Depressive symptoms in children and adolescents – early intervention and prevention

Are there sub-groups of children with similarities in the development of depressive symptoms? And, if there are, could this be a basis for early intervention and prevention of depressive symptoms? These were the questions the researchers (Shore et al., 2017) sought to answer through a systematic review of twenty English language longitudinal studies published between 2002 and 2015. The combined study population was 41,236 with a baseline age of <19 years.

The studies selected all used trajectory modeling, a unique statistical analysis that groups individuals with similar symptom change patterns over time. Across the included papers, five subgroups of children and adolescents were identified:

• those with ‘no or low’ depressive symptom trajectory (56%)
• those with ‘moderate’ depressive symptom trajectory (26%)
• those with ‘high’, ‘increasing’, or ‘decreasing’ depressive symptom trajectories (12%).

Opportunities for prevention

The children and adolescents  in the moderate symptom subgroup were consistently associated with higher risk factors and poorer adjustment and outcomes relative to those in low symptom subgroup. This held true even for children as young as four years of age and across studies that varied in sample, methods, and measures. This suggests that moderate child and adolescent depressive symptom patterns should be investigated as a potential early intervention and prevention target.

The review confirmed previous research that supportive parents and peers are potentially strong protective factors and were associated with lower depressive symptoms in middle to late childhood. Conversely, family problems were an associated factor in the ‘increasing’ depressive symptom subgroup. Other early risk factors for this subgroup included:

• female gender
• low socioeconomic status
• stressful life events
• conduct issues, and
• substance use.

These findings suggest that interventions with parents and children carried out in early childhood, aimed at reducing risk factors and ensuring sensitive and supportive family environments, should be evaluated to increase the population of children in no or low depression trajectories. Equally, providing parental and peer psycho-education may increase the protective factors available to an adolescent.

Diagnosis of depression in children and adolescents

The findings have implications for the diagnosis of depressive symptoms in children and adolescents. Current diagnostic distinctions are largely based on adults, rather than children and adolescents. Formally classifying child depressive symptom trajectories may be an important initial step in reforming diagnostic criteria to account for opportunities to prevent the development of depressive symptoms. Classifying child depressive symptom trajectories using standardised measures and methodologies could encourage further exploration of the origins of depression and stimulate investment in prevention strategies aimed at reducing the number of children in high-risk trajectories.

In summary:

• differing developmental trajectories of depressive symptoms are consistently identified across longitudinal studies
• the observed differences in the development of child depressive symptoms may be underpinned by several associated psychosocial factors
• understanding predictors and providing early intervention strategies to children may support increased membership of the ‘no or low’ depressive childhood symptom trajectories
• reforming diagnostic criteria to classify child depressive symptom trajectories using standardised measures and methodologies could enhance understanding of the development of depression in children and adolescents.

Lori Shore B.A, Grad Dip. Couns. Psych., M. Comm, M. Psych (Clin), PhD
Clinical, Counselling and Organisational Psychologist