Week 8: Depression - Development and Correlates

Question 1

How does depression present in kids

Answer 1

For a long time, people thought that children could not be depressed
-Within the psychoanalytic tradition, children lacked sufficient superego
development to be depressed
-Do not have a sufficiently enough developed self concept to experience
the discrepancy between the real and ideal self that underlies guilt

Actually, even very young children can be depressed
-May be hard for adults to see it
-Sometimes adult’s do not see what kids have to be depressed about
-Many of the symptoms of depression are internal
-Sadness, shame, guilt, feelings of worthless
-Behavioral profile is heterogeneous
-Avoidance, reduced assertiveness, but some children are more aggressive
and hostile

Question 2

Depression in Preschoolers

Answer 2

Was originally thought that children would only show “masked” symptoms of depression

E.g., aggression, somatic symptoms, loss of skills/milestones (regression) such as regressing to not being potty trained

Outward manifestations of an underlying depressed mood

Would not show the “typical” symptoms of depression

Research indicated that these symptoms were presented, but if you
did a thorough psychiatric interview, the typical symptoms were
also there

Are the DSM symptoms evident in preschoolers?

Can we identify preschoolers with depression using the DSM criteria?

Question 3

Searching for depression in preschoolers

Sudy

Answer 3

Parents of preschoolers completed a psychiatric interview

Psychiatric interview asked about typical symptoms

Also asked about “masked symptoms”

Ended up with three groups of children

(1) MDD (59 children)
(2) ODD/ADHD
(3) No disorder

RESULTS

For masked symptoms thee was significant differences between depressed and ADHD/ODD kids in somatic complaints, unexcited, violet pretend play and withdrawal

For DSM5 symptoms, there was significant differences between depressed and ADHD/ODD kids in every single category except trouble thinking/concentrating AND Anhedonia was UNIQUE to depressed kids (others did not have it)

Question 4

Depression in Preschoolers

High sensitivity

Answer 4

Some typical symptoms show high sensitivity

Sensitivity is the likelihood that a child with the disorder will have the symptom

Perfect sensitivity every child with the disorder will have that
symptom

Sadness/grouchiness - if not reported, not depression

Absence of symptom rules out the disorder

(Snout sensitivity + out)

Question 5

Depression in Preschoolers

High specificity

Answer 5

Typical symptoms often showed high specificity

Specificity is the likelihood that children without the disorder will not have the symptom

Anhedonia

Presence of anhedonia rules in the disorder

(Spin: specificity + in)

Question 6

Snout, Spin

depression

Answer 6

(Snout sensitivity + out)

Sadness/grouchiness

(Spin: specificity + in)

Anhedonia

Question 7

DSM5 modifications for preschoolers

Answer 7

Some modifications to DSM criteria need to be made

Sadness and unhappiness versus sadness and depression

“Activities and play” versus “work and school”

Themes of suicide and death in play, kids wont talk about suicide but might have it in play

Possible that 2 week duration used for older children and adults may not
be applicable to young children

Basically though, DSM-5 works

Question 8

Course of Depression
How long do both types last?
Is it all done when it is over?
Residual?

Answer 8

Course

• Untreated MDD lasts 8 12 months
• Untreated dysthmic disorder (DD) lasts 2 5 years
• Residual symptoms frequently present at end of episode
• This means there are not enough to meet criteria but some left over
• Residual symptoms strong risk factor for recurrence

MDD recurrence

Preschoolers with depression are 4 times more likely than those without depression to meet criteria for major depressive disorder 2 years later

For children and adolescences who experience a major depressive episode, recurrence is common:

25% within 1 year
40% within 2 years
70% within 5 years
30% develop Bipolar Disorder (“BP switch”)

Most adults with MDD date onset of first episode to adolescence SO IS IMPORTANT

Question 9

Kindling

Answer 9

Kindling

First episodes frequently follow significant life stress
-Super common is the first breakup in puberty

Biological changes that make you more reactive to stress in the future

Thus, later episodes may require less stress to begin

Question 10

Depression Prognosis

Answer 10

Depression recurs

Children and adolescents who have a depressive episode are more likely to have depressive episodes as adults

Within adolescence, girls are more likely to experience recurrence than are
boys, but in adulthood recurrence is equally likely among men and women

Earlier it starts, the worse the prognosis is
-More severe, chronic course, greater suicidality

Is depression in childhood/adolescence associated with likelihood of
other disorders in adulthood?
-Heterotypic continuity

Is depression in childhood/adolescence associated with other problems in adulthood?

Question 11

Prognosis Study

Answer 11

Study of a longitudinal cohort in New Zealand

• Followed them from birth
• Met DSM criteria for Major Depression at 15 to 16 years of age
• Examined psychopathology, educational, and social outcomes in early adulthood

Note that these analyses took into account a number of factors associated with adolescent depression and outcomes: e.g., SES
and sexual abuse

Note also that these analyses took into account co morbid
conditions (e.g., conduct disorder)

SO ALL THESE ARE VERY CONSERVATIVE

3.5x risk of future Major Depression

2.5x risk of Anxiety Disorder
(this is a risk over and above existing risk factors for anxiety)

SO there is high risk for other conditions with depression

Question 12

Co-Morbidity

Answer 12

For Major Depressive Disorder

• Anxiety
• Dysthymia, conduct problems, ADHD, substance use
• In general, co morbid conditions come first THEN MDD

For Dysthymia:

• MDD
• Anxiety, conduct disorder, ADHD Again, these usual precede dysthymia

Question 13

Clinical Correlates

Answer 13

Cognitive and academic functioning

• IQs in the normal range
• Youth with depression perform more poorly in school

Symptoms of depression:

• Poor concentration
• Low energy
• Fatigue

So cause worse performance

Question 14

Suicidality

Answer 14

SUICIDE: taking ones own life
SUICIDALITY: also includes attempts, intent, ideation

Suicide is the second leading cause of death among Canadian children and adolescents (ages 10 to 19 years) - First is accident

In 2008, 20.4% of all deaths for youth aged 10 to 19 were due to suicide, compared to 1.5% of all deaths in Canada

Major depression is a risk factor for suicidality

NCS A:

30% of adolescents with major depression reported suicidal thoughts

11% of adolescents with major depression reported a suicide attempt

OCHS S

Depression predicts greater suicidal ideation even after accounting for other types of symptoms (depression uniquely contributes to suicidality)

Question 15

Non-Suicidal Self Injury (NSSI)

Answer 15

Deliberate, destruction of your own body tissue in the absence of intent to die

People are not good at judging lethality

Cutting, burning, biting

17% of adolescents report engaging in one of these behaviors

Associated with a number of psychological disorders, including depression and anxiety

Question 16

Dealing with NSSI

Answer 16

Functional approach to NSSI

Behavior is reinforced by intra or interpersonal consequences

Way to regulate negative mood

Intrapersonal negative reinforcement
-Reduces or stops aversive thoughts and feelings

Intrapersonal positive reinforcement
-Generates desired feelings

Way to obtain desired consequences in the environment (no school, less responsibility)

• Interpersonal positive reinforcement
• Care and attention

Interpersonal negative reinforcement
-Less responsibility

If you do not understand the reinforcement, you will be unable to help as they will carry on