developmental trajectories of adolescents’ depressive symptoms: predictors of change. J Consult Clin Psychol. 2002;70(1):79–95. https://doi.org/10.1037/0022-006X.70.1.79.

    Article  PubMed  Google Scholar 

  15. Gladstone TRG, Kaslow NJ. Depression and attributions in children and adolescents: a meta-analytic review. J Abnorm Child Psychol. 1995;23(5):597–606.

    Article  CAS  Google Scholar 

  16. Costello DM, Swendsen J, Rose JS, Dierker LC. Risk and protective factors associated with trajectories of depressed mood from adolescence to early adulthood. J Consult Clin Psychol. 2008;76(2):173–83. https://doi.org/10.1037/0022-006X.76.2.173.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lewinsohn PM, Clarke GN, Seeley JR, Rohde P. Major depression in community adolescents: age at onset, episode duration, and time to recurrence. J Am Acad Child Adolesc Psychiatry. 1994;33(6):809–18. https://doi.org/10.1097/00004583-199407000-00006.

    Article  CAS  PubMed  Google Scholar 

  18. Weissman MM, Orvaschel H, Padian N. Children’s symptom and social functioning self-report scales: comparison of mothers’ and children’s reports. J Nerv Ment Dis. 1980;168:736–40.

    Article  CAS  Google Scholar 

  19. American Academy of Pediatrics Bright Futures. https://www.brightfutures.org/development/adolescence/depression.html.

  20. Bhatia SK, Bhatia SC. Childhood and adolescent depression. Am Fam Physician. 2007;75:73–80.

    PubMed  Google Scholar 

  21. Thomas JF, Temple JR, Perez N, Rupp R. Ethnic and gender disparities in needed adolescent mental health care. J Health Care Poor Underserved. 2011;22(1):101–10. https://doi.org/10.1253/hpu.2011.0029.

    Article  PubMed  Google Scholar 

  22. Alegria M, Vallas M, Pumariega A. Racial and ethnic disparities in pediatric mental health. Child Adolesc Psychiatr Clin N Am. 2010;19(4):759–74. https://doi.org/10.1016/j.cbc.2010.07.001.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. Am J Psychiatry. 2002;159:1548–55.

    Article  Google Scholar 

  24. Shaw RJ, DeMaso DR. Clinical manual of pediatric psychosomatic medicine: mental health consultation with physically ill children and adolescents. Washington, DC: American Psychiatric Publishing, Inc.; 2006.

    Google Scholar 

  25. Waller DA, Rush AJ. Differentiating primary affective disease, organic affective syndromes, and situational depression on a pediatric service. J Am Acad Child Psychiatry. 1983;22(1):52–8.

    Article  CAS  Google Scholar 

  26. Rundell JR, Wise MG. Causes of organic mood disorder. J Neuropsychiatry Clin Neurosci. 1989;1(4):398–400.

    Article  CAS  Google Scholar 

  27. Goodman E, Whitaker RC. A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics. 2002;110(3):497–504.

    Article  Google Scholar 

  28. Essau CA. Comorbidity of substance use disorders among community-based and high-risk adolescents. Psychiatry Res. 2011;185(1-2):176–84.

    Article  Google Scholar 

  29. Libby AM, Orton HD, Stover SK, Riggs PD. What came first, major depression or substance use disorder? Clinical characteristics and substance use comparing teens in a treatment cohort. Addict Behav. 2005;30(9):1649–62.

    Article  Google Scholar 

  30. Riggs PD, Mikulich SK, Coffman LM, Crowley TJ. Fluoxetine in drug-dependent delinquents with major depression: an open trial. J Child Adolesc Psychopharmacol. 1997;7(2):87–95.

    Article  CAS  Google Scholar 

  31. Jellinek MS, Murphy JM, Robinson J, Feins A, Lamb S, Fenton T. The pediatric symptom checklist: screening school-age children for psychosocial dysfunction. J Pediatr. 1998;112:201–9.

    Article  Google Scholar 

  32. Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282(18):1737.

    Article  CAS  Google Scholar 

  33. Jellinek MS, Murphy JM, Burns BJ. Brief psychosocial screening in outpatient pediatric practice. J Pediatr. 1986;109(2):371–8.

