Childhood and adolescent depression

Major depression affects 3 to 5 percent of children and adolescents. Depression negatively impacts growth and development, school performance, and peer or family relationships and may lead to suicide. Biomedical and psychosocial risk factors include a family history of depression, female sex, childhood abuse or neglect, stressful life events, and chronic illness. Diagnostic criteria for depression in children and adolescents are essentially the same as those for adults; however, symptom expression may vary with developmental stage, and some children and adolescents may have difficulty identifying and describing internal mood states. Safe and effective treatment requires accurate diagnosis, suicide risk assessment, and use of evidence-based therapies. Current literature supports use of cognitive behavior therapy for mild to moderate childhood depression. If cognitive behavior therapy is unavailable, an antidepressant may be considered. Antidepressants, preferably in conjunction with cognitive behavior therapy, may be considered for severe depression. Tricyclic antidepressants generally are ineffective and may have serious adverse effects. Evidence for the effectiveness of selective serotonin reuptake inhibitors is limited. Fluoxetine is approved for the treatment of depression in children eight to 17 years of age. All antidepressants have a black box warning because of the risk of suicidal behavior. If an antidepressant is warranted, the risk/benefit ratio should be evaluated, the parent or guardian should be educated about the risks, and the patient should be monitored closely (i.e., weekly for the first month and every other week during the second month) for treatment-emergent suicidality. Before an antidepressant is initiated, a safety plan should be in place. This includes an agreement with the patient and the family that the patient will be kept safe and will contact a responsible adult if suicidal urges are too strong, and assurance of the availability of the treating physician or proxy 24 hours a day to manage emergencies.     

Childhood depression and suicide

Recent years have witnessed accumulating evidence that the disorders subsumed under the heading of childhood depression are much more prevalent than used to be believed; that these conditions in prepubertal youngsters are more similar to those disorders occurring in adolescents and adults than was previously believed; that childhood depression can co-exist with many other childhood conditions; and that, although a rare occurrence, suicide is committed by older children. To quote a professional in the child mental health field: It is difficult to see how depression could not be involved in almost every form of psychopathology. The various theories of personality speculate on the existence of unhappy and depressing feelings and cognitions at the core of human development, with ineffective means of dealing with these concerns expressed by abnormalities. . . . Thus it becomes reasonable to argue that depression is everywhere in childhood and adulthood and hence we must be careful to specify under what conditions it is to be regarded as pathological.     

Childhood and adolescent sports-related overuse injuries

Youth sports participation carries an inherent risk of injury, including overuse injuries. Little leaguer's shoulder, a stress fracture of the proximal humerus that presents as lateral shoulder pain, usually is self-limited. Little leaguer's elbow is a medial stress injury; treatment consists of complete rest from throwing for four to six weeks followed by rehabilitation and a gradual throwing program. Spondylolysis is a stress fracture of the pars interarticularis. Diagnostic modalities include plain film radiography, bone scan, computed tomography, single photon emission computed tomography, and magnetic resonance imaging. Treatment usually is conservative. Spondylolisthesis is the forward or anterior displacement of one vertebral body over another and may be related to a history of spondylolysis. Diagnosis is made with plain film radiography and graded according to the amount of displacement. Osgood-Schlatter disease presents as anterior knee pain localized to the tibial tubercle. Diagnosis is made clinically, and most patients respond to conservative measures. Calcaneal apophysitis (or Sever's disease) is a common cause of heel pain in young athletes, presenting as pain in the posterior aspect of the calcaneus.     

Treatment of childhood and adolescent depression

Major depressive disorder in children and adolescents is a common condition that affects physical, emotional, and social development. Risk factors include a family history of depression, parental conflict, poor peer relationships, deficits in coping skills, and negative thinking. Diagnostic criteria are the same for children and adults, with the exception that children and adolescents may express irritability rather than sad or depressed mood, and weight loss may be viewed in terms of failure to reach appropriate weight milestones. Treatment must take into account the severity of depression, suicidality, developmental stage, and environmental and social factors. Cognitive behavior therapy and interpersonal therapy are recommended for patients with mild depression and are appropriate adjuvant treatments to medication in those with moderate to severe depression. Pharmacotherapy is recommended for patients with moderate or severe depression. Tricyclic antidepressants are not effective in children and adolescents. Antidepressants have a boxed warning for the increased risk of suicide; therefore, careful assessment, follow-up, safety planning, and patient and family education should be included when treatment is initiated.     

