Depression in recently bereaved prepubertal children

OBJECTIVE: The purpose of this study was to ascertain depressive symptoms in recently bereaved prepubertal children and compare these symptoms with those of depressed prepubertal children. METHOD: The subjects were 38 children who had recently experienced the death of one but not both of their parents. They had to meet strict inclusion criteria so that the effects of bereavement per se, rather than other significant stressors, could be assessed. The comparison group consisted of 38 hospitalized, depressed children individually matched to each bereaved subject for age, sex, and socioeconomic status. All of the children underwent systematic and comprehensive evaluation. They and their parents were independently evaluated by trained interviewers using the parent and child versions of the Diagnostic Interview for Children and Adolescents. Family histories and basic demographic information were also obtained. RESULTS: The recently bereaved children endorsed many depressive symptoms. Thirty-seven percent of them met the DSM-III-R criteria for a major depressive episode. The depressed children, however, had more depressive symptoms on average than the bereaved children. The factors associated with increased depressive symptoms in the bereaved children were 1) the mother as the surviving parent, 2) preexisting untreated psychiatric disorder in the child, 3) family history of depression, and 4) high socioeconomic status. CONCLUSIONS: A considerable number of the bereaved children developed the clinical symptoms of a major depressive episode immediately after the death of a parent. The relation of these symptoms to the subsequent course of grief and to major depressive disorder remains unknown and should be studied further.     

A prevention program for bereaved children

The death of a parent seriously threatens children's social and emotional development. When the death can be anticipated, early intervention may facilitate children's adjustment. A prevention program designed to enable parents to foster their children's necessary grief work and resolution of the loss is described.     

Psychological tasks for bereaved children.

The grief process in bereaved children is conceptualized as a series of psychological tasks that must be accomplished over time. Early tasks include understanding and self-protection; middle-phase tasks include acceptance and reworking; late tasks pertain to identification and development. This timing model has practical implications for the conduct of psychotherapy at different times during the grief process.     

Prevalence of affective disorders in children and adolescents: findings from the Zurich Epidemiological Studies

OBJECTIVE: Affective disorders were studied in two epidemiological studies of children and adolescents in the Canton of Zurich, Switzerland. METHOD: In the Zurich Epidemiological Study of Child and Adolescent Psychopathology Study (ZESCAP) in 1994 a representative cohort of 1964 pupils aged 7-16 years was studied. The Zurich Adolescent Psychology and Psychopathology Study (ZAPPS) included 1089 adolescents aged 15-19 years who were assessed in 1997. A two-stage approach with questionnaire screening of the entire sample in stage 1 and consecutive interviews in stage 2 was used in both studies. Diagnoses according to DSM-III-R were derived from structured parent interviews in the ZESCAP and from both parent and adolescent interviews in the ZAPPS. RESULTS: The total prevalence rate for affective disorders in the ZESCAP was 0.66% (SE 0.25) whereas it was 5.1% based on adolescent interviews and 1.2% based on parent interviews in the ZAPPS. Adolescent girls have significantly higher prevalence rates for affective disorders than boys (9.4 vs. 1.1%). CONCLUSION: These findings are in accordance with various other international epidemiological studies on affective disorders in children and adolescents.     

Posttraumatic stress responses in bereaved children after the Oklahoma City bombing

OBJECTIVE: To investigate the responses of middle and high school students exposed to the 1995 Oklahoma City bombing across a spectrum of loss. METHOD: A questionnaire measuring exposure, personal consequences, initial response, and current posttraumatic stress and other symptoms was administered to 3,218 students 7 weeks after the explosion. RESULTS: More than one third of the sample knew someone killed in the explosion. Bereaved youths were more likely than nonbereaved peers to report immediate symptoms of arousal and fear, changes in their home and school environment, and posttraumatic stress symptoms. Retrospective measures of initial arousal and fear predicted posttraumatic stress symptoms at 7 weeks. CONCLUSIONS: The results support the literature addressing the role of initial response in posttraumatic stress symptom development. The study raises concern about the impact of television, and traumatized youths' reactivity to it, in the aftermath of disaster.     

