{[ promptMessage ]}

Bookmark it

{[ promptMessage ]}

class 7_depression during school age years

class 7_depression during school age years - CHAPTER 12...

Info icon This preview shows pages 1–18. Sign up to view the full content.

View Full Document Right Arrow Icon
Image of page 1

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 2
Image of page 3

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 4
Image of page 5

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 6
Image of page 7

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 8
Image of page 9

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 10
Image of page 11

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 12
Image of page 13

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 14
Image of page 15

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 16
Image of page 17

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 18
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: CHAPTER 12 DEPRESSION DURING THE SCHOOL-AGED YEARS DAPHNA omens/inn“ University ofMichignn Depression is a psychobiologica] reaction that can be provoked in anyone, though much more easily in those with predisposing vulnerabilities (Brockless, 1997). Depression in childhood and adolescence is a common disorder (Lewinson et 211., 1.993), serious in its consequences when it disrupts normal functioning or attainment of developmental goais (Brent et a1, 1997'; Kovacs & Bastiaens, 1995; Remschmidt (BL Schulz, 1995). Research from the past two decades has shown that even very young children get clinically de~ pressed and. that the rate of diagnosable depression increases in the early adoiescent years (Cantwell & Baker, 1991; Kazdin, 1988). Episodes of depression in childhood and adoles~ cence increase the risk of other negative mental health outcomes (Fieming & Offord, 1990; Peterson et al., 1993) and reduce the likelihood of attaining ageuappropriate cognitive, so— cial, and emotional developmental milestones (for a review, see Angold, Costello, & Worthman, 1998). in her review of the iiterature, Brookless {1997) found depressed mood reported by between 14 and 2.0 percent of chiid and adolescent respondents in large—scale studies. The percent reporting symptoms meeting criteria for serious depressive disorder was lower; I to 3 percent of child and 2 to 8 percent of adolescent respondents met criteria for serious depressive disorder. Social contextual forces such as poverty and fami]y stress increase risk of depres- sion, as does family history of the disorder: however, these stresses are importantly medi— ated by parenting quality and other buffering factors. Factors that increase risk of depression may also increase risk of other problematic outcomes (Resnick & Burt, 1996). Antecedents of depression such as poverty, problematic neighborhood, family dysfunction, and behavioral markers such as poor school performance and nonconforming/deviant be— havior (e.g., early sexual behavior, substance use, truancy-run away)——niay or may not present in a particular situation (Resnick & Burt, 1996). I Note: Support whiie writing this chapter came from NIMH grant numbers ROE Nil-15432} and R3] MH57495. Support of the Center for Advanced Studies in the Behavioral Sciences, Stanford, is gratet'uliy acknowiedged, as is Kirsten Firminger and Carol Carlin‘s assistance with the reference iist, DEPRESSiON DURING THE scuooimonn YEARS 265 Depression is part of the everyday discourse of middle-class Americans, but it can mean a variety of different things, from dampened mood within the bounds of normal ex— perience or in response to an adverse event, to a personaiity trait in which mood is damp— ened in response to adverse events that would cause little-upset in others, to abnormally dampened mood or mood that is dampened for an abnormally long period of time. Thus, depression sometimes refers to symptoms of depression and other times refers to meeting specific criteria for a depressive disorder. This Chapter will outline current definitions of depression, methods of assessing dew pression, recent evidence about the prevalence of depression, antecedents and conse- quences of depression, and information about universal selected and targeted preventive interventions relevant to promoting healthy development and reducing the risk of depres sion in school—aged children and adolescents Readers of this chapter will learn to identify depression and depressive symptoms and gain an understanding of the antecedents and consequences of depression as welt as a sense of appiicahie interVention approaches. i DEFENITION Similar to depression in adults, depression in childhood and adolescence is a mood state, typ ically characterized by dysphoric affect (i.e., feeling low, blue, sad, lacking energy; feelings of uselessness and low selfuworth; lack. of motivation; and inabiiity to concentrate or to feel pleasure in everyday activities) (American Psychiatric Association, 1994; Cicchetti & Toth, , 1998). The most widespread criteria to formally assess depression are those of the Diagnose i tic and Statistical Manual of Mental Disorders (DSM—IV) (American Psychiatric Associa~ tion, i994). According to these criteria, depression