Depression in children and adolescents is a common problem, although it is, in most cases, not recognized. Approximately two percent of children below puberty age experience the disorder, while 5-8 percent of all adolescents suffer from the condition. The clinical spectrum for depression ranges from sadness to disorders such as major depression. Risk factors related to the disorder are family history, among others. In the past three decades, depression was perceived as a predominantly adult problem. Adolescents and children were seen as developmentally not mature to experience depression. The low mood experienced by some adolescents was perceived as a normal aspect of the mood swings expressed by teenagers. However, research on development has changed these perceptions. Almost all the studies now agree that children and adolescents also experience depressive disorders. Depression in children and adolescents is linked to adverse outcomes such as social impairment and mental problems, among other issues later in life. It is a severe problem that can result in suicide if left untreated. In most cases, depression has biological, social, and psychological causes.
Epidemiology
The prevalence of depression among children and adolescents in the United States is estimated to be 1% for preschool children, 2% for school-going children, and 5-8% of adolescents. Depression’s prevalence seems to be on the increase in successive generations, and the onset is at an earlier stage in life. The number of male and female pre-puberty children experiencing depression is equal. However, in adolescents, male: female ratio is 1:2. Existing evidence shows that both children and adolescents suffer from different mood disorders, as well as a significant number of deaths and morbidity related to the disorders ( Bernaras et al., 2019 ). An increase in suicide rates is now a major public health issue because the number of suicides among children and adolescents is on the increase.
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Signs of Depression in Children and Adolescents
Depression during childhood is mostly characterized by persistent sadness. The affected child feels lonely, hopeless, lack of self-worth, and helplessness ( Ismach & Fish, 2010 ). Such feelings can last for weeks or several months. Children and adolescents experiencing depression are irritable, lack interest, and are socially isolated. The disorder may also present some physical symptoms that include changes in sleeping patterns, digestive problems, feeling fatigued, and appetite changes (Hurst, 2015). In addition, the affected children and adolescents may find it hard to concentrate. As a consequence of the condition, daily activities, education, and peer relationships are negatively affected.
Causes of Depression in Children and Adolescents
Depression is a complicated disorder caused by several factors as well as causal pathways. Existing literature argues that depression in the age groups is caused by a family history of depression, psychosocial factors, gene-environment, neurocognitive and neuroendocrine factors, and developmental issues. These factors are discussed in depth below.
Family History of Depression
Studies indicate that depression experienced by children of all ages and adolescents is caused by a family history of depression. In addition, being exposed to stressing and depressing situations in life are the primary risk factors of depression. The condition runs in different families, and the risk of developing the condition among children from such families is significantly increased. Factors inherited from families are, to some extent, responsible for the depression, although some genome studies are still in the process of identifying the replicated genetic variants related to depression (Thapar et al., 2012). Studies on genetics and depression also claim that psychosocial pathways are also responsible for depression transmission in families. There exists a high risk of developing depression in children born of depressed women even when there is no biological relationship between the mothers and children pairs.
Psychosocial Factors
The psychosocial factors that contribute to depression in children and adolescents are bereavement in families, divorce, family conflicts, child abuse and maltreatment, being bullied, child neglect, and peer conflicts ( O’Shea et al., 2013 ). Chronic stressful situations that affect relationships have a greater effect than occasional acute situations, especially among females (Thapar et al., 2012). There are etiological variations between the onset of depression in adults, adolescents, and children. A balance between inherited factors and environmental aspects varies with studies showing that risks for heredity in depression are lower in children compared to adolescents (Maughan et al., 2013). In addition, depression onset in children and adults have different psychosocial factors with depression in children and adolescents strongly linked to poverty during childhood, neglect, and relationship problems.
Gene-Environment Factors
Existing evidence propose that genes and the environment work together to cause vulnerability to depression in children and adolescents (Kwon, 2017). Heritable aspects increase the risk of exposure to stressing situations and being susceptible to psychosocial stress. A type of serotonin gene known as 5-HTTLPR is considered important in the onset of depression in children. One of its variants is known to increase the risk of developing depression in adolescents and children exposed to stressful situations in life or maltreatment.
