Week 10

Question 1

Depressive states vs. Depressive Disorders

Answer 1

Depressive states:
 Feeling in low spirits, “sad”, “down”, “feeling blue”
 Appropriate response to loss or other painful life events
 May feel tired, irritable, and have changes to sleep, eating, and concentration

Depressive disorder:
 Significant distress and/or interference with functioning

Question 2

Emotion vs Mood vs Affect

Answer 2

Emotions:
shorter term response that is evaluative in nature
and involves physiological arousal, subjective experience,
and behaviours

 Mood:
pervasive and sustained emotions

 Affect:
observed by others (remarkable affect would be quite noticeable)

Question 3

Depressive Disorders in Children

Answer 3

In decades past, depression in children was not recognised

 Previously, children were described as showing other behaviours in response to traumatic losses, e.g.,
rebelliousness, restlessness, and somatic symptoms (“masked depression”)

 Now widely recognised that children can exhibit same
characteristics of depression as adults

 Behaviour problems can accompany depression (rather than masking it)

Question 4

MDD and Persistent Depressive Disorder: Common Features

Answer 4

Depressed mood (or irritability
 in children)

Accompanying symptoms:
 Changes in appetite and/or eating behaviour
 Changes in sleep
 Changes in energy level
 Low self-esteem (PDD)
 Poor concentration, indecisiveness
 Feelings of hopelessness (PDD)
 Diminished interest or pleasure (MDD)
 Worthlessness, guilt (MDD)
Recurrent thoughts of death or suicide (MDD)
 Clinically significant distress and/or impairment in social, occupational or other important areas of functioning

Question 5

Differential diagnosis: the basics

Answer 5

Major Depressive Disorder:
5 or more symptoms in 2 week period

Persistent Depressive Disorder: persists for at least one
year in children (2 years in adults); can have periods of MDD (“double depression”)

Bipolar disorder:
presence of manic or hypomanic episodes

Adjustment Disorder with Depressed Mood:
essential feature is reaction to a recent identified stressor

Question 6

Disruptive Mood Dysregulation Disorder (DMDD):

Answer 6

New category for children under 12
 Chronic, severe, persistent irritability, which may take the form of aggressive outbursts or angry mood
Aggressive outbursts or angry mood not limited to discrete episodes (as in Bipolar Disorder)
 Inconsistent with child’s developmental level
 Lasts for at least 12 months

Question 7

MDD Point prevalence

Answer 7

1-2% pre-schoolers
1-3% school-age children
5-6% adolescents

Question 8

MDD Lifetime prevalence

Answer 8

15-20% adolescents

Question 9

Course and gender differences

Answer 9

Marked increase in prevalence at adolescence

Females&raquo_space; Males

Question 10

Prevalence: Other Depressive Disorders

Answer 10

Important point: 
Less research for these categories
Disruptive Mood Dysregulation Disorder
Estimated at 2-5% in youth
Expected to be more common in children compared to 
adolescents
More common in boys than girls

Persistent Depressive Disorder
Not as common as MDD
Gender disparity seen in MDD not seen in PDD

Question 11

Aboriginal and Torres Strait Islander people:

Answer 11

Aboriginal and Torres Strait Islander people are nearly twice as likely to die by suicide.
Indigenous Australians are nearly three times more likely to be psychologically distressed than non-Indigenous Australians.
Racism, both perceived and actual experiences, is increasing which affects wellbeing

Question 12

Dramatic increase in adolescence, esp. for girls

Proposed explanations

Answer 12

Gender-specific life stressors
 Early developing girls exposed to interpersonal stressors, sexual harassment
 Onset of puberty
 Girls more likely to see changes of adolescence as negative
 Girls may more sensitive to peer pressure
 Girls may more sensitive to interpersonal stressors in family
 Also limited opportunities for girls compared to boys?

Question 13

Depressive Disorders in Children: Comorbidity

Answer 13

Commonly comorbid with anxiety

Also comorbid with CD, eating disorders, substance abuse

Question 14

Associated problems

Answer 14

suicide (can be suicidal without depression)

Question 15

Recovery and Recurrence

Answer 15

High rates of recovery paired with high rates of recurrence

Question 16

Child and Adolescent Suicide

Answer 16

Suicide can occur in children and adolescents with
depression

 In 2015, suicide was the leading cause of death of children between 5 and 17 years of age (HeadSpace website, based on ABS stats)

 Suicidal ideation needs to be monitored in children and adolescents with depression

 Individual risk assessment by health professional is essential

Question 17

Child and Youth Suicide in Australia

Answer 17

Total deaths per year 306 in 2006 to 405 in 2015. in the 0-14 range gone from 8 in 2006 to 22 in 2013

Question 18

Child and Adolescent Suicide, Who is at risk?

