Study Helps Pinpoint Children With Depression

Anyone who has ever spent time around very young children knows how crucial play is for them. Thus, when a very young child loses interest in play, it suggests that something is wrong.

Indeed, a loss of interest in play appears to be a red flag that a child between the ages of 3 and 6 is depressed, a new study reveals. Two other major warning signals are sadness and irritability.

The study was headed by Joan Luby, M.D., an assistant professor of child psychiatry at Washington University School of Medicine in St. Louis. The study’s results were reported in the March Journal of the American Academy of Child and Adolescent Psychiatry.

It’s hard to believe that for a number of decades, development theorists doubted whether very young children could be depressed because of their immature cognition and emotions. But when evidence started surfacing that they could, the suspicion then was that they might express their depression through physical symptoms like stomachaches or headaches, although older children do not tend to do so. Hence Luby and her colleagues decided to launch a study to find out which symptoms exhibited by very young children truly signal depression.

For the study Luby and her colleagues recruited 155 children from mental health and primary care settings. All were between the ages of 3 and 6 years. Of the 155, 55 were depressed according to DSM-IV criteria (except for the two-week duration), 43 had attention-deficit/hyperactivity disorder (ADHD) and/or oppositional defiant disorder (ODD) according to DSM-IV criteria, and 57 had no psychiatric disorder. All three groups were similar in gender, ethnicity, parental education, and annual household income.

The researchers used a structured psychiatric interview—a modified version of the Diagnostic Interview Schedule for children—as well as two structured questionnaires—the Preschool Symptom Module and an age-appropriate version of the Child Behavior Checklist—to glean information about each subject’s physical, mental, and behavioral states. The information was provided by the subjects’ mothers in most of the cases, and by the subjects’ fathers in the remaining ones.

The investigators then determined how many subjects in each of the three groups experienced this or that physical, mental, or behavioral state. They found, for instance, that whereas 18 percent of the ADHD/ODD group experienced somatic complaints, none experienced loss of pleasure in play or activities, and 50 percent were sad and/or grouchy. Moreover, whereas 38 percent of the depressed subjects incurred somatic complaints like stomachaches or headaches, 58 percent had a loss of pleasure in play or activities, and 98 percent were sad and/or grouchy.

The researchers then compared the different kinds of states reported for the three groups to see whether certain states were more common in the depression group to a statistically significant degree. They were, they found. For instance, the depression group was significantly more likely than the other two groups to be sad/grouchy; exhibit loss of pleasure in play or activities; experience appetite, weight, and sleep problems; exhibit low energy; or engage in death- or suicide-play talk.

The scientists likewise calculated the odds ratio for various states in the depression group. Compared with the psychologically healthy group, the depression group was some seven times more likely to exhibit somatic symptoms, 26 times more likely to engage in violent pretend play, 42 times more likely to whine or cry, 75 times more likely to exhibit lack of energy, 115 times more likely to be sad and/or grouchy, and infinitely more likely to show loss of pleasure in play and activities since this state was not found in even one comparison subject.

Last but not least, the researchers analyzed their data to identify those symptoms that best signal depression in very young children. They found that the most sensitive marker—that is, the one most likely to identify depression without missing children who have it—was sadness and/or irritability. They found that the most specific marker—that is, the one most capable of pinpointing depression without falsely diagnosing children for it—was loss of pleasure.

These results suggest that when very young children are depressed, they may express their depression through physical symptoms such as stomachaches or headaches, but they are much more likely to exhibit it in more conventional ways—say, through sadness, irritability, or loss of pleasure. In fact, when a young child stops deriving pleasure from play and other activities, he or she “is extremely likely to have a clinical depression,” Luby and her team declared in their study report.

“I think this study has important implications for clinical psychiatrists,” Luby told Psychiatric News, “in that it clarifies the types of symptoms that they need to look for if they want to diagnose depression in very young children correctly. It gives clinicians the tools, for the first time, to identify depression in children as young as age 3.”

The study was funded by the National Institute of Mental Health, which will fund Luby’s next study. “It will be the first large-scale study of preschool depression in a community sample,” she said.

An abstract of the study, “The Clinical Picture of Depression in Preschool Children,” is posted on the Web at http://ipsapp002.lwwonline.com/content/getfile/2600/104/13/abstract.htm. ▪