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DEPRESSION - DEFINITION
BC Ministry of Education (2001)
“Depression is a mental illness in which a person has feelings of sadness, instability, loneliness, hopelessness, worthlessness, and guilt.”
Kauffman (2001)
“Depression is part of a larger category of mood disorders delineated in the DSM-IV. ... Dysphoria may be shown as irritability as well as unhappiness in children and adolescents.”
TYPES OF DEPRESSION
BC Ministry of Education (2001)
v There are 3 main types of depression in children:
Ø Adjustment disorder with depressed mood
Ø Major depressive order
Ø Bipolar mood disorder
Ø Adjustment disorder with depressed mood
§ Occurs in response to some identifiable experience or stressor – death of a loved one, major illness, divorce, or move
§ Person may feel sadness and may not be able to enjoy some aspects of life, but these are transitory effects that settle within 6 months
§ Symptoms include depressed mood, fearfulness, instability, or feelings of hopelessness
Ø Major depressive disorder
§ Period of at least 2 weeks during which there is a depressed or irritable mood and loss of interest or pleasure in nearly all activities.
§ Difficulty with concentration, short attention span, low self-esteem, tiredness or low energy, overeating or lack of appetite, insomnia or sleeping too much, feelings of hopelessness, jumpy behavior, observable agitation, clumsy, slow movements, recurrent thoughts of death or suicide
Ø Bipolar mood disorder
§ Sometimes depression co-exists with another mental state called mania
§ Extreme mood swings – euphoria alternating with hostile anger
§ Giddiness, silliness, irritability, rushed speech, heightened sense of self-power or importance, inappropriate risk-taking behaviors – drug and alcohol abuse, sex
§ Less common than major depression
§ Bipolar people more likely to commit suicide (Merrell, 2001)
Other Types of Depression
Ø Dsthymic disorder (dysthymia)
§ Chronic depression - depression is less a temporary state and has become more a stable trait - being depressed becomes part of one’s personality or general way of being
§ Children and adolescents exhibit mild or moderate symptoms of depression for at least one year (Merrell, 2001)
§ Dysthymic disorder half as common as major depression, but it lasts longer
§ Higher risk of getting major depression later -10% will have major depression within a year (Winkler, 2000)
Ø Cyclothymic disorder (cyclothmia)
§ Some similarity to bipolar disorder - milder form - mood swings not as extreme, but go on for a longer period of time (Winkler, 2000)
§ “emotional roller coaster”
DEPRESSION - CHARACTERISTICS
v Depression tends to be episodic and of long duration
v People tend to have repeated bouts with depression
v Often co-exists with other disorders, including anxiety, conduct disorder, ADHD
v Depression indicated only if:
Ø Several symptoms are exhibited over a protracted period of time
Ø Symptoms are not temporary, reasonable response to life circumstances
(Kauffman, 2001)
v Numerous sources, including DSM-IV, identify the following 14 characteristics
v Students with depression do not necessarily exhibit all of these characteristics
v Overwhelming feelings of sadness or grief
Ø cry easily, sadness seems out of proportion, difficult to console
v Anger and irritability
Ø quarrelsome, disrespectful of authority, hostile, prone to sudden anger
Ø increased shouting and screaming
v Fatigue or lack of energy
Ø mental and/or physical exhaustion
Ø students may complain of tiredness
v Physical/somatic complaints
Ø students may complain of aches and pains - headaches, stomachaches
v Sleep disturbances
Ø sleeping too much or not enough
Ø leads to fatigue and loss of energy
Ø difficulty falling asleep or awaken several times during the night
Ø may have difficulty getting up in the morning – school attendance problem
v Psychomotor agitation or retardation
Ø activity is speeded up or slowed down
Ø psychomotor retardation – coordination poor, student seems clumsy, slowing of physical movement and speech
Ø physical agitation – restless, irritable behavior, inability to sit still, excessively fidgeting, picking or pulling at hair, skin, clothing
v Disturbance of appetite and significant weight gain or loss
Ø dramatic change in appetite- increased or decreased
Ø loss or gain of weight (5% in one month)
v Avoiding other people
Ø make less effort to participate in group activities or maintain friendships
Ø feel less friendly and outgoing
Ø problems with school attendance, resistance to cooperative learning groups
v Loss of interest in taking part in activities
Ø anhedonia – inability to experience pleasure in all or nearly all activities
Ø may wander at recess, do not show interest in activities that most peers see as fun or exciting
v Difficulty concentrating or making decisions
Ø difficulty maintaining the attentiveness necessary for learning – “daydreaming” – poor performance in school
Ø language learning and mathematics learning commonly affected
v Unreasonable guilt, helplessness, or hopelessness
Ø see themselves as more responsible for problems in their environment than they actually are
Ø constant feelings of worthlessness and self-hatred
Ø “It’s all my fault”, “I can’t do anything right”
v Feeling overwhelmed by small things
Ø easily annoyed and hypersensitive to comments and actions of others
v Substance abuse
Ø increased use drugs and alcohol to try to escape a sense of helplessness and hopelessness
v Thoughts of death, suicide, or harm to others
Ø significant numbers of people who commit suicide are depressed
Ø preoccupation with death and dying
Ø giving away personal or prized possessions
Ø excessive risk-taking
v characteristics of depression similar for both children and adolescentsØ differences:§ preoccupation with death more prevalent in adolescent depression as concept too vague and abstract for young children§ substance abuse more common in adolescents
Clinical features of child vs. adolescent depression:
(Ryan et al. ... (1992,1994)
SIGNS/SYMPTOMS CHILDREN ADOLESCENTS
Anhedonia less more
Hopelessness less more
Sleep less more
Weight little change often changes
Suicide decreased lethality increased lethality
Appearance more depressed less depressed
Somatic complaints more less
Fears and worries more less
DEPRESSION - PREVALENCE
v Difficult to estimate with much certainty how many children and youth suffer from depression:
Ø Few large-scale studies - have often overlooked children and youth (Merrell, 2001)
Ø Many young people who are depressed remain untreated for the disorder (Kauffman, 2001)
(Appendix 2)
v Ministry of Education, 2001
Ø Rates of depressive symptoms in children are approximately 9%
Ø By adolescence, the rate increases to over 20 %
v Centre for Addiction and Mental Health, ON (2002)
Ø At any given time, almost 3 million Canadians have serious depression, but less than 1/3 seek help
Ø Females have higher rates of major depression than males by a ratio of 2:1
v Kauffman, 2001
Ø Increases in prevalence with age
Ø Prepubescent children – prevalence about the same in boys and in girls
Ø By age 15, girls twice as likely as boys to be depressed (Appendix 3)
Ø Rates of depression are going up
Ø Bipolar disorder is increasingly diagnosed
Ø Comorbidity of depressive disorders with other disorders, (conduct disorder and ADHD), increasingly recognized
Why is prevalence increasing?
Approximate Word count = 5294
Approximate Pages = 21.2
(250 words per page double spaced)
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