Depression in children is multifactorial in origin. It results from interactions between both environmental factors and biological vulnerabilities. Heritability is the leading risk factor for mental illness. The interaction between genes and environmental factors further contributes to this risk. Genes-environmental interaction increases the susceptibility to environmental stress.
Psychosocial factors can also increase the risk of developing depression, such as in the case of stressful life events which precede depressive symptoms in children and adolescents (Bremner et al., 2020). Cognitive factors can also contribute to the development of depression. Depressed children and adolescents have memory and attentional bias. These children tend to recall more negative words.
Also, children who underestimate their competence are more likely to have depressive symptoms. Children who have had depression before are also likely to underestimate their competence. Other factors that may contribute to the development of depression include substance and alcohol abuse, other mental illnesses, and comorbidities such as diabetes, epilepsy, and obesity.
The signs and symptoms of depression in children include pessimism and hopelessness about the future, a lack of interest in activities they previously enjoyed, feeling sad and irritable, criticism of themselves, difficulties in concentration in school, lack of energy, and problems with sleeping. Children may also experience symptoms such as stomach aches and headaches. There can be an increase or decrease in appetite. Weight changes can also be noticed, such as a remarkable weight gain or weight loss when not dieting. As Charles and Fazeli (2017) note, morbid thoughts may progress to suicidal ideations or suicide attempts.
Diagnosis of depression is made with the presence of at least five of the above symptoms with a change in function within 2 weeks. These symptoms should be accompanied by a depressed mood and should not be explained by another medical condition (Forman-Hoffman & Viswanathan, 2018).
Treatment of depression in children and adolescents targets recovery and returning to the premorbid level of functioning. Treatment involves the use of both pharmacological and nonpharmacological methods (Leichsenring et al., 2021).
Pharmacological methods involve the use of antidepressant medications. The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs). These drugs are fluoxetine, citalopram, sertraline, and escitalopram. Fluoxetine and escitalopram are FDA approved for the treatment of depression in children and adolescents (Leichsenring et al., 2021). Children on antidepressants should, however, be monitored for risk of suicide. This is one of the major side effects of antidepressants.
Nonpharmacological methods include the use of psychosocial interventions which involve both the children and the parents. Psychosocial interventions are used in the case of mild to moderate depression. It entails using psychoeducation, including education about illness, nutrition, and the importance of good sleep.
Patients should be encouraged to exercise for at least 30 minutes daily. Cognitive-behavioral therapy is also used to help patients identify cognitive distortions, learn problem-solving skills, and modify behaviors predisposing them to depressive symptoms (Oar et al., 2017). Interpersonal therapy is used to help individuals learn interpersonal problem-solving skills.
Parents should contact a healthcare provider if they observe changes in mood and functioning of the child. Mental health nurses and pediatricians should ensure they promote mental health and increase awareness to decrease the stigma associated with mental illness. Depression in children and adolescents is a treatable condition.
Treatment in an outpatient setting is recommended. Treatment should involve an interprofessional team comprising a mental health nurse, a pediatrician, a psychiatrist, a case manager, and a psychotherapist. In severe cases of depression, the management of patients in an inpatient setting is recommended (Leichsenring et al., 2021).
Bremner, J. D., Moazzami, K., Wittbrodt, M. T., Nye, J. A., Lima, B. B., Gillespie, C. F., Rapaport, M. H., Pearce, B. D., Shah, A. J., & Vaccarino, V. (2020). Diet, Stress and Mental Health. Nutrients, 12(8), 2428. https://doi.org/10.3390/nu12082428
Charles, J., & Fazeli, M. (2017). Depression in children. Australian Family Physician, 46(12), 901–907.
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