Psychopharmacologic treatment of adolescent depression

Child and adolescent depression is one of the greatest health concerns in our society today. This article critically reviews the literature on the psychopharmacologic treatment of adolescent depression. Although double-blind studies have failed to show the efficacy of tricyclic antidepressants, more recent evidence has emerged for the use of selective serotonin reuptake inhibitors in this population. However, placebo-controlled, double-blind studies are limited, and many of the other newer antidepressants have yet to be investigated in treating adolescent depression. Nonetheless, antidepressants are widely prescribed to these populations, and psychiatric nurses are actively involved in assessing and monitoring the need for these medications in adolescents.     

Self-esteem and depression in adolescent diabetic girls

This investigation was designed to examine self-esteem and depression in diabetic adolescent girls. One hundred nondiabetic girls age 12-16 and 105 diabetic girls age 12-16 were administered the Rosenberg Self-Esteem Scale and the Beck Depression Inventory. Results indicated no significant difference between diabetic and nondiabetic girls in self-esteem scores. Diabetic girls showed significantly more depression than nondiabetic girls. Close examination of results revealed that, in fact, diabetic and nondiabetic adolescent girls were very similar. A major finding was that depression in the diabetic group was expressed primarily through physiologic symptoms of depression as seen in the vital depression scores, rather than through the pessimism, indecision-inhibition, or self-debasement measures of depression. Results were interpreted to mean that diabetic girls did not manifest deeper depression than nondiabetic girls but, rather, a greater awareness of their physiologic status. Diabetes emerged as a focus for the expression of normal adolescent conflicts. The importance of integrating developmental issues into the treatment plans for diabetic patients is emphasized.     

Korean American adolescent depression and parenting.

PROBLEM: Korean American adolescents tend to experience more mental health problems than adolescents in other ethnic groups. METHODS: The goal of this study was to examine the association between Korean American parent-adolescent relationships and adolescents' depressive symptoms in 56 families. FINDINGS: Thirty-nine percent of adolescents reported elevated depressive symptoms. Adolescents' perceived low maternal warmth and higher intergenerational acculturation conflicts with fathers were significant predictors for adolescent depressive symptoms. CONCLUSIONS: The findings can be used to develop a family intervention program, the aim of which would be to decrease adolescent depressive symptoms by promoting parental warmth and decreasing parent-adolescent acculturation conflicts.     

Evaluation and management of pediatric and adolescent depression

Youth who have mental health issues are more likely than their peers to seek primary care services. The primary care setting is an appropriate venue for screening and identifying pediatric depression. Additionally, nurse practitioners can provide initial management or referral to psychiatric mental health professionals for evidence-based treatments.     

Understanding adolescent depression in ethnocultural context

Asian-American adolescents often are regarded as a "model minority" and as being less likely to experience depression than adolescents of other ethnic groups. African-American adolescents are more often diagnosed with schizophrenia than depression. Do these epidemiologic phenomena reflect the real facts, or are these just artifacts shaped by cultural bias or insensitivity prevailing in this society? This article explores the diagnostic bias resulting in misdiagnosis of adolescent depression and reviews the role of culture/ethnicity in mental health and the ethnocultural variations in depression among African-American, Hispanic-American, and Asian-American adolescents. By discussing the issues, this article guides nurses to enhance cultural competence in nursing care.     

The interactive influence of adolescent and maternal depression on adolescent social and cognitive functioning

The hypothesis examined in this study was that the interaction of maternal and adolescent depression would be a better predictor of adolescent social and cognitive functioning than either variable alone. A depression measure was completed by each of 89 young adolescents and their mothers. Social functioning was assessed by a teacher-completed measure and two ratings of videotaped mother-adolescent interactions, while cognitive functioning was assessed by a teacher-completed measure and academic grades. The results indicated that for four of the five criterion measures the interaction term was the only predictor which entered into the multiple regression equation. For two of these measures strong support was provided for the proposed hypothesis. The results were discussed in terms of maternal and adolescent resources available to facilitate adolescent functioning. Implications for clinicians and researchers were also noted.This research was supported in part by the William T. Grant Foundation, NIMH grant MH 40704, and the University of Georgia's Institute for Behavioral Research. Nicholas Long is now at the University of Kansas Medical Center.     