includes mood and physical symptoms E and can be either a low mood disorder {unipolar affective disorder) or, less commonly, ink volve alternating periods of low and high mood (bipolar affective disorder). Physical symptoms or vegetative signs of depression include weight gain or loss, E sleep disorder (insomnia or hypersomnia), psychomotor agitation or retardation, fatigue, other somatic complaints, and suicidal ideation/attempts (American Psychiatric Associa~ tion, 1994). For children, symptoms of irritability, somatic complaints, and social with— drawal are more salient than low mood; for adolescents, symptoms of motor retardation, hypersomnia, and delusions are more common tor than for children (American Psychiatric Association, 1994). Because weight gain is normative in adolescence, this symptom alone may be less relevant in adolescence than adulthood. A depression diagnosis, according to DSM»! V criteria, is appropriate if for or least two weeks, a youth experiences core symptoms of dysphoric mood or loss of interest/pleasure in nearly all activities, and at least four of the following “noncore” symptoms: change in sleep, appetite, or weight; decrease in energy; change in psychomotor activity; feelings of worth- lessness or guilt; difficulty concentrating or making decisions; recurrent thoughts of death i or suicide; or suicide plans/attempts. Perhaps because diagnosis in childhood and adoies— l cence is relatively new, some clinicians adopt a more descriptive approach to diagnosis. That is, they may substitute “depressive equivalents” such as aggressive behavior, refusing to go to school, and other phobic responses for the noncore symptoms, or they may be fies“ ible in the number of noncore symptoms needed to make a preliminary diagnosis, or they may be flexible about the needed duration of symptoms. Substitutions such as these are 266 CHAPTER 12 problematic because depression frequently co—occurs with other disorders, particularly anxi— ety and avoidant/phobic disorders, and especially for boys, oppositional and conduct dison ders, so that these substitutions may blind a clinician to seeing a co~occuning disorder (for reviews, see Allen-Meares et al., in press; Brockless, 1997), Moreover, this flexibility may paradoxically lead. to a simpler view or diagnosis than is appropriate in a given circumstance. Although there is general agreement on the broad definition of depression, clinicians differ in their description of subtypes of depression, depending on its severity, other concern» itant symptoms, the existence of precipitating events, and differences in the expression of depression during different developmental phases of childhood. Generally, depression is ex— pressed {can be observed) through inhibition of normal. activities, with the importance of overtly dysphoric mood increasing with age. However, it is important to note that when reading literature on depression, readers must ascertain whether the author means ( l) dys— phoric mood is present; {2) various symptoms are present but not necessarily enough to define as a disorder; { 3) a specific cluster of symptoms are present that together define a depressive disorder, but that may be secondary to some other condition; or (4) a specific cluster of symptoms are present with duration and impact on functioning that warrant def— inition as psychiatric disorder (Cantwell & Baker. l99l). Further, a depressive response may be an adaptive response to stressful life events if it allows children to reassess or puil back from problematic situations. Thus, although depression is not necessarily maladap- tive, its symptomsmlow energy, low mood, feelings of worthlessnessw~can interfere with getting help or changing the situation. METHODS OF ASSESSING DEPRESSION Although it is possible to assess depression based solely on self-report, input from another source, particulariy a parent, is typicaily considered helpful because use of multiple inform mants increases reliability and validity of psychiatric diagnosis in children and adolescents (Bird, Gould, & Staghezza, 1992; Pianoentini, Cohen, & Cohen, 1992). However, self~report and parent report of depression (low mood; feeiings of hopelessness, heiplessness, and worthlessness) are likely to vary because parents have iess access to the internal states of the child than the child does'(Brockless, 1997). Indeed, numerous studies have shown that par- ents and youth differ significantly in their reports of youth problems, including internalizing (depression and anxiety) and externalizing (aggression, delinquency) (Achenbach et al., 1987; Edelbrock et al., 1985; see Hartos and Power, 2000, for a review). Generally, mothers report more symptoms than do youth (Hartos 8.: Powers, 2000) and. the correlation between youth and parent report declines as children enter adolescence (Achenbach et al., 1987): Depression can be assessed with standardized scales, less structured interviews, ob- servational procedures, and interpretive tools. Standardization. is helpful. because it allows comparability. However, less structured approaches such as direct observation can be criti- cal in suggesting that a problem may exist. Standardized scales typically ask the youth or