Feeling hopeless and sad is a normal part of life for children. However, the problem becomes alarming when this feeling starts to interfere with their daily life. If children don’t feel interested in activities they previously enjoyed, also known as anhedonia, they may be diagnosed with childhood depression. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes several changes to childhood disorders. According to the DSM-5, dysthymia is a persistent feeling of depression that occurs throughout the day; for at least two years. To diagnose a child with depression, feelings of depression and irritability must last for at least a year. The DSM-5 renamed childhood depression as persistent depressive disorder (American Psychiatric Association, 2015).
Childhood depression affects about three percent of American children. There are many cases of undiagnosed childhood depression in the United States. 3.2% of children 3 to 17 years of age were diagnosed with childhood depression (CDC, 2022). A combination of different factors plays a role in the development of depression in children. Girls and boys are equally at risk for depression during childhood. However, during adolescence, girls are more prone to depression than boys. In 2017, a total of 3.2 million cases of adolescent depression were reported. Cases increased by 8% from 2007. Total cases increased by 59% from 2007 to 2017. It is observed that the growth rate of adolescent girls (66%) is faster than that of adolescent boys (44%) (Ghandour, et al., 2019).
Studies have demonstrated that a number of factors can cause and act as risk factors in their lives, which can increase their chances of developing depression. Some of the most recognized risk factors are-
There are cases where infants develop depressive symptoms at an early age. Genetics and family history are associated with childhood depression. Parental inconsistency, stress, and negative thinking are the most effective factors associated with childhood depression. It is also associated with a family history of mood disorders. According to a study, when depressed adults were asked to recount their childhood experiences, most of them said they had been victims of abuse, neglect, rejection, and parents. violence. It is observed that 30 to 40% of children diagnosed with depression have biological parents who also have mental illness (CASA, 2022).
When children who have experienced stress, physical or emotional abuse, abusive parents, and trauma develop a lasting symptom that begins to interfere with their activities and relationships, they can diagnosed with PTSD; Post traumatic stress disorder. Common symptoms of PTSD in children are-
Children who have experienced traumatic events may appear restless, restless, and have difficulty staying awake and organized. Studies have reported that 1-6% of boys and 3-15% of girls have been diagnosed with PTSD in the United States. U.S. child protective services experience about three million cases of PTSD each year. Of the three million cases, 5.5 million were children (ptsd.va.gov, 2022).
Medical examination is the first step towards diagnosing depression in children. This leads to the exclusion of a physical symptom caused by a psychological condition. Psychiatric history is important in understanding a child’s symptoms. Social and family history should be sought. Face-to-face interviews with children have been shown to be effective. It can take place in many forms, including observation, interaction, and open-ended questions.
Treatment options for depression in children are similar to those for depression in adults. It includes medication and psychotherapy (counseling). Psychotherapy is the first priority in the treatment of depression in children. Medical professionals only consider medication a second option if symptoms are severe and do not improve with psychotherapy. Interpersonal communication therapy and cognitive behavioral therapy (CBT) have been shown to be effective in the treatment of depression in children. The combination of medication and CBT has been shown to be more effective than medication alone (Crowe & McKay, 2017).
It is not possible to prescribe drugs in the same dosage to children because their neurotransmitters may not be fully developed. In addition, the norepinephrine and serotonin systems have different maturation rates. Tricyclic antidepressants have been prescribed for children, but studies have found that the drugs have not shown improvement in children. Experts have named citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft) as the most beneficial drugs for children with depression. For children over 12 years of age, escitalopram (Lexapro) is considered the most effective. Medicines for children are given at the lowest possible dose and are titrated according to the child’s response. Antidepressants are not preferred for children because they are associated with an increased risk of suicide. There are some side effects of the drug such as nervousness, gastrointestinal effects, headache and restlessness. Psychological counseling is required if the child does not respond to any medication (Olfson, King, & Schoenbaum, 2015). Children with depression often feel lonely and anxious, which can be a barrier to treatment. The medication creates a hormonal imbalance and requires nursing intervention to keep the child stable until treatment is complete. Nurses also educate patients and their families about treatment and potential side effects to help them stay prepared and informed. Therefore, psychological nursing becomes an important part of treatment. Nurses first understand the psychological changes in children and then provide the necessary education for patients and families. Nourishment enhances resistance, relieves anxiety and helps children establish the right cognitive perspective. The role of the psychiatric nurse is very important in the treatment of depression in children. Psychiatric nurses help doctors develop an appropriate treatment plan and use their therapy skills to help patients and their families explore a variety of options. They provide services including psychotherapy and disorder diagnosis (Sun, Cui, Fu, Ma, & Li, 2017).