青少年抑郁障碍患者病前家庭因素研究

目的探讨病前家庭因素对青少年抑郁障碍患者的影响。方法对61名青少年抑郁障碍患者及其父母（研究组）与57名正常青少年及其父母（对照组）采用家庭评估问卷进行测评分析。结果研究组青少年病前与父母、同学或老师人际关系不良,早年负性生活事件及父母关心与控制两个方面有问题者均显著高于对照组（P〈0．01）。研究组父母有焦虑、抑郁问题,教育能力受损者占44．3％,情感表达困难占63．9％,均显著高于对照组（P〈0．05或0．01）;父母教育态度与各自婚姻关系感受呈正相关,研究组父母教育态度不一致占54．1％,显著高于对照组的31．6％（P〈0．05）。结论家庭因素对青少年抑郁障碍的发生有重要影响,因此,在制定青少年抑郁障碍预防及早期治疗策略时需考虑家庭危险因素与高危人群。     

家庭因素对青少年抑郁的影响

目的：影响青少年抑郁的因素有很多，抽取关于家庭对青少年抑郁的影响，以便更好地从家庭角度理解青少年抑郁并提示可行的治疗。资料来源：应用计算机检索Elseview 1970-01／2005—10关于家庭对青少年抑郁的影响的文章，检索词为“adolescent，depression，family，parenting”，并限定语言种类为英语。同时手工检索与青少年抑郁及其家庭方面内容相关的书籍。资料选择：对资料进行初审，纳入标准：青少年抑郁及其相关的家庭方面的文献。排除标准：重复性研究。资料提炼：共收集37篇相关的文献，排除重复研究18篇，选择19篇文献用于综述，并采用了3本相关书籍的内容。资料综合：家庭可以从不同方面对青少年的抑郁产生影响：父母的遗传影响青少年的抑郁倾向；父母的生育年龄过高或过低都会对青少年的情绪有着负性的影响；家庭的应激事件和青少年抑郁有着密切的相关；父母抑郁，特别是母亲抑郁，会使得青少年抑郁的风险大幅提高；父母以负性教养方式为主，缺乏正性的情感支持，则青少年抑郁发生的可能会增加。．结论：家庭可以从许多方面对青少年抑郁产生影响。提示针对家庭的干预可能有助于减少青少年抑郁的发生。     

家庭因素对青少年抑郁的影响

目的:影响青少年抑郁的因素有很多,抽取关于家庭对青少年抑郁的影响,以便更好地从家庭角度理解青少年抑郁并提示可行的治疗。资料来源:应用计算机检索Elseview1970-01/2005-10关于家庭对青少年抑郁的影响的文章,检索词为“adolescent,depression,family,parenting”,并限定语言种类为英语。同时手工检索与青少年抑郁及其家庭方面内容相关的书籍。资料选择:对资料进行初审,纳入标准:青少年抑郁及其相关的家庭方面的文献。排除标准:重复性研究。资料提炼:共收集37篇相关的文献,排除重复研究18篇,选择19篇文献用于综述,并采用了3本相关书籍的内容。资料综合:家庭可以从不同方面对青少年的抑郁产生影响:父母的遗传影响青少年的抑郁倾向;父母的生育年龄过高或过低都会对青少年的情绪有着负性的影响;家庭的应激事件和青少年抑郁有着密切的相关;父母抑郁,特别是母亲抑郁,会使得青少年抑郁的风险大幅提高;父母以负性教养方式为主,缺乏正性的情感支持,则青少年抑郁发生的可能会增加。结论:家庭可以从许多方面对青少年抑郁产生影响。提示针对家庭的干预可能有助于减少青少年抑郁的发生。