another informant (e. g a parent, teacher, or primary caregiver) to report on the youth’s be— havior and affect over a period of two weeks prior to the assessment. Behaviorai recall is subject to error {for a discussion of problems with recall as related to program evaluation, see Schwarz & Oyserman, 200i ). Clinicians should attempt to structure the recall process DEPRESSiON DURING THE SCHOOL—AGED YEARS 267 to help respondents focus on the events of the past weeks that can serve as memory cues. Typically, the assessment goal is twofold: to assess if the youth is currently depressed and to assess symptoms of depression as a baseline against which to gauge success of interven-~ ‘5 - tion efforts. Summaries of instruments for measuring depression in childhood and adoles~ i cence may be found in Maddox (1997), Murphy, Conoley, and lmpara (1994), and Strober i and Worry {3986); these sources also provide reliability and validity information. it is im— : portant to examine the questions asked in each inventory and decide which. scales focus on i issues likely to be relevant to the risk of depression in the particular youth or group of youth that are the target of a preventive intervention. Some scales focus more on the mood-- relevant symptoms, others more on somatic symptoms. A more comprehensive assessment tool, such as the Child and Adolescent Psychiatric Assessment (CAPA), takes about an hour to administer (Angold et £11., 2000). CONSEQUENCES OF DEPRESSEON Because behavioral “acting out” can mask depression, depression may not necessarily be assessed or treated. Depression may be masked by sexual, aggressive, or other problem be haviors and the type of masking activity may he gendered. Brocidess (1997) suggests that in teenage girls, depression can sometimes be masked as an avid pursuit of sexual gratifi— cation. Brookaunn and Petersen {1.991) conclude that cowoccurrence of depression with aggression is more common with boys. Episodes of depression in childhood and adolescence increase the risk of. other neg— ative mental health outcomes (Fleming & Offord, 1990; Peterson et 211., 1993) and reduce the likelihood of attaining age~appropriate cognitive, social, and emotional developmental milestones (for a review, see Angold. Costelio, 82. Worthman, 1998}. It is particularly criti— cai that depression be prevented where possible; previous episodes of depression are the single—most significant predictor of future episodes of depression (Hammen, 1992). One reason for future risk is that depression may shift cognitive processing style. Depression 3 carries with it a negative cognitive style—depressed individuals see themselves and the g world more negatively than noridepre'ssed individuals do.' This negative style is sometimes referred to as depressive realism and often remains after the episode has remitted. More prosaicaliy, the incapacitation and lack of energy that accompanies depression results in youth falling behind academically, withdrawing from activities that can provide positive reinforcement such as sport and social interchange, leaving youth with less positive reinm forcementi a less dense social network, and fewer accomplishments to provide a positive sense of self. INCIDENCE AND i’REVALENCE 0F DEPRESSION j Depression is one of the most commonly occurring disorders in childhood and adolescence i (Lewinson et a1., l993). Over the past two decades, researchers have documented de— ' pression even in very young children, although rates of diagnosahle depression increase markedly in the early adolescent years {Cantwell & Baker, i991; Kazdin, 1988}. Using 268 CHAPTER 13 self—report measures, rates as high as 35 percent have been inund, but rates are much lower, somewhere betWeen 7.4 percent {for a review, see lellinek & Synder, 1998) and 5 percent (BrooltsuGunn & Petersen, 1991) for severe depression when stricter DSM criteria are used. Before puberty, rates of depression do not differ for boys and girls, but after puberty, girls are twice as likely to have a depressive episode (Jellinek & Synder, 1998). This evi— dence comes from the United States of America and has either focused on white samples or not analyzed differential rates by racial/ethnic groups. The interplay betvveen gender and racial/ethnic status is just beginning to be studied. African American and. white youth do not appear to differ in prevalence of depression, but Latino youth, especially Mexican migrants, appear to be at ioWer risk, even though they are more likely to come from poor families (a risk increaser) (Plough, 200i). in adolescence, episodes of depression last an average of 5.4 months (lellinek St Synder, 1998). RlEVlEW 0F RESEARCH Psychosocial Risk Factors Related to Increased Risk of Depression Poverty has a negative effect on the psychological well—bein g of children (for a review, see Sa~ maan, 1998). Researchers have documented this effect for white children and adolescents {Conger et al., 1999; Elder, Nguyen, & Caspi. 