    Article  CAS  Google Scholar 

  34. Chorpita BF, Moffitt CF, Gray J. Psychometric properties of the revised child anxiety and depression scale in a clinical sample. Behav Res Ther. 2005;43(3):309–22.

    Article  Google Scholar 

  35. Radloff LS. The CES-D Scale. Appl Psychol Measur. 1977;1(3):385–401.

    Article  Google Scholar 

  36. Angold A, Costello EJ. Mood and feelings questionnaire (MFQ). developmental epidemiology program. Durham, NC: Duke University; 1987.

    Google Scholar 

  37. Angold A, Costello EJ, Messer SC, Pickles A, Winder F, Silver D. The development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res. 1995;5:237–49.

    Google Scholar 

  38. Jellinek MS, Patel BP, Froehle MC. Bright futures in practice: mental health Vol 2. Tool kit. Arlington, VA: National Center for Education in Maternal and Child Health; 2002. p. 57–8. Center for Epidemiological Studies Depression Scale for Children (CES-DC). Available at http://www.brightfutures.org/mentalhealth/pdf/professionals/bridges/ces_dc.pdf. Accessed 9 Nov 2017.

    Google Scholar 

  39. Faulstich ME, Carey MP, Ruggiero L, et al. Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Am J Psychiatry. 1986;143(8):1024–7.

    Article  CAS  Google Scholar 

  40. Garrison CZ, Addy CL, Jackson KL, McKeown RE, Waller JL. The CES-D as a screen for depression and other psychiatric disorders in adolescents. J Am Acad Child Adolesc Psychiatry. 1991;30:636–41.

    Article  CAS  Google Scholar 

  41. Johnson JG, Harris ES, Spitzer RL, Williams JBW. The Patient Health Questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health. 2002;30:196–204.

    Article  Google Scholar 

  42. Kroenke K, Spitzer RL, Williams J. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(14):1284–92. https://doi.org/10.1097/01.MLR.0000093487.78664.3C.

    Article  PubMed  Google Scholar 

  43. Kroenke K, Spitzer RL, Williams J. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2003. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.

  44. Sharp LK, Lipsky MS. Screening for depression across the lifespan: a review of measures for use in primary care settings. Am Fam Physician. 2002;66(6):1001–8.

    PubMed  Google Scholar 

  45. Hazell P. Depression in children and adolescents. Evid Based Ment Health. 2003;6:103–4. https://doi.org/10.1136/ebmh.6.4.103.

    Article  PubMed  Google Scholar 

  46. Weisz JR, McCarty CA, Valeri SM. Effects of psychotherapy for depression in children: a meta-analysis. Psychol Bull. 2006;132(1):132–49. Available from: http://www.who.int/mediacentre/factsheets/fs369/en/.

    Article  Google Scholar 

  47. Merry S, McDowell H, Hetrick S, Bir J, Muller N. Psychological and/or educational interventions for the prevention of depression in children and adolescents. Cochrane Database Syst Rev. 2004;2004(2):Art. No.: CD003380. https://doi.org/10.1002/14651858.CD003380.pub2.

    Article  Google Scholar 

  48. Stice E, Shaw H, Bohon C, Marti CN, Rohde P. A meta-analytic review of depression prevention programs for children and adolescents: factors that predict magnitude of intervention effects. J Consult Clin Psychol. 2009;77(3):486–503. https://doi.org/10.1037/a0015168.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Practicewise.com.

  50. Arsanaw J, et al. Long-term benefits of short-term quality improvement interventions for depressed youths in primary care. Am J Psychiatry. 2009;166(3):1002–10. https://doi.org/10.1176/appi.ajp.2009.08121909.

    Article  Google Scholar 

  51. Sterling S, et al. Implementation of screening, brief intervention, and referral to treatment for adolescents in pediatric primary care: a cluster randomized trial. JAMA Pediatr. 2015;169(11):e153145. https://doi.org/10.1001/jamapediatrics.2015.3145.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Tompson MC, Boger KD, Asarnow JR. Enhancing the developmental appropriateness for depression in youth: integrating the family in treatment. Child Adolesc Psychiatry. 2012;21(2):345–84.