Neurocognitive and Neuroendocrine Mechanisms
Certain neurocognitive and neuroendocrine mechanisms play a part in the onset of depression in children and adolescents. The mechanisms are influenced by activities in the neural circuits that take part in threat and reward processing (Maughan et al., 2013). In processing both rewards and threats, the circuits are associated with an increased risk of developing depression. According to Maughan et al. (2013), the circuit involved in threats is linked to HPA axis as well as other related areas such as the amygdala and the prefrontal cortical area among other regions. The rewards circuit links different related areas, such as the striatum and the ventral dopamine-related areas, among others. The two types of circuits continuously mature and demonstrate emergent sex variations during adolescence.
Developmental Factors
Childhood and adolescent depression from a developmental opinion are related to factors that lead to an increase in depression after puberty and emergent variations in sex (Maughan et al., 2013). Some of the developmental mechanisms related to depression during childhood and adolescence include gender variations in cognitive processing of situations that cause stress and coping strategies. Also, more exposure and being sensitive to psychosocial stress among female adolescents, changes in hormones related to puberty, and changes related to brain development are related to the onset of depression. Furthermore, adolescents encounter different challenges related to development as they attempt to become autonomous and seek identity (Klein et al., 2009). They rely on their friends and peers as they strive to meet the challenges. This period creates an environment for such adolescents to develop a sense of despair and lack of hope. If persistent, such a situation can lead to depression in adolescents.
Conclusion
Children and adolescent depression is a disorder related to emotions affecting individuals who are below the age of eighteen years. Similar to adult depression, childhood and adolescent depression is characteristic of a persistent sense of hopelessness, feeling sad, and reduced self-esteem. The symptoms can be experienced for weeks or several months. The disorder is most common today than it was in the past two or three decades. The disorder in children and adolescents is, in most cases, not diagnosed and is left untreated. Besides psychological signs such as lack of interest, physical signs such as changes in appetite are experienced. Depression in children and adolescents is caused by different factors that include a family history of depression, gene-environment factors, psychosocial aspects, and developmental factors, among others. If untreated, depression may cause adverse effects that can last for a lifetime.
References
Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and adolescent depression: A review of theories, evaluation instruments, prevention programs, and treatments. Frontiers in Psychology , 10 . https://doi.org/10.3389/fpsyg.2019.00543
Ismach, M., & Fish, M. C. (2010). Familial factors associated with symptoms of depression in preschool children. PsycEXTRA Dataset . https://doi.org/10.1037/e642452010-001
Klein, D. N., Shankman, S. A., Lewinsohn, P. M., & Seeley, J. R. (2009). The identification of risk factors in adolescents with subthreshold depression who later develop diagnosable depression. PsycEXTRA Dataset . https://doi.org/10.1037/e507212010-006
Kwon, S. (2017). Effects of traumatic experiences on suicidal ideation among Korean adolescents: The roles of depression and self-esteem. https://doi.org/10.26226/morressier.5971be87d462b80290b534e8
Maughan, B., Collishaw, S., & Stringaris, A. (2013). Depression in Childhood and Adolescence. Journal of the Canadian Academy of Child and Adolescent Psychiatry , 22 (1), 35–40..
O’Shea, G., Spence, S. H., & Donovan, C. L. (2013). Interpersonal factors associated with depression in adolescents: Are these consistent with theories underpinning interpersonal psychotherapy? Clinical Psychology & Psychotherapy , n/a-n/a. https://doi.org/10.1002/cpp.1849
Hurst, Fidalgo, S., & Gard, P. (2015). Guiding intervention- Identifying parental psychological risk factors which contribute towards children pre-operative anxiety. Pediatric Oncall , 12 (2). https://doi.org/10.7199/ped.oncall.2015.12s
Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012). Depression in adolescence. The Lancet , 379 (9820), 1056-1067. https://doi.org/10.1016/s0140-6736(11)60871-4