Answer 18

When depression is combined with hostility, impulsiveness, substance abuse, personality disorders
 Indigenous youth
 Sexual minority youth
 Protective factors include family support

Intervention:
Crisis intervention, CBT, Family Therapy

Question 19

Suicide Prevention

Answer 19

Suicide prevention is important
Media reporting of suicide: recommendations to reduce contagion effects (Kerig, et al. 2012, p. 338)
 School-based programs should focus on risk and protective factors

Question 20

Depression presentation Infancy and Toddlerhood

Answer 20

Loss of developmental accomplishments, e.g., toilet training
 Self-harming behaviours, e.g., head-banging, self-biting
 Self-soothing behaviours, e.g., thumb-sucking

Question 21

Depression presentation Preschool

Answer 21

Inability to enjoy play activities

Social withdrawal, separation anxiety

Vague somatic complaints, irritability, sleep problems, 
nightmares

Question 22

School Age depression presentation

Answer 22

Presentation becomes more similar to adults, i.e., depressed mood, low self-esteem, self-criticism, guilt, loss of pleasure
 Eating and sleep disturbances
 Disruptive and aggressive behaviours may impair peer relationships and academic performance

Question 23

Adolescence depression presentation

Answer 23

More likely to verbalise their sad feelings and distress
 Sharp mood swings, negativity
 Hypersomnia (sleeping too much); changes in eating behaviour
 More likely to show anhedonia (loss of pleasure), hopelessness, and social withdrawal compared to younger children

Question 24

Etiology: Integrative Model of Depression in
Children and Adolescents
(Fig. 5.1, Hammen, et al., 2014)

Answer 24

Early adverse experiences
Genetics

->

Biological, emotional, cognitive, interpersonal

->

Proximal stressors

->

Depression

Question 25

Biological context etiology

Answer 25

Genetic risk Temperament Brain structure and function HPA dysregulation

Question 26

Etiology Individual context: | Cognitive factors

Answer 26

Internal working models of attachment  Beck’s cognitive theory of depression - Worthlessness, helplessness, hopelessness - Negative thoughts about self, world, future Low self-efficacy Rumination: dwelling on negative thoughts and feelings  Seligman – Learned Helplessness Perceived competence and control – underestimate competence Attentional bias – towards negative stimuli

Question 27

Etiology - Individual context: | Emotional factors

Answer 27

High negative emotionality  Low positive emotionality  Emotional responding – rumination  Emotion regulation – failure to regulate emotional responses  Emotional processing – deficits in identifying and understanding emotions

Question 28

Etiology Family context: | Interpersonal

Answer 28

Family support?  Family conflict?  Loss of parent  Depressed parent/s - Impact parent-child relationships - Impact on development of emotion regulation skills - Effects partly mediated by parenting style

Question 29

Social / Peer relationships Etiology

Answer 29

Transactional relationship between peer relationships, social difficulties, and depression  May be antecedents or consequences of depression  Romantic relationships – risk factor for subsequent depression Cultural  Poverty? (query whether it is a factor for youth) Life stress, e.g., racial discrimination

Question 30

Empirically Supported Treatment

Answer 30

Pharmacotherapy Cognitive-Behavioural Treatment Interpersonal Therapy

Question 31

Pharmacotherapy

Answer 31

SSRIs For severe depression For moderate depression where psychological therapy is not available, or is refused, or does not lead to improvement Within context of therapeutic relationship and management plan Thorough ongoing monitoring, particularly for increased suicidal ideation Combined with CBT and/or IPT

Question 32

Cognitive-Behavioural Treatment

Answer 32

Psychoeducation and lifestyle information Behaviour monitoring and behavioural activation Development of skills that promote competence Problem solving skills training Identify, challenge and restructure maladaptive thoughts and beliefs Skill development in distress tolerance and emotion regulation (mindfulness)

Question 33

Interpersonal Therapy

Answer 33

Focus on development of communication and social skills To assist young people to establish or re-establish meaningful, supportive and enjoyable peer relationships