1985), African American children and adoles— cents {McLeod & Shanahan, 1993), and American Indian children and adolescents (Costello, Farmer, Angold, Burns, & Erkanli, 1997). However, the effects of poverty seem to be bulfered somewhat by cultural factors such as spirituality and communal belonging (Sainaan, 1998). Genetic Risk Factors Related to Increased Risk of Depression Adoption studies document up to an eightfold increase in depression and a fifteenfold in— crease in suicide among adopted individuals whose biological parents have. an affective disorder (leiiinek. & Synder, 2998). Children growing up in families with parents with de pressive disorder are more likely to develop depression earlier and have a longer duration of episodes of illness {Jellinek & Synder, 1998). Clearly, biology is not destiny; neverthe— less, decades of research clearly show that depression runs in families {H.ammon, 1997). intrafamilial transmission of psychopathology is an important factor in the etiology of psy~ chiatric disorder (Kendler, Davis, & Kessler, 1997). That is, risk of depression increases if parents have a depressive disorder. According to Downey and Coyne’s (1990) review of the literature, children of parents referred for treatment of depression are six times more likely to receive a diagnosis of major affective disorder than are children without an affec— tively ill parent. For these and other mental illness diagnoses, the likelihood of the identified patient’s firstedegree relatives also having a diagnosis reflects genetic contributions, but. environmen— tal circumstances are necessary to trigger genetic vulnerabilities. A number of epidemio— logical studies have found high rates of diagnosis in children of mentally ill parents, but the diagnoses are not necessarily the same as those of their parents, which may reflect either a more general risk. or problems with our current system of diagnosis (US DHHS, i999}. onenessron Durant; THE sonooonosn YEARS 269 'r E i l i i Heritability indices vary from estimates of 80 percent for bipolar disorder, 75 percent for schizophrenia, to 34 to 48 percent for depression (Rutter, Silberg, O’Connor, & Siminoff. l999). Thus, the process by which biological risk is transferred is not yet clear. It is possir ble that the low heritability indices for depression are due to the difficulty in disentangling depression from other diagnosis ( error) or the importance of environmental factors in turn— ing on genetic vulnerabilities. Life Event Factors and Risk of Depression First, it is unmistakable that undesirable life events increase risk of depression (Kessler, 1997); according to some estimates, haif of depressive episodes in young people are pre- ceded by an undesirable event (Goodyer, 2001}. Goodyer notes, however, that children do not necessarily perceive events or interpret them the way adults do, so that it is important to un— derstand the child’s perspective of the desirability of an event. Second, although generaily only events felt to be moderately or severely undesirable increase risk of depressive disorder in school~aged children, children who experience multiple losses are more at risk of depres sion, even in the face of modestly undesirabie events. Third, bereavement seems to increase risk only if it occurs during the schoolwaged years, not before. Brief separations from parents or other caregivers do not carry a risk for depression, but permanent separations-mdne to 3 death or removal from the home—«can increase risk, depending on the quality of the parent— child bond prior to its disruption and the nature of the caregiving that replaces it (Rutter, 3 1990). Fourth, in some research, both negative life events and lack of social support have in dependent negative effects on risk of depression. In other research, negative life events in— crease the risk of depression only when accompanied by lack of social support {Goody/er, J 200i). Finally, though little research on this issue exists, it appears that. depression increases 3 subsequent risk of negative life events, particularly lack of continuity {break—ups) in friend— 3 ships and peer networks (Goodyer, 200]). It appears that early negative events, especialiy 3 permanent separations, influence children by fostering creation of negative mental images or 3 representations of social relationships. Also, multiple negative events set up conditions for 3 chronic impairment in important relationships that could foster positive mental images or 3 representations of both the self and others in social relationships.“ INTERFACE BETWEEN RISK AND PROTECTEVE FACTORS One useful framework for thinking about depression in childhood and adolescence is Bron“ i fenbrenner’s developmental—ecological perspective (1989). Within this framework, individu— als develop within a set of embedded contexts. From smallest to largest, these are t 1) micro— systerns {people with whom the individual is in direct contact), (2) mesowsysteins {systems that indirectly influence individuals by influencing microsystems), and (3) exo—systems (those institutional or sociocultural normative contexts in which micro— and meso—systems are em— bedded). Each of these factors is part of the consteilation of factors influencing risk of de— pression and individual protective factors such as feelings of competence, optimism about the future, and sense of well—being that can reduce...
View Full Document

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern