Results: Although 3-month prevalence of any disorder averaged 13.3% (95% confidence interval [CI], 11.7%15.0%), during the study period 36.7% of participants (31% of girls and 42% of boys) had at least 1 psychiatric disorder. Some disorders (social anxiety, panic, depression, and substance abuse) increased in prevalence, whereas others, including separation anxiety disorder and attention-deficit/hyperactivity disorder (ADHD), decreased. Lagged analyses showed that children with a history of psychiatric disorder were 3 times more likely than those with no previous disorder to have a diagnosis at any subsequent wave (odds ratio, 3.7; 95% CI, 2.94.9; P.001). Risk from a previous diagnosis was high among both girls and boys, but it was significantly higher among girls. Continuity of the same disorder (homotypic) was significant for all disorders except specific phobias. Continuity from one diagnosis to another (heterotypic) was significant from depression to anxiety and anxiety to depression, from ADHD to oppositional defiant disorder, and from anxiety and conduct disorder to substance abuse. Almost all the heterotypic continuity was seen in girls. Conclusions: The risk of having at least 1 psychiatric disorder by age 16 years is much higher than point estimates would suggest. Concurrent comorbidity and homotypic and heterotypic continuity are more marked in girls than in boys.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/207725/YOA20769.pdf

Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence

This article reviews the various literatures on the adjustment of children of depressed parents, difficulties in parenting and parent-child interaction in these families, and contextual factors that may play a role in child adjustment and parent depression. First, issues arising from the recurrent, episodic, heterogeneous nature of depression are discussed. Second, studies on the adjustment of children with a depressed parent are summarized. Early studies that used depressed parents as controls for schizophrenic parents found equivalent risk for child disturbance. Subsequent studies using better-defined samples of depressed parents found that these children were at risk for a full range of adjustment problems and at specific risk for clinical depression. Third, the parenting difficulties of depressed parents are described and explanatory models of child adjustment problems are outlined. Contextual factors, particularly marital distress, remain viable alternative explanations for both child and parenting problems. Fourth, important gaps in the literature are identified, and a consistent, if unintentional, "mother-bashing" quality in the existing literature is noted. Given the limitations in knowledge, large-scale, long-term, longitudinal studies would be premature at this time.

Children of depressed parents: an integrative review.

The existence of depression in children and adolescents is well established, but debate remains about the phenomenology of the depressive syndrome in the young. In order to discover possible age differences in rates and etiology, the definition and measurement of depression must be comparable across the ages to be studied. A widely used self-report depression symptom scale, the Center for Epidemiologic Studies Depression (CES-D) Scale, was administered to convenient (and not necessarily representative) samples of high school and college students. The scores and patterns of responses to the 20 symptom items of the scale were compared with already existing data from junior high school students, from depressed patients, and from a representative community sample of adults and young adults. The results of the analyses suggest that the CES-D Scale is acceptable and reliable in all the groups studied. The scores of the junior high school group may be inflated by an excess of transient symptoms and should be interpreted with caution, but the scale seems to be very suitable for the high school and older groups.

The Use of the Center for Epidemiologic Studies Depression Scale in Adolescents and Young Adults

Data were collected on the point and lifetime prevalences, 1-year incidence, and comorbidity of depression with other disorders (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) in a randomly selected sample (n = 1,710) of high school students at point of entry and at 1-year follow-up (n = 1,508). The Schedule for Affective Disorders and Schizophrenia for School-Age Children was used to collect diagnostic information; 9.6% met criteria for a current disorder, more than 33% had experienced a disorder over their lifetimes, and 31.7% of the latter had experienced a second disorder. High relapse rates were found for all disorders, especially for unipolar depression (18.4%) and substance use (15.0%). Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.

Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students.

• We investigated the prevalence of DSM-III disorders in 792 children aged 11 years from the general population and found an overall prevalence of disorder of 17.6% with a sex ratio (boys-girls) of 1.7:1. The most prevalent disorders were attention deficit, oppositional, and separation anxiety disorders, and the least prevalent were depression and social phobia. Conduct disorder, overanxious disorder, and simple phobia had intermediate prevalences. Pervasive disorders, reported by more than one source, had an overall prevalence of 7.3%. Examination of background behavioral data disclosed that children identified at 11 years as having multiple disorders had a history of behavior problems since 5 years of age on parent and teacher reports. Fifty-five percent of the disorders occurred in combination with one or more other disorders, and 45% as a single disorder.

DSM-III disorders in preadolescent children. Prevalence in a large sample from the general population.

Neurotic depressive reactions of mid-childhood may be classified into three distinct categories. Masked depression is the most frequent, appearing in children whose personality and family display severe psychopathology. Children suffering acute depression are fairly well adjusted prior to the traumatic event that precipitates the depression; there may be mild psychopathology in the family. Chronically depressed children have a history of marginal premorbid social adjustment, depression, and repeated separations from important adults; in addition, at least one parent has a history of recurrent depression.

Proposed Classification of Childhood Depression

• We investigated the prevalence of depression in a sample of 9-year-old children from the general population being studied longitudinally. Current point prevalences of major and minor depressive disorder were estimated at 1.8% and 2.5%, respectively. A comparison of children with depression and a nondepressed group disclosed no significant differences by sex, nor any significant association between depression and socioeconomic status, teacher reports of behavior problems, and cognitive or motor development. The children with current depression were reported by a parent to have had a history of more behavioral problems, had been referred more often for assessment or treatment of behavioral or emotional problems, and had more negative self-perceptions of their academic ability. The results suggested that parents may be more sensitive than teachers to the behavior problems exhibited by depressed children.

Depression in a Sample of 9-Year-Old Children: Prevalence and Associated Characteristics

The rapidly increasing research interest in childhood depression indicates that it has become a recognized disorder. The authors review the literature on depression in children, focusing on epidemiology, various diagnostic criteria, classification schemes, assessment instruments, and intervention studies that have been applied to childhood depression. Given that there are many etiological factors, it will be important to study the disorder from various conceptual frameworks, including biochemical, genetic learned helplessness, life stresses, cognitive distortion, behavioral reinforcement, and sociological models.

Current perspectives on childhood depression: an overview.

Seven male children who each had a manic-depressive parent (five alos had a parent with unipolar depression) and 12 control children were studied. The proband children had shown a range of adjustment problems as infants and toddlers. Four years later, they continued to have substantial behavior problems, including ones that could be classified as DSM-III psychiatric diagnoses. On the basis of psychiatric interviews and psychological assessments, the proband children received more DSM-III diagnoses than the control children. Proband children reported internalizing symptoms; this pattern was corroborated by their mothers, who also characterized these children as showing antisocial behavior patterns.

A follow-up investigation of offspring of parents with bipolar disorder.

The authors attempt to conceptualize a pattern of defense against the depressive process that changes with age. They enumerate several forces that oppose or promote these defensive operations, resulting in three levels at which the depressive process manifests itself: fantasy, verbalization, and mood and behavior. The shifting balance of these forces helps to explain the variability with which the depressive process manifests itself throughout the various phases of the life cycle.

Leon Cytryn

Papers

Proposed Classification of Childhood Depression

Depression in a Sample of 9-Year-Old Children: Prevalence and Associated Characteristics

Current perspectives on childhood depression: an overview.

A follow-up investigation of offspring of parents with bipolar disorder.

Factors Influencing the Changing Clinical Expression of the Depressive Process in Children