The American Nurses Association designed the scope and standards for psychiatry. There are six standards of practice including assessment, diagnosis, identification, planning, implementation, and evaluation. The purpose of these standards is to guide nurses in making an accurate diagnosis and planning appropriate treatment. Psychiatric nurses are expected to meet these standards. In addition, there are rules that talk about the rights of children with depression. It is essential that doctors respect medical ethics. Failure to comply creates ethical problems (Silén, Haglund, Hansson, & Ramklint, 2015). For example, if doctors don’t respect confidentiality, it would be an ethical issue. Health care professionals are not permitted to publicly disclose children’s information or discuss it with other psychiatrists (Völlm, Bartlett, & McDonald, 2016). If doctors lack information about depression in children, it becomes an ethical issue. Legal issues related to psychiatric care include psychiatrists in court, the results of crazy pleas, and runaway behavior in depressed children.
In conclusion, depression in children is not an uncommon mental illness. Neglecting behavioral change in children has increased the number of undiagnosed cases of childhood depression. According to studies, cases of depression are twice as common in girls as in boys. Parental abuse, environment, stress, genetics, and family history are risk factors for depression in children. Medical professionals prefer psychotherapy to treatment and medication as a last resort. The drugs work effectively but have harmful consequences. To manage adverse drug reactions and make children and families understand the disease, nursing intervention is required. They help organize treatment plans and support families. Professionals must follow the right standards to prevent ethical and legal problems from arising.
American Psychiatric Association. (2015). Depressive Disorders: DSM-5® Selections. American Psychiatric Pub.
CASA. (2022, April 12). CHILDHOOD DEPRESSION. https://www.azcourts.gov/casa/Training/Training-Courses/Childhood-Depression
Crowe, K., & McKay, D. (2017). Efficacy of cognitive-behavioral therapy for childhood anxiety and depression. Journal of Anxiety Disorders, 49, 76-87. https://doi.org/10.1016/j.janxdis.2017.04.001
Ghandour, R., Sherman, L., Vladutiu, C., Ali, M., Lynch, S., Bitsko, R., et al. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in US children. The Journal of pediatrics, 206, 256-267. https://doi.org/10.1016/j.jpeds.2018.09.021
Olfson, M., King, M., & Schoenbaum, M. (2015). Treatment of young people with antipsychotic medications in the United States. JAMA psychiatry, 72(9), 867-874. 10.1001/jamapsychiatry.2015.0500
ptsd.va.gov. (2022, April 12). How Common is PTSD in Children and Teens? https://www.ptsd.va.gov/understand/common/common_children_teens.asp#:~:text=Learn%20how%20many%20children%20and%20teenagers%20have%20PTSD.&text=Studies%20show%20that%20about%2015,certain%20types%20of%20trauma%20survivors.
Silén, M., Haglund, K., Hansson, M., & Ramklint, M. (2015). Ethics rounds do not improve the handling of ethical issues by psychiatric staff. Nordic Journal of Psychiatry, 69(6), 1700-1707. https://doi.org/10.3109/08039488.2014.994032
Sun, Q., Cui, C., Fu, Y., Ma, S., & Li, H. (2017). Nursing interventions in depressed children with low serum levels of BDNF. Experimental and Therapeutic Medicine, 14(4), 2947-2952. https://doi.org/10.3892/etm.2017.4921
Völlm, B., Bartlett, P., & McDonald, R. (2016). Ethical issues of long-term forensic psychiatric care. Ethics, Medicine and Public Health, 2(1), 36-44. https://doi.org/10.1016/j.jemep.2016.01.005
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