Posttraumatic stress symptoms in parentally bereaved children and adolescents

OBJECTIVE: To compare parentally bereaved children with a disaster comparison group and a nontrauma control group on measures of emotional adjustment. METHOD: Children and adolescents who had lost a parent (n = 39), had experienced a tornado disaster (n = 69), or were coping with an ongoing social or academic stressor (n = 118) completed measures of posttraumatic stress disorder (PTSD) symptoms, anxiety, and depression. Risk factors for symptoms among the bereaved children also were evaluated. RESULTS: Parentally bereaved children reported significantly more PTSD symptoms than the disaster and nontrauma control groups. Among the bereaved children, girls, younger children, and children living with a surviving parent who scored high on a measure of posttraumatic stress reported more symptoms. CONCLUSION: Children and adolescents who have lost a parent could be vulnerable to PTSD symptoms.     

Group intervention for children bereaved by the suicide of a relative

OBJECTIVE: This study evaluated efficacy of a manual-based bereavement group intervention for children who suffered suicide of a parent or sibling. METHOD: Seventy-five families (102 children) were screened from medical examiners' lists of suicide victims. Fifty-two families (75 children) were eligible and assigned in alternating order to receive (27 families, 39 children) or not to receive (25 families, 36 children) the intervention. Intervention efficacy was evaluated as change in children's symptoms of anxiety, depression, posttraumatic stress, social adjustment, and parents' depressive symptoms from initial to outcome assessments. RESULTS: Changes in anxiety and depressive symptoms were significantly greater among children who received the intervention than in those who did not. A greater dropout of children assigned not to receive (75%) than to receive (18%) intervention led to an imbalance in retention of intervention and nonintervention participants. CONCLUSIONS: A bereavement group intervention focusing on reactions to death and suicide and strengthening coping skills can lessen distress of children bereaved after parental or sibling suicide. Such intervention may prevent future morbidities.     

Circadian rhythms in human performance and affective state

After reviewing earlier contributions to the understanding of the physiology of circadian system in man, in particular his cognitive aspects, we report on own studies obtained using the fractional desynchronization technique to induce internal desynchronization in man. These results show that in temporal isolation studies, rhythms in some performance measures follow a period of about 21 hours, even when the subject's physiological rhythms are apparently synchronized to the 24 hour day. These data are discussed in relationship to current theoretical frameworks in chronobiology.     

Seasonal affective disorder in children and adolescents

The authors studied seven children with symptoms of seasonal affective disorder. During the winter months the children regularly experienced irritability, fatigue, school difficulties, sadness, and sleep changes as well as other symptoms of seasonal affective disorder found in adults. An open trial of bright environmental light reversed many of these symptoms and improved mood and psychosocial functioning in the winter months. School counselors and therapists should consider seasonal affective disorder in the differential diagnosis of children with school difficulties that are most prominent in the fall-winter semester.     

Pharmacotherapy of affective disorders in children and adolescents

The pharmacotherapeutic management of affective disorders in children and adolescents follows the same general principles as for adults. In addition to the adult principles and guidelines, children present a specific challenge in diagnosis because of the specifics of symptomatology to development. The immaturity of the organism results in less responsivity to biologic therapies because of the poorly established biologic basis of the illness at this stage of life. The metabolic aspects of pharmacotherapy modify dosage and necessitate special attention to the effects of pharmacotherapeutic agents on physical and emotional development.     

