CHAPTER 10
Depression
To avoid confusion, it is useful to distinguish between three distinct
meanings of the term ‘depression’. It can refer to:
a single symptom;
a symptom cluster;
a disorder.Depression as a single symptom
Epidemiological studies show that many children and adolescents are
miserable. In the Isle of Wight studies, about 10% of 10-year-olds
were miserable according to their parents, and over 40% of 14-year-olds
were miserable by their own account (with almost 15% being observably
sad at interview). Among children and adolescents with psychiatric disor-
ders, the symptom of misery is commoner still (being common among
those with behavioural as well as emotional disorders). It is uncertain
whether the symptom of depression differs from ordinary sadness in kind
or just in degree. Possible features distinguishing abnormal depression
from normal sadness include greater severity, longer persistence and the
individual describing the mood as qualitatively different from ordinary
sadness.
Depression as a symptom cluster
Just as in adults, the symptom of depression in children and adolescents
is sometimes part of a wider constellation of affective, cognitive and
behavioural symptoms. Associated symptoms include: reduction or loss
of ability to experience pleasure (anhedonia); low self-esteem; self-blame;
guilt; helplessness; hopelessness; suicidal thoughts and acts; loss of energy;
poor concentration; restlessness; and changes in appetite, weight and
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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