Depression W8 L15 412 Flashcards
Depression: Symptom versus Syndrome versus Disorder
Symptom
Feeling or emotion of sadness
Very common (40% at any given time)
Syndrome
Cluster of common symptoms
“Negative affect” and dimensional view of depression
Disorder / Diagnosis
Syndrome with minimum duration
Syndrome with required impairment
Core Features of depression?
At least one of the following, most of the day, nearly every day, for two weeks:
Dysphoria
prolonged sadness
some sadness normal, even needed in life, but prolonged and distressing no good. Nearly everyday for two weeks but for children …
Irritability
excessive sensitivity, hostility, and moodiness
unique to children and adolescents
Anhedonia
loss of pleasure or interest in previously enjoyable activities
Major Depressive Disorder
5 Symptoms Total needed (9 possible)
During the same two week period
At least one of:
Depressed mood, most of the day, nearly every day OR irritability (children
and adolescents only), most of the day, nearly every day
Anhedonia (loss of interest or pleasure), most of the day, nearly every day
Significant weight loss or gain or decrease or increase in appetite nearly every
day (In children, consider failure to make expected weight gains)
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observable by others), extreme sluggishness walking through molasses.
Fatigue or loss of energy nearly every day
Feelings or worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day,
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Persistent Depressive Disorder (Dysthymia)
Depressed or irritable mood for most of the day, more days than not, as indicated by either subjective account or by observation by others, for at least 1 year
(In adults, mood must be depressed and must last for 2 years)
Presence while depressed, of two (or more) of the following:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
During the 1 year period, the person has never been without the symptoms for more than 2 months at a time
Persistent Depressive Disorder (Dysthymia)
Specification / co-occurrences
Pure dysthymic syndrome
Full criteria for major depression have not been met in the
preceding year
With persistent major depressive episodes
Full criteria for a major depressive episode have been met
throughout the preceding year
With intermittent major depressive episodes
Person has met criteria for one or more major depressive episodes during the preceding year
Depression Diagnoses
Categorical (same in kind) versus dimensional
Recall that one disadvantage of a categorical approach is that there are a group of individuals who will not quite make the cutoff
Many children and adolescents will have subclinical depression
They will not quite make diagnostic criteria, but they have a significant number of symptoms
Show significant impairment (e.g., academic, social)
At greater risk for going on to develop depression as well as other disorders and difficulties (e.g., substance use)
Epidemiology of Major Depressive Disorder (MDD)
Prevalence
1% of preschool children
2% of schoolchildren
Note that these could be underestimates
8% of adolescents lifetime
Cultural and contextual differences
Higher symptoms in minority youths
Likely reflects SES differences
Life stressors and daily hassles important
More hassles for children in low-SES environments
Epidemiology
Gender differences
NO gender differences in childhood – between 6 and 11 years
of age, boys and girls are equally likely to be depressed
Between ages 13 and 15, ratio becomes 2 girls:1 boy, driven by increase in girls
This maintains through adulthood
Gender Differences in Depression
A lot of research has been done to try and understand why adolescent girls (and women) are so much more likely to experience depression
Important to note that no one variable explains the difference
Likely a combination of factors:
Higher experience of stressors and trauma
Biological
Dysregulated HPA axis – overly reactive to stress
Coping styles
Gender Differences in Depression
Higher experience of stressors and trauma
Robust link between stress and depression
Girls/women far more likely to be sexually assaulted
Women are more likely to live in lower-SES conditions
Biological
Gender differences in depression
Coping styles
Rumination
Thinking about a problem constantly, but never moving to active problem-solving
In the context of depression: Why do I feel like this? Why is this happening to me? What’s going to happen to me? I’ll never get better. I’ll never feel good again. This is so unfair.
Course and Prognosis of depression
For a long time, people thought that children could
not be depressed
Within the psychoanalytic tradition, children lacked sufficient superego development to be depressed. WRONG!
Even very young children can be depressed
May be hard for adults to see it
Many of the symptoms of depression are internal
Sadness, shame, guilt, feelings of worthless
Behavioral profile is hetergeneous, withdrawal less assertive or conversely could be more aggressive,
Avoidance, reduced assertiveness, but some children are more aggressive and hostile
Depression in Preschoolers?
Was originally thought that preschoolers would only show “masked” symptoms of depression
E.g., aggression, somatic symptoms
Outward manifestations of an underlying depressed mood
Would not show the “typical” symptoms of depression
Luby et al. 2003, depression of preschoolers,
Luby et al. (2003) tested this hypothesis
Parents of preschoolers completed a psychiatric
interview
Ended up with three groups of children MDD (59 children)
ODD/ADHD No disorder
Procedure:
Psychiatric interview asked about typical symptoms
Also asked about “masked symptoms”
Results:
Typical symptoms often showed high specificity/sensitivity
Absence Of symptôme jeans nô disorder.
Specificity is the likelihood that child without the disorder will not have the symptom
Anhedonia
Presence of anhedonia rules in the , inhérent in the discorder, specificity to the disorder.
Unlike sensitivity, where if you do not have sadness are not depressed, can have sadness without being depressed.
Do see some masked symptoms, but also see specificity of classic depression symptoms, like sadness or anhedonic.
Depression in Preschoolers sensitivity
Some typical symptoms also show high sensitivity
Sensitivity is the likelihood that a child with the disorder will have the symptom
Sadness/grouchiness
Absence of symptom rules out the disorder