Meeting the needs of parentally bereaved children: a framework for child-centered parenting

This article describes the development and deployment of a framework for measuring parenting capacities in the context of bereavement. Grounded theoretical analysis of interviews with a community sample of 41 bereaved spouses with school-aged children elicited a set of nine bereavement-specific parenting tasks. A corollary coding system (covering all nine parenting tasks) was created to transform interview materials into quantitative data, thus permitting systematic empirical investigation of the parenting capacities of bereaved spouses. Parenting behaviors were coded on a 5-point scale ranging from least child-centered to most child-centered. Sex of surviving parent and circumstances of death proved to be significant mediating variables: mothers were more child-centered than fathers, and parents surviving sudden deaths more child-centered than those surviving anticipated deaths. Lengthy illness was associated with less child-centered parenting. The more child-centered the parenting, the less symptomatic the child as measured by parent report (Child Behavior Checklist) and child self-report (Children's Depression Inventory, Revised Child Manifest Anxiety Scale). Child-centered parenting was associated with more positive and fewer negative perceptions of the surviving parent by the child as measured by the Parent Perception Inventory. Implications of findings are discussed.     

A preventive intervention program for bereaved children: problems of implementation

A brief, standardized intervention program to facilitate children's adjustment to the terminal illness and death of a parent posed the following implementation problems: estimation of patient life expectancy; engagement of the family in crisis; adhesion to the parental guidance model; and termination of formal clinical intervention. Resolution of these issues is described, and adaptation of such programs to other high-risk populations is considered.     

Altered resting‐state activity in seasonal affective disorder

At present, our knowledge about seasonal affective disorder (SAD) is based mainly up on clinical symptoms, epidemiology, behavioral characteristics and light therapy. Recently developed measures of resting‐state functional brain activity might provide neurobiological markers of brain disorders. Studying functional brain activity in SAD could enhance our understanding of its nature and possible treatment strategies. Functional network connectivity (measured using ICA‐dual regression), and amplitude of low‐frequency fluctuations (ALFF) were measured in 45 antidepressant‐free patients (39.78 ± 10.64, 30 ♀, 15 ♂) diagnosed with SAD and compared with age‐, gender‐ and ethnicity‐matched healthy controls (HCs) using resting‐state functional magnetic resonance imaging. After correcting for Type 1 error at high model orders (inter‐RSN correction), SAD patients showed significantly increased functional connectivity in 11 of the 47 identified RSNs. Increased functional connectivity involved RSNs such as visual, sensorimotor, and attentional networks. Moreover, our results revealed that SAD patients compared with HCs showed significant higher ALFF in the visual and right sensorimotor cortex. Abnormally altered functional activity detected in SAD supports previously reported attentional and psychomotor symptoms in patients suffering from SAD. Further studies, particularly under task conditions, are needed in order to specifically investigate cognitive deficits in SAD. Hum Brain Mapp 35:161–172, 2014. © 2012 Wiley Periodicals, Inc.     

Motor activity and affective illness. The relationship of amplitude and temporal distribution to changes in affective state

We measured motor activity with a self-contained monitoring device worn on the wrists of affectively ill patients and volunteer normal control subjects. Decreases in the daytime motor activity level were observed in depressed patients, compared with their improved (euthymic) or manic mood states. Moreover, affectively ill patients, even during euthymic periods, showed lower daytime motor activity levels than the control group housed in the same ward. These data provide objective evidence for decreases in motor activity that occur concomitantly with the depressive phase of illness in patients with affective disorder, and fluctuate in patients in euthymic or manic phases.     

Dexamethasone suppression test and depressive symptoms in bereaved children: a preliminary report

Eighteen bereaved children and adolescents were assessed using the dexamethasone suppression test (DST) and the Diagnostic Interview for Children and Adolescents 4 weeks following parental death. Thirty-nine percent had a positive (nonsuppressed) DST. DST-positive subjects reported more DSM-III-R depressive symptoms (6.3 +/- 2.9 vs. 3.9 +/- 2.7, means +/- SD) than DST-negative subjects. Most frequently reported symptoms included dysphoria, loss of interest, sleep disturbance, appetite disturbance, psychomotor disturbance, and morbid and suicidal ideation. Post-dexamethasone cortisol levels were significantly correlated with the total number of depressive symptoms and suicidal ideation.