August 31, 2023
3 min read
Source/Disclosures
Disclosures:
Korczak reports receiving grants from the Canada Institutes of Health Research and the SickKids Foundation during the preparation of the editorial. Madigan reports receiving funding support from the Canada Research Chairs program. All other authors report no relevant financial disclosures.
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Key takeaways:
- Dozens of studies showed no substantial increase in depression among children between 2004 and 2019.
- Depression was “uncommon, perhaps even more uncommon than previous estimates.”
Depression among children did not increase substantially between 2004 and 2019, according to the results of a systematic review and meta-analysis published in JAMA Pediatrics.
In the United States, experts have warned about a crisis in pediatric mental health brought on by COVID-19 and a shortage of mental health professionals, and the authors of the new study acknowledged signs that depression has increased since the pandemic.
Data derived from Spoelma MJ, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.3221.
“Depression during childhood is uncommon but is nevertheless an important clinical priority given the greater severity of long-term mental health sequelae compared with individuals with a later age of onset,” the authors wrote in the new study. “Compared with adolescents, there are lower rates of children receiving appropriate evidence-based care for depression, despite there being a strong evidence base for interventions such as cognitive behavioral therapy.”
The researchers examined 12,985 records and 154 full texts, dating from 2004 to May 27, 2023, and noted “noticeable environmental changes to childhood experiences over the last 2 decades that may have negatively affected child mental health outcomes,” such as family dynamics, parenting styles, sedentary behaviors, screen time, sleep, physical activity levels and diet.
“These trends are more often observed in combined child and adolescent populations, and the outcomes in children 12 years and under specifically are unknown,” they wrote. “Many epidemiologic studies have been conducted to determine the prevalence of depression in childhood, but there have been few meta-analyses, and even fewer that have considered prevalence changes over time.”
They included 41 studies in their review and calculated pooled prevalence estimates for depressive disorders among children between 2004 and 2019. The estimates were 0.71% for major depressive disorder, 0.3% for dysthymia and 1.6% for disruptive mood dysregulation disorder, with no substantial increase in that time period.
“The findings of our meta-analyses suggest that depressive disorders in children younger than 13 years are uncommon, perhaps even more uncommon than previous estimates,” they wrote. “Despite the increased risk posed by lifestyle factors in modern times, depressive disorders do not appear to be increasing for children younger than 13 years.”
However, they wrote, “The association between the COVID-19 pandemic and diagnostic prevalence is yet to be determined, but data from studies identifying depressive symptoms using questionnaires suggest that this has increased. Therefore, depression prevalence studies in childhood using standardized interviews are a research priority, as are more nuanced investigations of moderators of these outcomes.”
The study was accompanied by an editorial coauthored by Sheri Madigan, PhD, a faculty member of the department of psychology at the University of Calgary, and Daphne J. Korczak, MD, MSc, a faculty member at the department of psychiatry at the Hospital for Sick Children in Toronto.
“From a public health standpoint, it is critical to ascertain a clear understanding of the earliest emergence of depressive disorders and their prevalence throughout childhood so that supports and resources can be effectively used and targeted to those who need it most urgently,” Korczak and Madigan wrote.
They noted that chronic depressive symptoms may be “particularly problematic” especially during childhood, when symptoms could interfere with “key social, emotional, and interpersonal developmental tasks necessary for future social, relational, and occupational success.”
Korczak and Madigan emphasized the importance of longitudinal cohort investigations that “accurately characterize symptoms at the phenotypic level, while also examining the psychosocial and biological factors at the family and environmental level.”
“Although executing such endeavors is difficult and painstaking, they are critical for improving the diagnostic nosology necessary for the diagnosis of depression in younger children,” they wrote. “Armed with such knowledge, the field will be better equipped to determine whether childhood depression is actually rare or whether it has just been rarely diagnosed.”
References:
Madigan S, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.3130.
Spoelma MJ, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.3221.
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