Body image distortion. Feeling “ugly”
ugly” or otherwise unattractive.
Loss of appetite and weight. Losing interest in eating, or eating erratically.
Lack of satisfaction. Being upset about herself, about life at school and at home and
about social life.
Irritability. Being easily angered and hostile; snapping at family, friends and
and teachers.
Social withdrawal. Ceasing to spend time with friends; spending most of the time
alone.
Drop in school performance. Loss of interest in and enthusiasm about school, as well
as other activities.
Fatigue, lassitude
Inappropriate guilt, feels worthless
Can’
Can’t concentrate, be decisive, think clearly
Dwells on thoughts of death, suicide
Not due to medical problem, bereavement
1.DSM
1.DSM--IV Symptoms Shared with Adult Major Depressive Disorder.
Those prominent in children:
Physical complaints
Irritability
Withdrawal
Less sleep disturbance
2.Prevalence
2.Prevalence:: Among most prevalent disorders for teens & adults. Increases with
with age.
1% in 11-6 yr
2% in 77-12 yr
9%9%-13% in teens and adults
3.Sex
3.Sex Distribution
No differences in children
Female prevalence begins in early teens
By late teens twice as many females.
Rates more even in college students!
4.Prevalence
4.Prevalence Trends
1
Depression more prevalent, especially for males and younger people
people
5.Co
5.Co--Morbidity
Anxiety
Substance abuse
Defiant
Disruptive behavior
Eating disorders in teens
Treatment less effective when
coco-morbid disorders present
6.Episode
6.Episode Length
Typically 6 mos. Or more. Some symptoms persist longer in 20%20%-30% of cases
7. Risk Factors
Depressed family members esp. mothers
Parents’
Parents’ marital conflict
Strict, cold, controlling family
Negative life events
Negative cognitive style in teens
Binge drinking
Romantic breakup in teens
8. Treatment
Antidepressants, esp. SSRI’
SSRI’s prescribed; but limited because of slight increase in suicidal thinking.
Strong placebo effect (30% or more improved) makes it difficult to demonstrate drug efficacy.
Tricylic antidepressants ineffective with children, teens
9. Tx.
Tx. Cognitive Behavioral Therapy
Moderately effective; best in groups for teens (Lewinsohn
). Combination of drugs and therapy
(Lewinsohn).
advised.
10. Suicide Risk
Suicide increases with age, as does depression.
36% of a group of depressed teens made an attempt, mainly ineffectual.
ineffectual.
A previous attempt makes a youth 18 times more likely to repeat.
Prevention programs should be a priority.
Annual Suicides/100,000
Teenagers’
Teenagers’ Experience with Suicide
Research in the Public Interest*
Research Issue: Guns in the home are used in many youth suicides and accidental shootings. What
are the safest methods to store guns?
Study Method: Records from hospitals and medical examiners were surveyed on shootings
shootings including
82 suicide attempts and 24 accidents involving guns by persons younger
younger than 20 years. No other types
of shootings were studied.
2
A control/comparison group of 480 families contacted by randomrandom-digit dialing. All were
asked about their gun storage.
Gun storage methods varied from:
Gun in a locked location or with a lock
Gun was stored unloaded
Gun unloaded but locked up
Ammunition stored separately
Ammunition stored in locked location
Findings:
Of 82 gun suicide events, 95% were fatal
Of 24 accidental shootings, 52% were fatal
In families of youth suicides and accidental shootings, children were less protected from the guns.
Guns of families with tragedies were:
o
o
o
o
Less likely to be stored unloaded
Less likely to be stored locked
Less likely to be stored separately from ammunition
Less likely to have ammunition locked up.
than control families with no gun accidents or suicides. Each of these safety practices added to
the total safety of the home.
Less sensitive, alert to child problems
Less warm and accepting
Less talkative, engaged with child
Less responsive to child
Presents a less appropriate model
More life stress (major events)
More daily hassles
Marital problems
Less social support
More parenting problems
Five or more of the following, for the same 22-wk period, with at least 1 being depressed mood or
loss of interest/pleasure.
1. Depressed mood most of the day, nearly every day. Can be irritable
irritable mood in children.
2. Loss of interest/pleasure in most activities most of the time
3. Significant weight loss/gain or prolonged decr/incr in appetite. Child’
Child’s failure to make expected
3
weight gains.
4. Daily insomnia/ hypersomnia
5. Psychomotor agitation/retardation daily. Observable by others.
6. Fatigue, loss of energy
Negative > positive affect
Poor affect regulation
Lower activity level
Gaze aversion
Fussiness
Insecure attachment
Fewer mothermother-child interactions
Less prosocial behavior
!
"
Professionals can be blinded by preconceptions.
Psychoanalytic theory said child depression impossible.
Depressive symptoms coco-occur with many other disorders
Symptoms differ for children, teens and adults.
Depression is not a single disorder, but heterogeneous, with varied
varied origins.
Depressive disorders have both genetic and environmental roots.
Special assessment and treatment methods required for children.
"
Body image distortion. Feeling “ugly”
ugly” or otherwise unattractive.
Loss of appetite and weight. Losing interest in eating, or eating erratically.
Lack of satisfaction. Being upset about herself, about life at school and at home and
about social life.
Irritability. Being easily angered and hostile; snapping at family, friends and
and teachers.
Social withdrawal. Ceasing to spend time with friends; spending most of the time alone.
alone.
Drop in school performance. Loss of interest in and enthusiasm about school, as well as other
other
activities.
8. Treatment
4
Antidepressants, esp. SSRI’
SSRI’s prescribed; but limited because of slight increase in suicidal thinking.
Strong placebo effect (30% or more improved) makes it difficult to demonstrate drug efficacy.
Tricylic antidepressants ineffective with children, teens
9. Tx.
Tx. Cognitive Behavioral Therapy
Moderately effective; best in groups for teens (lewinsohn
). Combination of drugs and therapy
(lewinsohn).
advised.
5