    Article  Google Scholar 

  53. Reinecke MA, Ryan NE, DuBois DL. Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 1998;37(1):26–34.

    Article  CAS  Google Scholar 

  54. Harrington R, Whittaker J, Shoebridge P, Campbell F. Systematic review of efficacy of cognitive behavior therapies in childhood and adolescent depressive disorder. BMJ. 1998;316:1559–63.

    Article  CAS  Google Scholar 

  55. Glad-PC Steering Committee. Guidelines for adolescent depression in primary care (Glad-PC) toolkit. http://www.gladpc.org.

  56. Centers for Disease Control and Prevention. https://www.cdc.gov/childrensmentalhealth/depression.html.

  57. American Academy of Child and Adolescent Psychiatry. Suicide in children and teens. http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teen-Suicide-010.aspx.

  58. American Academy of Child and Adolescent Psychiatry. Depression Resource Center. http://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Depression_Resource_Center/FAQ.aspx#What%20are%20the%20signs%20and%20symptoms%20of%20depression?.

  59. American Academy of Child and Adolescent Psychiatry. Depression in children and teens. http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Depressed-Child-004.aspx.

  60. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression/index.shtml.

  61. Shen N, Levitan MJ, Johnson A. Finding a depression app: a review and content analysis of the dperession app marketplace. JMIR Mhealth Uhealth. 2015;3(1):e16. https://doi.org/10.2196/mhealth.3713.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Crawford L. There’s an app for that feeling. 2016. www.greatschools.org/gk/category/emotional-smarts/.

  63. Payne HE, Liste C, West JH, Bernhardt JM. Behavioral functionality of mobile apps in health interventions: a systematic review of the lliterature. JMIR Mhealth Uhealth. 2015;3(1):e20. https://doi.org/10.2196/mhealth.3335.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Labbate LAF, Maurizio F, Rosenbaum JF, Arana GW. Handbook of psychiatric drug therapy. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.

    Google Scholar 

  65. American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry. The use of medication in treating childhood and adolescent depression: information for patients and families. Washington, DC: American Psychiatric Association; 2010. ParentsMedGuide.org.

    Google Scholar 

  66. March JS, Vitiello B. Clinical messages from the Treatment for Adolescents with Depression Study (TADS). Am J Psychiatry. 2009;166(10):1118–23.

    Article  Google Scholar 

  67. US Federal Drug Administration. Antidepressant use in children, adolescents, and adults. 2007. http://foodconsumer.org/7777/8888/Non-f_ood_Things_27/050408232007_FDA_Antidepressant_Use_in_Children_Adolescents_and_Adults.shtml.

  68. Friedman RA. Antidepressants’ black-box warning – 10 years later. N Engl J Med. 2014;371(18):1666–8.

    Article  Google Scholar 

  69. Kafali N, Progovac A, Hou SS-Y, Cook BL. Long-run trends in antidepressant use among youths after the FDA black box warning. Psychiatr Serv. 2017;69(4):389–95. https://doi.org/10.1176/appi.ps.201700089.

    Article  PubMed  Google Scholar 

  70. Valenstein M, Kim HM, Ganoczy D, et al. Antidepressant agents and suicide death among US Department of Veterans Affairs Patients in Depression Treatment. J Clin Psychopharmacol. 2012;32(3):346–53.

    Article  CAS  Google Scholar 

  71. Wooltorton E. Paroxetine (Paxil, Seroxat): increased risk of suicide in pediatric patients. Can Med Assoc J. 2003;169(5):446.

    Google Scholar 

  72. Axelson DA, Perel JM, Birmaher B, Rudolph GR, Nuss S, Bridge J, et al. Sertraline pharmacokinetics and dynamics in adolescents. J Am Acad Child Adolesc Psychiatry. 2002;41(9):1037–44.

    Article  Google Scholar 

  73. Findling RL, McNamara NK, Stansbrey RJ, Feeny NC, Young CM, Peric FV, et al. The relevance of pharmacokinetic studies in designing efficacy trials in juvenile major depression. J Child Adolesc Psychopharmacol. 2006;16(1-2):131–45.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

McMickens, C.L., Landers, A.J. (2018). Depression. In: Vinson, S., Vinson, E. (eds) Pediatric Mental Health for Primary Care Providers. Springer, Cham. https://doi.org/10.1007/978-3-319-90350-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90350-7_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90349-1

  • Online ISBN: 978-3-319-90350-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics